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The purpose of this study was to determine the average age of individuals diagnosed with cervical spinal myelopathy who are known cocaine users vs nonusers, as well as the postoperative change in neurological condition between cocaine users and nonusers. Medical records of patients diagnosed with cervical spinal myelopathy between January 1990 and May 2006 were reviewed. Ninety-four patients were identified who underwent any surgical intervention with at least 2 years of follow-up. Group 1 comprised patients with cervical spinal myelopathy who had used cocaine, and group 2 comprised patients with cervical spinal myelopathy who had not used cocaine. All patients were clinically evaluated by the Nurick grade preoperatively and at most recent follow-up. Mean follow-up was 25 months. Mean age at presentation was 52 years (range, 44–62 years) in group 1 and 56 years (range, 42–88 years) in group 2. Average duration of symptoms prior to surgical intervention was 18.6 months in group 1 and 10 months in group 2. Average Nurick grade at presentation was 2.7 for group 1 and 2.7 for group 2. Average postoperative Nurick grade was 1.9 for group 1 and 1.33 for group 2. Change in Nurick grade was 0.8 for group 1 and 1.11 for group 2. Linear regression analysis comparing change in Nurick grade (from pre- to postoperative) was conducted, showing a correlation of −0.45 with a P value of .044. To the authors’ knowledge, this is the first study demonstrating that cocaine use has an effect on postoperative improvement of neurological function in cervical spondylotic myelopathy.

The purpose of this anatomic study was to determine the extent of lateral dissection that can be performed during anterior cervical decompression and fusion to maximize decompression without compromising the vertebral arteries. Although vertebral artery injury is rare, it is sometimes catastrophic and leads to significant morbidity and mortality. Previous studies have attempted to establish standards for surgical anatomy during anterior cervical decompression and fusion; however, none have accounted for significant degenerative changes that occur with increased age. The uncus-to-uncus distance, representing part of the vertebral endplate, of 500 cervical spine specimens was measured at each vertebral level from C3 to C7. The corresponding femoral head diameter (a correlate of body mass index) was also measured. These values were used to determine whether a specific uncus-to-uncus distance exists per vertebral level regardless of age, and whether the uncus-to-uncus distance becomes more specific when correlated with body mass index. According to the data, uncus-to-uncus distance increases between each vertebral level, and each level has a range of approximately 6 mm. The range does not decrease when compared with femoral head diameter. Although a statistically significant, positive correlation existed between uncus-to-uncus distance and femoral head diameter, the correlation coefficient was not large enough to suggest that uncus-to-uncus distance varies greatly from femoral head diameter. Although anatomical markers such as the distance between the uncinate processes can aid surgeons in safe decompression of the cervical vertebrae, vertebral artery injury is best avoided by thorough pre- and intraoperative radiological and anatomical analysis.