Anterior decompression and reconstruction with the titanium mesh cage plus plate and self-locking stand-alone cage for the treatment of multi-level cervical spondylotic myelopathy

English Keywords:Multi-level cervical myelopathy  Anterior decompression  Fusion  Self-locking stand-alone cage  Titanium mesh cage

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical and radiological results of the reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage for treating multi-level(≥3) cervical spondylotic myelopathy(CSM). Methods: From January 2012 to August 2014, 32 consecutive patients with multi-level CSM were treated with anterior decompression and reconstruction with titanium mesh cages plus plate and self-locking stand-alone cages, including 17 males and 15 females. The age ranged from 53 to 74 years (mean, 65.7±4.2 years) at surgery. All patients had symptoms and signs of nerve compression at multiple segments that were refractory to conservative treatment. Clinical outcomes were evaluated by using JOA scores and Odom criteria. Complications, fusion rate and time, cages subsidence and spinal curvature were assessed. Results: The operations were completed successfully, the titanium mesh and self-locking stand-alone cage were successfully placed. The average operation time was 113.0±12.5min, and the average blood loss was 123.0±9.4ml. The mean follow-up period was 23.2±2.3 months(12-41 months). The JOA score and degree of spinal curvature significantly increased at the final follow-up compared with preoperative ones(P<0.05). All cases finally achieved a solid fusion, and the time of solid fusion was 6.4±0.7 months. Postoperative complications included cerebrospinal fluid leakage in 1(3.1%) which was cured after 7d of conservative treatment and titanium mesh subsidence in 2(6.2%) which had no clinical symptoms. No dysphagia and hoarseness occurred. According to the Odom criteria, 11 patients got an excellent outcome, 17 patients got a good outcome and 4 patients showed a fair outcome. Conclusions: Anterior decompression and reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage can be used safely and effectively for CSM. This procedure can effectively restore cervical lordosis, reduce the complications related to long plate fixation, and lead to satisfactory outcomes.