Degenerative cervical myelopathy is a progressive neurological disorder resulting from extradural compression of the spinal cord at the cervical level. Clinically, it manifests with motor dysfunction, including hand clumsiness, gait instability, and signs of upper motor neuron involvement. In patients with multilevel cervical involvement, posterior decompressive laminectomy combined with lateral mass screw fixation is aimed at achieving effective spinal cord decompression while maintaining postoperative spinal stability. This prospective case series aims to evaluate the clinical outcomes and quality of life following posterior decompression and lateral mass fusion in patients with multilevel compressive cervical myelopathy. A total of 30 patients with compressive cervical myelopathy involving two or more levels were included in the study. Radiological assessments, including X-rays, MRI, and CT scans, were performed for evaluation. All patients underwent posterior cervical decompressive laminectomy combined with lateral mass fusion. Functional outcomes and quality of life were assessed preoperatively and at the one-year postoperative mark using the Japanese Orthopaedic Association (JOA) score and the Denis Pain and Work Scale as primary outcomes. Secondary outcomes assessed were perioperative complications, such as blood loss, neurological deterioration, infections, and implant failure. The mean age of the patients was 49.5 years. Surgical intervention involved two-level decompression in nine patients (30%), three-level decompression in 14 patients (46%), and four-level decompression in seven patients (24%). The average blood loss was 202.6 mL, and the mean operative time was 135.3 minutes. At the one-year follow-up, the modified Japanese Orthopaedic Association (mJOA) score improved from a preoperative mean of 7.3 to 12.4. The Denis Pain Scale showed an improvement from 3.9 to 1.8, while the Denis Work Scale improved from 4.8 to 3.2. Postoperative complications included wound infections in two patients and transient neurological worsening in four patients, all of which resolved over time. There were no instances of implant failure. Multilevel cervical laminectomy combined with lateral mass screw fixation is a reliable and effective surgical approach for the management of multilevel cervical myelopathy. This technique facilitates adequate spinal cord decompression, minimizes the risk of postoperative spinal deformities, and preserves the structural integrity of the posterior tension band.
Singh et al. (Sat,) studied this question.