Posterior decompression for myelopathy due to cervical spondylosis: laminectomy alone versus laminectomy with dentate ligament section. 1977

D G Piepgras

In summary we have reviewed some of the studies and theories regarding the role of the dentate ligaments in cervical spondylosis and myelopathy and the logic which has been proposed either for or against their transection in the surgical treatment of this disease. A review of our own series of patients shows no significant increased morbidity in patients undergoing decompressive laminectomy, dentate ligament section, and dural graft as compared to laminectomy alone for treatment of myelopathy due to cervical spondylosis. Of equal importance is the fact that we could demonstrate no superiority in terms of neurological benefit between these two types of operative therapy. However, intradural inspection carried out as a matter of routine did reveal unexpected midline disk protrusions in two cases, the removal of which allowed the patients to do better than might have been expected from laminectomy alone. These findings lead us to conclude that intradural exploration is always indicated if there exists any doubt as to the nature of the basic pathological process. Also there has been presented some experimental evidence to support division of the dentate ligaments if an unresectable anterior lying mass is found.

UI MeSH Term Description Entries
D007796 Laminectomy A surgical procedure that entails removing all (laminectomy) or part (laminotomy) of selected vertebral lamina to relieve pressure on the SPINAL CORD and/or SPINAL NERVE ROOTS. Vertebral lamina is the thin flattened posterior wall of vertebral arch that forms the vertebral foramen through which pass the spinal cord and nerve roots. Laminotomy,Laminectomies,Laminotomies
D008297 Male Males
D010841 Pia Mater The innermost layer of the three meninges covering the brain and spinal cord. It is the fine vascular membrane that lies under the ARACHNOID and the DURA MATER. Mater, Pia,Maters, Pia,Pia Maters
D002574 Cervical Vertebrae The first seven VERTEBRAE of the SPINAL COLUMN, which correspond to the VERTEBRAE of the NECK. Cervical Spine,Cervical Spines,Spine, Cervical,Vertebrae, Cervical
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013116 Spinal Cord A cylindrical column of tissue that lies within the vertebral canal. It is composed of WHITE MATTER and GRAY MATTER. Coccygeal Cord,Conus Medullaris,Conus Terminalis,Lumbar Cord,Medulla Spinalis,Myelon,Sacral Cord,Thoracic Cord,Coccygeal Cords,Conus Medullari,Conus Terminali,Cord, Coccygeal,Cord, Lumbar,Cord, Sacral,Cord, Spinal,Cord, Thoracic,Cords, Coccygeal,Cords, Lumbar,Cords, Sacral,Cords, Spinal,Cords, Thoracic,Lumbar Cords,Medulla Spinali,Medullari, Conus,Medullaris, Conus,Myelons,Sacral Cords,Spinal Cords,Spinali, Medulla,Spinalis, Medulla,Terminali, Conus,Terminalis, Conus,Thoracic Cords
D013117 Spinal Cord Compression Acute and chronic conditions characterized by external mechanical compression of the SPINAL CORD due to extramedullary neoplasm; EPIDURAL ABSCESS; SPINAL FRACTURES; bony deformities of the vertebral bodies; and other conditions. Clinical manifestations vary with the anatomic site of the lesion and may include localized pain, weakness, sensory loss, incontinence, and impotence. Conus Medullaris Syndrome,Myelopathy, Compressive,Extramedullary Spinal Cord Compression,Spinal Cord Compression, Extramedullary,Compression, Spinal Cord,Compressions, Spinal Cord,Compressive Myelopathy,Conus Medullaris Syndromes,Spinal Cord Compressions,Syndrome, Conus Medullaris,Syndromes, Conus Medullaris
D013122 Spinal Diseases Diseases involving the SPINE. Disease, Spinal,Diseases, Spinal,Spinal Disease
D013577 Syndrome A characteristic symptom complex. Symptom Cluster,Cluster, Symptom,Clusters, Symptom,Symptom Clusters,Syndromes

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