Neurologic Complications in Managing Degenerative Cervical Myelopathy: Pathogenesis, Prevention, and Management

https://doi.org/10.1016/j.nec.2017.09.008Get rights and content

Section snippets

Key points

  • In the nonsurgical treatments of degenerative cervical myelopathy, cervical spine manipulation therapy and cervical traction are at higher risk of causing neurologic complications.

  • Surgical treatments of degenerative cervical diseases can injure spinal cord, spinal nerves, cranial nerves, and sympathetic nerve trunk and major vessels and lead to developing neurologic complications.

  • Anterior cervical corpectomy and posterior fixation surgery are at higher risk of inducing severe complications than

Neurologic complications of nonsurgical management

Nonsurgical treatment of degenerative cervical diseases includes cervical immobilization with a soft collar, the use of anti-inflammatory and/or muscle relaxants, spinal injections, manipulation therapy, thermal therapy, cervical traction, discouragement of high-risk activities, and an avoidance of risky environment.6, 7, 8 Among these treatments, manipulation therapy is known to cause deterioration of myelopathy and ischemic neurologic complications.9, 10 Although it is less often than

Neurologic complications of surgical management for degenerative cervical myelopathy patients

A variety of techniques have been developed to improve functional outcomes of DCM, including anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), laminoplasty, laminectomy, and laminectomy with fusion.17 Regarding the complications of surgical treatments to cause neurologic symptoms, the spinal cord, spinal nerves, and vertebral artery can be injured by both anterior and posterior approaches, and cranial nerves, sympathetic nerve trunk, and carotid

Summary

There are a variety of neurologic complications with the nonsurgical and surgical treatments for DCM. Ten common or disabling complications are selected, and the incidence, pathogenesis, prevention, and management are reviewed. Among the nonsurgical treatments for DSM, cervical spine manipulation therapy and cervical traction are at higher risk of causing neurologic complications. Surgical treatments for degenerative cervical diseases can injure spinal cord, spinal nerves, cranial nerves,

First page preview

First page preview
Click to open first page preview

References (92)

  • A. Nanda et al.

    Surgical complications of anterior cervical diskectomy and fusion for cervical degenerative disk disease: a single surgeon's experience of 1,576 patients

    World Neurosurg

    (2014)
  • H.B. Gokcen et al.

    Bilateral diaphragm paralysis due to phrenic nerve palsy after two-level cervical corpectomy

    Spine J

    (2016)
  • A. Kimura et al.

    Fall-related deterioration of subjective symptoms in patients with cervical myelopathy

    Spine

    (2017)
  • P.G. Matz et al.

    The natural history of cervical spondylotic myelopathy

    J Neurosurg Spine

    (2009)
  • M.G. Fehlings et al.

    Introduction: degenerative cervical myelopathy: diagnostic, assessment, and management strategies, surgical complications, and outcome prediction

    Neurosurg Focus

    (2016)
  • S.K. Karadimas et al.

    Pathophysiology and natural history of cervical spondylotic myelopathy

    Spine (Phila Pa 1976)

    (2013)
  • Z. Kadanka et al.

    Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study

    Spine (Phila Pa 1976)

    (2002)
  • J.M. Rhee et al.

    Nonoperative management of cervical myelopathy: a systematic review

    Spine

    (2013)
  • D.G. Malone et al.

    Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice

    Neurosurg Focus

    (2002)
  • M.S. van Zagten et al.

    Cervical myelopathy as complication of manual therapy in a patient with a narrow cervical canal

    Ned Tijdschr Geneeskd

    (1993)
  • E.C. So

    Facial nerve paralysis after cervical traction

    Am J Phys Med Rehabil

    (2010)
  • S. Haldeman et al.

    Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation

    Spine

    (2002)
  • P.E. Greenmann
  • F.C. Powell et al.

    A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain

    Neurosurgery

    (1993)
  • V. Dabbs et al.

    A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain

    J Manipulative Physiol Ther

    (1995)
  • P.V. Mummaneni et al.

    Cervical surgical techniques for the treatment of cervical spondylotic myelopathy

    J Neurosurg Spine

    (2009)
  • L. Tetreault et al.

