Single-step treatment of the cervical spinal stenosis
Cervical spinal stenosis is the narrowing of the spinal canal, which occurs for various reasons, mainly due to traumas and degenerative dystrophic changes in the skeletal, ligamentous and joint systems, which over time lead to gradual narrowing of the cervical spine canal. This is the reason of chronic spinal cord compression, leading to chronic vascular disorders. Due to these phenomena, changes are taking place in the spinal cord, the so called myelopathy, with top-down conduction disorder along nerve fibers. Neurological changes occur in all limbs with sensory disturbances and movement violations until the inability to walk. In this case surgical intervention for spinal decompression is prescribed.
A patient S.F., 83-y/o, in 14.07.15 has admitted to Neurosurgery Department of MC Erebouni complaining of pains and weakness in all limbs, more in the left, inability to move independently because of the weakness in his left leg. MRI examination has found: • violation of statics of the cervical spine, • antelisthesis of C3 and TH2 of vertebral body, • multiple disc protrusions, • thickening with bulging into the spinal canal of yellow ligaments, • absolute stenosis of spinal canal at the C3-4 level, • myelopathy at the same level He was diagnosed with : antelisthesis of C3 vertebral body, absolute stenosis of spinal canal at the C3-4 level, myelopathy at the C3-4 level, tetraparesis more on the left.
It was decided to perform posterior lateral mass fixation of the cervical spine by a special construction. In 16.07.15 the patient was operated under general anesthesia by the Head of Neurosurgery Department Prof. Mamikon A. Egunyan and Head of the Spine Pathology and Vertebral Surgery Department Dr. Karapet G. Momjyan. It was performed decompressive laminectomy of C3 vertebra, exploration of the spinal canal, removing hypertrophied yellow ligaments, compressing the spinal cord, and posterior lateral mass screw fixation of C2-C4 vertebrae with hooks and rods.
Post-operational period was uneventful, wound healed by primary intention. On the 3rd day the patient began to walk, and currently is undergoing rehabilitation.
In Armenia such kind of surgeries are carried out in two stages:
1. Decompressive laminectomy through a posterior approach
2. Fixation of the spine through an anterior approach. In many clinics such kind of surgeries in the above diagnosis are carried out in one-step.
In Armenia, in particular in MC Erebouni, has long been practiced implementation in everyday practice achievements of world medicine and effective methods of treatment, the results of which are comparable to those of leading clinics of the world.