Multilevel anterior discectomy and fusion for aged patients with cervical spondylotic myelopathy

English Keywords:Cervical spondylotic myelopathy  Multilevel  Discectomy  Spine fusion  Aged

English Abstract:

  【Abstract】 Objective：To investigate the efficacy of multilevel anterior cervical discectomy and fusion for aged patients with cervical spondylotic myelopathy.Method：Twenty seven patients（15 males and 12 females） with the mean age of 66.5±5.1 years（range，61-75 years） treated surgically between March 2004 and March 2009 were reviewed retrospectively.Multilevel（including C3-C6 in 11 case，C4-C7 in 9，C3-C7 in 7） anterior cervical discectomy and fusion with cage and dynamic titanium plate were performed.Japanese Orthopedic Association（JOA） scores and neck dysfunction index（NDI），as well as radiologic parameters such as cervical lordosis of fusion segement before and after operation were noted and compared.Improving rate of JOA and bony fusion were also evaluated.Clinical results were graded from excellent to poor using the Odom′s criteria.The sagittal alignment of fusion segements were measured using Cobb method.Result：The average operation time was 112.9±28.2min（range，75-180min），and mean blood loss was 78.9±52.8ml（range，50-300ml）.One patient was complicated with cerebrospinal fluid leakage which healed after conventional drain for 24h without surgical intervention.Another two cases had swallowing foreign body sensation，which disappeared after two months.All patients were followed up for 6-60 months，with an average of 23.8±7.5 months.The JOA score at final follow up（13.6±1.2） was significantly higher than preoperative（9.5±1.8）（P<0.001）.NDI at final follow up（7.8%±2.2%） was significant lower than preoperative（19.0%±3.4%）(P<0.001)．Radiograph analysis indicated that the average angle of lordosis was corrected from 8.8°±1.2° preoperatively to 18.0°±2.5° at final follow up（P<0.001）.The final follow up score according to Odom′s criteria was excellent in eight patients，good in fifteen and fair in remaining four，with excellent and good rate of 85.2%.At final follow up，no cage subsidence and displacement was noted and bony fusion rate was 100%.Conclusion：Multilevel anterior discectomy and fusion for aged patients with cervical spondylotic myelopathy is reliable and effective.