    Clinical and surgical predictors of complications following surgery for the treatment of cervicalspondylotic myelopathy: results from the multicenter, prospective AOSpine international study of 479 patients

    Neurosurgery

    (2016)
  • M.G. Fehlings et al.

    Perioperative and delayed complications associated with the surgical treatment of cervicalspondylotic myelopathy based on 302 patients from the AOSpine North America cervicalspondylotic myelopathy study

    J Neurosurg Spine

    (2012)
  • T.B. Flynn

    Neurologic complications of anterior cervical interbody fusion

    Spine

    (1982)
  • J.Y. Lee et al.

    Characterization of neurophysiologic alerts during anterior cervical spine surgery

    Spine

    (2006)
  • A.H. Daniels et al.

    Iatrogenic spinal cord injury resulting from cervical spine surgery

    Global Spine J

    (2017)
  • A.J. Clark et al.

    Intraoperative neuromonitoring with MEPs and prediction of postoperative neurological deficits in patients undergoing surgery for cervical and cervicothoracic myelopathy

    Neurosurg Focus

    (2013)
  • J. Inamasu et al.

    Vascular injury and complication in neurosurgical spine surgery

    Acta Neurochir (Wien)

    (2006)
  • M. Neo et al.

    Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations

    Spine

    (2008)
  • S.H. Oh et al.

    Quantitative three-dimensional anatomy of the subaxial cervical spine: implication for anterior spinal surgery

    Neurosurgery

    (1996)
  • T.G. Pait et al.

    Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures

    Neurosurgery

    (1996)
  • A.R. Vaccaro et al.

    Vertebral artery location in relation to the vertebral body as determined by two-dimensional computed tomography evaluation

    Spine

    (1994)
  • L.J. Curylo et al.

    Tortuous course of the vertebral artery and anterior cervical decompression: a cadaveric and clinical case study

    Spine

    (2000)
  • J.T. Hong et al.

    Anatomical variations of the vertebral artery segment in the lower cervical spine: analysis by three-dimensional computed tomography angiography

    Spine (Phila Pa 1976)

    (2008)
  • I.D. Farey et al.

    Modified Gallie technique versus transarticular screw fixation in C1-C2 fusion

    Clin Orthop Relat Res

    (1999)
  • N.M. Wright et al.

    Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons

    J Neurosurg

    (1998)
  • T. Cole et al.

    Anterior versus posterior approach for multilevel degenerative cervical disease: a retrospective propensity score-matched study of the MarketScan database

    Spine

    (2015)
  • W.K. Hsu et al.

    Epidemiology and outcomes of vertebral artery injury in 16 582 cervical spine surgery patients: an AOSpine North America Multicenter Study

    Global Spine J

    (2017)
  • A.A. Theologis et al.

    Safety and efficacy of reconstruction of complex cervical spine pathology using pedicle screws inserted with stealth navigation and 3D image-guided (O-Arm) technology

    Spine

    (2015)
  • T. Sugawara et al.

    Accurate and simple screw insertion procedure with patient-specific screw guide templates for posterior C1-C2 fixation

    Spine

    (2017)
  • R. Hartl et al.

    Carotid artery injury in anterior cervical spine surgery: multicenter cohort study and literature review

    Global Spine J

    (2017)
  • Cited by (10)

    • Anterior decompression and plate fixation in treatment of cervical myelopathy: A multicentric retrospective review

      2018, Acta Orthopaedica et Traumatologica Turcica
      Citation Excerpt :

      Complications of titanium mesh and expanding cages with autograft and anterior plates may include subsidence and kyphotic deformity22,23; when using these devices, any over distraction maneuvers should be avoided. Many factors have been shown to affect results of ventral cervical decompression surgery for cervical myelopathy including age, preoperative neurological condition, chronicity and the number of stenotic spinal segments.24,25 As regard the relationship between the duration of symptoms, signs and the clinical outcome, patients with a short time before surgery (up to one year) had much better chance of improvement than those patients with more than one-year of time before surgery.

    • Surgical Treatment of Cervical Spondylotic Myelopathy

      2023, Treatment of Spine Disease in the Elderly: Cutting Edge Techniques and Technologies
    View all citing articles on Scopus

    Disclosure: There are no conflicts of interest and funding sources.

    View full text