Clinical study of a cervical anterior hybrid technique for multilevel cervical spondylotic myelopathy

English Keywords:Cervical myelopathy  Multilevel  Disc replacement  Fusion  Hybrid technique

English Abstract:

  【Abstract】 Objective：To explore the early clinical effects of cervical anterior hybrid technique using anterior corpectomｙ and fusion（ACF） combined with cervical artificial disc replacement（C-ADR） for multilevel spondylotic myelopathy.Method：Hybrid technique ｗａｓ　applied in 24 cases of multilevel cervical spondylotic myelopathy（group A），ａｎｄ　28 patients were treated by the traditional anterior noncontiguous decompression and fusion（group B） between Oct 2008 and Jun 2009. Clinical results were evaluated by JOA score preoperatively and postoperatively ａｔ 3d，3 months，12 months，and 24 months.The operative time and blood losｓ were ｒｅｃｏｒｄｅｄ.The range of movement（ROM） in replaced segment and C2-7 of all cases were evaluated by radioｇｒａｐｈ（X-rays of bending，extending）.CT or MRI scan wａｓ applied postoperatively to find out the pressure of the spine and heterotopic ossification in the replaced segment.Result：There was no serious complication.Improvement in all cases ｏｃｃｕｒｒｅｄ obviously，ａｎｄ　JOA score increased（P<0.01） and stabilized postoperatively in all cases.There was no difference in JOA score between two groups（P>0.05）.The mean C2-7 ROM of both groups did　ｎｏｔ recover to the preoperative value，but group A showed faster and better C2-7 ROM recovery.Replaced segment achieved stability and restored partial of ROM.There was no prosthesis subsidence or excursion.No hetertopic ossification was found in the replaced level，and the movement ｈａｄ no significant difference（P>0.05） between preoperative and postoperative at two years post-operation.But the deteriorated adjacent level of 2 cases ｗｅｒｅ　ｆｏｕｎｄ in group B.Conclusion：In term of surgical time，blood loss and restoring stability and partial motion of the C2-7 ROM，the anterior hybrid technique ｉｓ superior compared with the traditional anterior noncontiguous decompression and fusion.At the same time，less compensatory motion occurs at the adjacent segments，and less ASD will result.