Selection and outcome of anterior vs posterior approach for multilevel cervical spondylotic myelopathy combined with cervical kyphosis

English Keywords:Cervical spondylotic myelopathy  Kyphosis  Surgical treament

English Abstract:

  【Abstract】 Objectives: To investigate the different surgical procedures and the clinical outcomes for cervical spondylotic myelopathy combined with cervical kyphosis. Methods: Between June 2013 and June 2015, fifty-five adult patients with multilevel cervical spondylotic myelopathy combined with cervical kyphosis undergoing different surgical procedures were reviewed retrospectively. According to cervical kyphosis Cobb angle and the imaging characteristics, all pateints were divided into mild(Cobb angle >5°, <20°), moderate(Cobb angle 20°-40°) and severe groups(Cobb angle >40°)． Based on the main pressure and kyphosis angle, anterior or posterior procedure was used accordingly. The mild group included 29 cases, anterior procedure was performed in 11 cases, posterior procedure in 18 cases. The moderate group included 18 cases, anterior procedure was performed in 14 cases, posterior procedure in 4 cases. The severe group included 8 cases, all were by anterior procedure. Preoperative Japanese Orthopaedic Association(JOA) score was used to evaluate the neurological function, and cervical kyphosis Cobb angle, the operation time and blood loss, the last follow-up assessment of cervical kyphosis Cobb angle and kyphosis correction rate, the last follow-up JOA score and JOA mean recovery rate were recorded and compared among these groups.Results: There was no difference in term of the average operation time between mild and moderate groups; intraoperatie blood loss of anterior approach was less than that of posterior approach(P<0.05). Complications: 1 case in mild group was noted cervical hematoma in 6 hours after operation, 1 case of epidural hematoma in moderate group in 12 hours after operation; laryngeal recurrent nerve injury occured in 4 cases in 3 days of postoperation; 11 cases with postoperative limb numbness and weakness deteriorated in 7 days; neck shoulder pain worsened in 9 cases in 7 days. In mild group: the correction rate of anterior approach was higher than that of posterior surgery(P>0.05), JOA mean recovery rate at last follow-up showed no difference(P>0.05). In moderate group: the correction rate of anterior approach at last follow-up was higher than that of posterior approach(P<0.05), JOA mean recovery rate showed no difference(P>0.05). Anterior surgery correction rate at last follow-up was: mild group(223.1%), moderate group(135.1%) and severe group(120.4%)(P<0.05). There was no difference in terms of JOA mean recovery rate at last follow-up for anterior approach in three groups(P>0.05). Conclusions: To multilevel cervical spondylotic myelopathy combined with mild or moderate cervical kyphosis, surgery approach is based on the compression of spinal cord, cervical kyphosis has no difference on neurological function improvement, for severe kyphosis, decompression and correction should be considered, anterior approach can achieve the purpose of this treatment target, at the same time get more satisfactory neurologicical improvement.