Smith-Robinson technique combined with corpectomy with the posterior vertebral wall intact to treat multi-level cervical spondylosis

English Keywords:Cervical spondylosis  Decompression  Smith-Robinson technique  Corpectomy  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To study the effect of smith-Robinson technique combined with cervical corpectomy with the posterior vertebral wall intact(anterior decompression through disc space and interbody fusion with bone graft) for multi-level(≥3) cervical spondylosis. Methods: 33 cases with multi-level（≥3） cervical spondylosis were treated with corpectomy with the posterior vertebral wall retention combined with Smith-Robinson technique from January 2010 to January 2014. There were 25 males and 8 females with an average age of 52.6±9.7 years(range, 42-71 years). 23 patients were diagnosed as cervical spondylotic myelopathy, and 10 patients were mixed type(myelopathy type + radiculopathy type in 6 cases, myelopathy type + radiculopathy type + vertebral artery type in 4 cases). The diseased segments were as follows: 12 cases at C3/4-C5/6, 14 cases at C4/5-C6/7 and 7 cases at C3/4-C6/7. 8 cases at C4, 18 cases at C5 and 7 cases at C6. All cases underwent the surgery of retained posterior vertebral wall at subtotal corpectomy and the adjacent discs were decompressed by Smith-Robinson technique. The position of the internal fixities was detected by X-rays (preoperation, and immediately after operation, the 1st, 6th, and 12th month after surgery) and CT-scan(the 3rd month after operation) and the fusion was evaluated by Bohlman method under CT scan. Neck and shoulder pain and neurological function was evaluated by the visual analog scale(VAS) and Japanese Orthopedic Association(JOA) score and the physiological curvature of cervical spine was assessed by measuring the C2-C7 Cobb angle preoperatively, 1 month postoperatively and at final follow-up. Results: The mean operation time was 105±24min(95-138min) and the mean blood loss was 270±95ml(180-450ml). 4 patients with postoperative hoarseness healed 2-3 weeks later. 2 cases were lost follow-up and 31 patients were followed up for 16.3±5.6 months(range, 12-24 months). The JOA score and VAS score improved significantly and showed significant difference(P<0.05) between the preoperation and 1 month after operation. At last follow-up, the value improved significantly compared with 1 month after operation(P<0.05). Among them, 18 cases were excellent, 10 good, 3 effective, with the excellent and good rate as 90.3%. 1 month after operation, C2-C7 Cobb angle increased obviously(P<0.05) compared with the preoperative ones. But there was no significant difference(P<0.05) between 1 month after surgery and the last follow-up. Bony fusion was noted in 31 patients at 3 to 6 months after operation. The complications such as plate loosening, titanium mesh and cage shift, vertebral collapse, pseudoarticulation formation were not noted. Conclusions: For multi-level cervical spondylosis, corpectomy with the posterior vertebral wall retention combined with Smith-Robinson technique is feasible and safety method, which can obtain complete decompression, reliable bony fusion and reducing complications.