Cervical stenosis in adults undergoing thoracolumbar deformity surgery: incidence, treatment, and complications

Object. The goals of this study were to determine the incidence of occult cervical stenosis in patients over 50 years old with thoracolumbar deformity and to assess the risk of progressive cervical myelopathy after complex thoracolumbar reconstruction in asymptomatic or mildly symptomatic patients with cervical stenosis. Methods. Charts and cervical imaging for patients who were over 50 years old when they had undergone thoracolumbar deformity surgery between 2005 and 2008 were reviewed. Patients with primary neurological disorders were excluded from the study. Results. Seventy-three patients (56 women and 17 men) met the study inclusion criteria. The minimum follow-up time was 2 years. Fifty-eight percent of patients (42 of 73) had cervical stenosis on advanced imaging. Thirty-three patients had mild or moderate stenosis; only 3 of these patients had clinical myelopathy. Nine patients (12%) had critical cervical stenosis, as determined from imaging; among these patients, 3 had moderate or severe myelopathy. Patients with noncritical stenosis and no or mild myelopathy underwent thoracolumbar reconstruction without any postoperative progression of myelopathy. Patients with critical stenosis and/or moderate or severe myelopathy were offered cervical decompression prior to thoracolumbar reconstruction; those who accepted this offer did not have progression of myelopathy. One patient underwent thoracolumbar reconstruction first despite critical cervical stenosis. At 20 months, her cervical myelopathy had progressed, and she ultimately required cervical decompression. Conclusions. Cervical stenosis, even critical stenosis in some cases, was seen in more than one-half of the patients. Most presented without obvious cervical complaints. In those with mild to moderate stenosis and no or mild myelopathy, lengthy thoracolumbar reconstruction procedures were not associated with progression of the myelopathy. The authors recommend that all adults with thoracolumbar deformity undergo a detailed upper- and lower-extremity neurological examination prior to major thoracolumbar reconstruction.