Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy

English Keywords:Anterior decompression  Multilevel cervical spondylotic myelopathy  Complications

English Abstract:

  【Abstract】 Objectives: Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy(CSM). Methods: This study retrospectively reviewed the postoperative complications in 327 patients with three-level CSM in whom the anterior cervical surgery was performed between January 2006 and August 2011. According to the decompression procedure, patients were divided into three groups: multilevel anterior cervical discectomy with fusion(ACDF) group(group A), multilevel anterior cervical corpectomy with fusion(ACCF) group(group B), hybride decompression technique (ACDF+ACCF)(group C). There were 69 males and 55 females in group A with an average age of 53.48±8.50 years old, 51 males and 43 females in group B with an average age of 54.36±7.82 years old, and 61 males and 48 females in group C with an average age of 53.68±7.80 years old. No significant differences were found among three groups. The differences of the complications among these groups were compared. Results: The average follow-up time was 3.5 years(ranging from 1.5 to 5 years). There were 69 patients who developed complications after surgery. The complications including graft migration, collapse or displacement, hoarseness, dysphagia, C5 palsy, cerebral fluid leakage and wound infection during the follow-up. 11 patients were observed graft migration and non-union during the follow-up, 3 patients(2.75%) in group C and 8 patients(8.51%) in group B. Patients in group B had significantly higher rate of non-union than patients in group A and C(P<0.05). Postoperative hoarseness was observed in 12 patients, 5(4.03%) of these patients were in group A, 3(3.19%) patients were in group B and the other 4(3.67%) patients were in group C. Postoperative dysphagia appeared in 26 patients, 11(8.87%) of them were in group A, 7(7.45%) of them were in group B and the other 8(7.34%) patients were in group C. 12 patients had C5 palsy after operation, 2(1.61%) of these patients were in group A, 5(5.32%) of these patients were in group B and the other 5(4.59%) patients were in group C. 3 patients in group A and 2 patients in group C had cerebral fluid leakage. 3 patients experienced wound infection(2 in group B and 1 in group C). The rate of complications was 16.94% in group A, 26.60% in group B and 21.10% in group C. Patients in group B had significantly higher rate of complications than the other two groups(P<0.05). Conclusions:　The multilevel ACDF approach has the lowest rate of non-union, long corpectomy approach should be selected prudently because of high rate of complications.