Analysis of anterior discectomy and fusion for treating cervical spondylosis accompanied by sympathetic symptoms

English Keywords:Cervical spondylosis  Sympathetic symptoms  Discectomy  Posterior longitudinal ligament  Outcome

English Abstract:

  【Abstract】 Objective：To investigate surgical results of anterior discectomy and fusion in treating cervical spondylosis accompanied by sympathetic symptoms.Method：A retrospective study was performed on 156 patients with cervical spondylosis myelopathy or myelopathy and radiculopathy accompanied by sympathetic symptoms such as dizzy and headache between October 2001 and October 2010.There were 59 with myelopathy whereas 97 with myelopathy and radiculopathy.The cases included single level（108 cases），two levels（39 cases），three levels（6 cases） and four levels（3 cases）.All the compression levels underwent anterior discectomy and fusion surgery with posterior longitudinal ligament（PLL） resection at the area of decompression.Clinical and radiologic evaluations were taken and compared at baseline，one week post-operation and final follow-up.Neurological status was evaluated by Japanese Orthopedic Association（JOA） scores and sympathetic symptoms were evaluated with sympathetic symptoms 20-point scoring system.Antero-posterior，lateral and extension-flextion radiographs were used to evaluate the radiologic outcomes.Result：Postoperatively，32 patients experienced transient sore throat and pharyngolaryngeal malaise，which was absent 3 to 5 days after surgery by fog inhalation therapy.No leakage of cerebrospinal fluid，infection and injury of vessels and nerves were observed.The average follow-up was 25 months（range，8 to 42 months）.The sympathetic symptoms score was 6.4±1.7 before surgery，1.6±1.7 one week after surgery，and 2.4±1.4 at the final follow-up，with the subjective satisfactory rate of 79%.The corresponding JOA scores were 9.8±2.4，11.9±2.5，and 12.9±2.2 respectively.A significant difference was observed regarding sympathetic symptoms scores and JOA scores before surgery and one week after surgery or at the final follow-up（P＜0.05），but no statistical significance between which of one week after surgery and the final follow-up（P>0.05）.Radiographs at the final follow-up indicated absolute postoperative fusion and reliable cervical stability without fixation failure or breakage.Two patients experienced deterioration in spinal cord function 3 years after surgery，and a subsequent revision of posterior decompression was performed.Conclusion：Cervical spondylosis accompanied by sympathetic symptoms can be managed successfully by the anterior discectomy and fusion with resection of PLL at the area of decompression.