Comparison of two anterior techniques in the surgical management of adjacent two-level cervical spondylotic myelopathy

English Keywords:Cervical spondylotic myelopathy  Discectomy  Corpectomy  Discectomy and fusion

English Abstract:

  【Abstract】 Objectives: To compare the outcome between double segments anterior cervical discectomy and fusion(ACDF) and anterior cervical corpectomy and fusion(ACCF) on the adjacent two segments in cervical spondylotic myelopathy. Methods: From September 2010 to July 2013, the application of two segments discectomy polyetheretherketone cages(PEEK cage) and bone grafting fusion and single segment corpectomy decompression and titanium mesh and bone graft for the treatment of 54 cases with adjacent two segments spondylotic myelopathy was analyzed retrospectively. Comparison of baseline data, length of hospital stay, operation time, amount of bleeding, Japanese Orthopaedic Association(JOA) scores and visual analogue scale(VAS) between two groups was performed. Analysis of two groups of cervical curvature, fusion segmental height and fusion rate of change at each follow-up time was conducted. Results: The fusion rate for two groups was 100%. The difference of age, gender, lesion segment, sagittal alignment, bone material, length of hospital stay and the operation time was not statistically significant, the amount of bleeding in group ACDF was significantly less than that in ACCF group(observation group, control group, 175.4+12.1ml VS 201.3+80.4ml). JOA and VAS score of two groups before surgery and at the final follow-up showed statistical significance(P=0.000), but there was no significant difference between two groups. Two groups had cervical curvature and height of the fused segment at 3 days after operation significantly increased compared with preoperation and final follow-up, that in ACDF group improved significantly than that in ACCF group(P＜0.05). Conclusions: For adjacent double segments cervical spondylotic myelopathy, ACDF has less blood loss, well improves the cervical curvature and maintains the height of the fused segment.