Contrastive study of the clinical effects of anterior cervical discectomy and fusion with ROI-C in treating two-level cervical spondylotic myelopathy

English Keywords:Cervical spondylotic myelopathy  Decompression  Spinal fusion  Internal fixation  Efficacy

English Abstract:

  【Abstract】 Objectives: To study the clinical effects of anterior cervical discectomy and fusion(ACDF) by using ROI-C implant via traditional titanium plate with cage in treating two-level adjacent cervical spondylotic myelopathy． Methods: From January 2011 to December 2012, a total of 57 patients with two-level cervical spondylotic myelopathy and undergoing ACDF by ROI-C(group A, n=25) or by titanium plate with cage(group B, n=32) were retrospectively analyzed． There was no statistical significance with regarding to the age, the gender, preoperative JOA scores, preoperative VAS scores of neck pain and surgical level between two groups(P>0.05). The operation time, intraoperative blood loss, postoperative JOA scores, postoperative VAS scores of neck pain, cervical physiological curvature(Cobb angle), segmental lordosis, fusion rate, dysphagia incidence and adjacent segment degeneration rate in both groups were measured and compared. Results: In group A, the operation time was 141.3±49.9min, intraoperative blood loss was 123.6±54.1ml, which was 168.3±44.4min and 126.2±32.6ml in group B respectively, the operation time of group A was significantly lower than group B(P<0.05), but there was no statistical significance in intraoperative blood loss between two groups(P>0.05). The JOA scores improved significantly after operation in both groups, the VAS scores of neck pain decreased significantly, there were no significant differences on JOA scores and VAS scores of neck pain between two groups at the same follow-up time(P>0.05). In group A, preoperative and final follow-up Cobb angle was 12.6°±7.3° and 21.9°±6.2° respectively, while 14.3°±9.3° and 19.6°±7.3° in group B, cervical lordosis(Cobb angle) at final follow-up was better than that of preoperation(P<0.05), but no significant difference was noted between two groups(P>0.05)． In group A, preoperative and final follow-up segmental lordosis was 3.4°±5.6° and 9.6°±5.5° respectively, while 4.4°±4.3° and 9.1°±4.1° in group B, segmental lordosis at final follow-up was higher than that of preoperation(P<0．05), while no significant difference was noted between two groups(P>0.05). In group A, the postoperative dysphagia occurrence rate was 8％, only 2 cases of 25 patients presented with mild dysphagia． In group B, postoperative dysphagia occurred in 34.4% of patients, in 32 patients, mild dysphagia was noted in 10 cases, moderate dysphagia in 1 case． Dysphagia rate in group A was obviously lower than that in group B(P<0.05)． The fusion rate at the 12th week after surgery was 88%(22/25) in group A and 87.5% in group B. In addition, bony fusion was obtained in all cases at the final follow-up postoper?鄄atively. Among the 50 adjacent levels in group A, 6 discs developed degeneration or progressive degeneration. Among the 64 adjacent levels in group B, 8 discs developed degeneration or progressive degeneration. There was no statistical significance in adjacentlevel degeneration rate between two groups(P>0.05). Conclusions: ACDF using ROI-C implant or traditional titanium plate with cage has similar effective treatments for two-level adjacent cervical spondylotic myelopathy, while the ROI-C can carry shorter operation time and a lower risk of postoperative dysphagia．