An Algorithmic Posterior Approach to the Treatment of Multilevel Degenerative Cervical Spine Disease: A Multicenter Prospective Study

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Figure 1
Algorithm for the surgical treatment of patients with multilevel degenerative disease of the cervical spine.⁹ CT, computed tomography; FJ, facet joints; IVD, intervertebral discs; MRI, magnetic resonance imaging.
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Figure 2
Flowchart for study selection. LF, laminectomy with lateral mass fixation; LP, laminoplasty; MRI, magnetic resonance imaging.
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Figure 3
Computed tomography of the cervical spine after open-door laminoplasty was performed from C4 to C6 (A, B); posterior decompression and instrumented fusion were performed from C4 to C6 (C, D).
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Figure 4
A total of 338 patients underwent surgery for multilevel degenerative cervical spine disease. Out of these, 34 patients were excluded. Reason *, loss of follow-up; Reason **, refusal to participate in the study; Reason ***, death unrelated to the operation (in these cases, there were no postoperative complications). f/u = follow-up; LP, open-door laminoplasty; LF, laminectomy with instrumented fusion; MRI, magnetic resonance imaging; NDI, Neck Disability Index; VAS, visual analog pain scale.

Table 1

Characterization of patients of the studied groups.

Criteria	Group I (n = 192)	Group II (n = 112)	Р Value
Age, y, median (Q1; Q3)	54 (45; 63)	59 (46; 64)	0.23
Male/female ratio, n (%)	134 (69.8)/58 (30.2)	76 (67.9)/36 (32.1)	0.42
Number of operated vertebrae, n (%)
3	117 (60.9)	73 (65.2)	0.14
4	61 (31.8)	31 (27.7)
5	14 (7.3)	8 (7.1)
Observation period, mo	27 (25; 32)	41 (35; 62)	-

Table 2

Comparison between Groups I and II for VAS and NDI scores preoperatively and at 2 y postoperatively.

Criteria	Group I (n = 192)	Group II (n = 112)	P Value
VAS, neck pain preoperatively	81 mm (75; 86)	82 mm (72; 94)	0.16
VAS, neck pain at 2 y postoperatively	10 mm (9; 12)	22 mm (12; 35)	0.02
NDI score preoperatively	47.5 (42; 48)	46 (43; 48)	0.31
NDI score at 2 y postoperatively	12 (8; 14)	18 (13; 27)	0.01

Table 3

Intergroup comparative analysis of the outcome of surgical treatment on the MacNab and Nurick Scales at long-term postoperative follow-up.

Criteria	Group I (n = 192)	Group II (n = 112)	P Value
MacNab Scale, n (%)
Excellent	107 (56%)	29 (26%)	<0.0001
Good	81 (42%)	43 (38%)
Satisfactory	4 (2%)	35 (31%)
Unsatisfactory	-	5 (5%)
Nurick Scale, n (%)
Complete regression of symptoms	102 (53%)	21 (19%)	<0.0001
Improvement of neurological status	90 (47%)	69 (62%)
No changes	-	18 (16%)
Worsening of symptoms	-	4 (3%)

Table 4

Complications.

Criteria	Group I (n = 192)	Group II (n = 112)	P Value
Intraoperative complications, n (%)	2 (1%)	6 (5.3%)	0.031
Dural tears	-	2
Root injury	-	1
Screws cut out intraoperatively	2	3
Early postoperative complications, n (%)	5 (2.6%)	15 (13.4%)	0.0004
Intramuscular hematoma	2	5
Surgical site infection	1	3
Venous thrombosis, pulmonary embolism	-	1
С5 palsy	2	6
Long-term postoperative complications, n (%)	4 (2%)	18 (16.1%)	<0.0001
Adjacent level disc herniation	2	3
Kyphotic deformity	-	6
Failure of the stabilization	-	2
Progression of symptoms due to inadequate decompression	-	4
Noncompressive neurologic symptoms	2	3