Axial symptoms after anterior cervical decompression and fusion for two-level cervical spondylotic myelopathy

English Keywords:Cervical spondylotic myelopathy  Anterior surgery  Axial symptom

English Abstract:

  【Abstracts】 Objective：To investigate the incidence of axial symptoms（AS） after anterior cervical corpectomy and fusion（ACCF） and anterior cervical discectomy and fusion（ACDF） for 2-level cervical spondylotic myelopathy（CSM） respectively.Method：From March 2004 to May 2007，the clinical and radiographic data of 113 CSM patients with 2-level involvement treated surgically were collected，there were 61 cases（42 males and 19 females） with the mean age of 56.2 years（range，36-73 years） undergoing ACCF（group A），while 52（37 males and 15 females） with the mean age of 54.6 years（range，33-77 years） underwent 2-level ACDF（group B）.The pre- and post-operative Japanese Orthopedic Association scores，segmental height and segmental lordosis were compared between each group.And the incidence of postoperative AS was analyzed either.Result：All patients were followed up for an average of 32.2 months（range，24-48months）.The improving rate of neurological function at final follow-up was （70.1±12.2）% and （63.5±4.7）% for group A and B respectively，with no significant difference（P>0.05）.However the change of fusion segments height was -0.04±0.02cm and 0.05±0.02cm，with significant difference（P<0.05）.Kyphosis rate for fusion segments was 34.4% and 13.5%，with significant difference（P<0.05）.The incidence of AS at final follow-up was 45.9%（28/61） and 26.9%（14/52） for group A and B respectively，with significant difference（P<0.05）.The prevalence of AS complicated with lowering of fusion segments height was higher than that with no lowering of fusion segments height（P<0.05），and the lowering of fusion segments height in group A was higher than that in group B（P<0.05）.The prevalence of AS complicated with severe kyphosis in group A was higher than that with no or mild kyphosis（P<0.05），and the prevalence of severe kyphosis in fusion segments in group A was higher than that in group B（P<0.05）.Conclusion：The incidence of the postoperative AS is much higher in patients complicated with decreased fusion segments height and/or with obvious kyphosis after anterior cervical decompression and fusion.Compared with ACCF，ACDF for CSM is associated with good outcomes and lower incidence of the postoperative AS.