"Only fixation:" Simple act, but mammoth stride toward great aspiration in managing cervical spondylotic myelopathy

Comparative outcome analysis of lateral mass fixation and trans-facet fixation with posterior decompression in the management of cervical spondylotic myelopathy: An institutional experience

Aims and Objectives

Posterior subaxial cervical fusion with lateral mass screw and rod instrumentation is a well-established fixation technique. Subaxial transarticular facet fixation is a lesser known fusion technique that has been shown to be biomechanically equivalent to lateral mass screws. The aim of this study was to evaluate the outcome of cervical decompressive laminectomy with lateral mass fixation compared with decompressive laminectomy with trans-facet fixation.

Materials and Methods:

The study was conducted with 20 patients operated for cervical decompressive laminectomy with lateral mass fixation compared with 20 patients operated with trans-facet fixation. The modified Japanese orthopedic association score (mJOA) scale, Nurick's functional grading and neurological recovery rate (NRR) was used as the functional outcome measurement. The clinical follow-up period was 6 months.

Results:

In Group I, the mean preoperative and postoperative mJOA scores in Group I and II were 8.2 ± 2.1 and 12.7 ± 2.8 and 9.3 ± 1.9 and 13.5 ± 1.88, respectively, were statistically significant (P < 0.05). Postoperative NRR at the end of the follow-up period was satisfactory (excellent and good) 55% in Group I and 60% in Group II. Fusion was documented in all 40 patients. No patients experienced neural or vascular injury as a result of screw position.

Conclusions:

Both trans-facet and lateral mass fixation techniques are simple, safe, and effective procedures in achieving relief and improvement in patients with multilevel cervical spondylotic myelopathy. Trans-facetal fixation can provide a reasonable alternative to lateral mass fixation.