Prospective study of axial symptoms after anterior cervical discectomy and fusion with plating for cervical spondylotic myelopathy

English Keywords:Anterior approach  Cervical surgery  Axial symptoms  Clinical factor

English Abstract:

  【Abstract】 Objectives: To identify clinical factors associated with the occurrence of axial symptoms following anterior cervical discectomy and fusion with plating. Methods: 107 patients diagnosed cervical spondylotic myelopathy undergoing anterior cervical discectomy and fusion with plating by the same surgeon from May 2011 to September 2011 were enrolled in this prospective study. All of the patients did not express any axial symptom such as pain or stiffness preoperatively and reviewed 3 months after surgery. New onset axial symptoms of the patients were recorded and evaluated by visual analogue scale(VAS). Eight clinical factors for each patient were collected including age, gender, the alignment of index segment(s) pre- and post-operation, the distraction of operating segment(s), the status of intervertebral bony fusion, postoperative rehabilitation, periods wearing cervical collar. The correlation among these eight clinical factors and the occurrence of axial symptoms were evaluated with Logistic regression analysis. The difference of recovery rate measured by modified Japanese Orthopaedics Association(mJOA) score between patients suffering from axial symptoms or not was analyzed by independent samples T test. Results: All patients were followed up for 3 months. The occurrence rate of axial symptoms in this study was 26.2%(28/107), with an average of 4 points VAS score. There was no statistical difference in mJOA recovery rate between patients whether appeared new onset of axial symptoms(P=0.317). Only three clinical factors including postoperative rehabilitation, the preoperative alignment of treating segment(s) and the status of intervertebral bony fusion were statistically correlated with patients′ new onset of axial symptoms(P=0.0003, 0.003, 0.016; OR=185.6, 8.1, 37.1). Conclusions: The axial symptoms following anterior cervical discectomy and fusion are not rare. Insufficient postoperative rehabilitation, the preoperative kyphosis of treating segment(s) and unsatisfied intervertebral bony fusion are correlated to the new occurrence of axial symptoms.