The mid-term clinical outcome of anterior surgical in the treatment of 4-level cervical spondylotic myelopathy

English Keywords:Anterior cervical surgery  Cervical spondylotic myelopathy  Postoperative complications  Mid-term clinical effects

English Abstract:

  【Abstract】 Objectives: To investigate the mid-term clinical results and the complications of patients with 4-level cervical spondylotic myelopathy who underwent anterior decompression and fusion surgery. Methods: Between September 2013 and October 2016, 31 patients of 4-level cervical spondylotic myelopathy who underwent anterior cervical surgery were included. There were 18 males and 13 females, whose mean age was 58.1±4.9 years old(range, 54-74 years). The neck and shoulder pain were evaluated by visual analogue scale(VAS), and neurological function measured using Japanese Orthopedic Association(JOA) scores. X-rays were conducted before and after surgery for cervical height, physiological curvature of C2-C7 and fusion rate. Complications of the patients were recorded and analyzed as well. Results: 27 cases completed the follow-up. The mean follow-up time was 52.7±3.6 months(35-72 months). At final follow-up, the VAS scores reduced from preoperative 7.2±1.5 points to 1.6±0.6 points(P<0.001), and the JOA scores increased from preoperative 8.8±3.7 points to 16.1±4.2 points(P<0.001). At final follow-up, the cervical height and physiological curvature showed significant improvement compared with pre-operation(P<0.001). The fusion rate was 100％. 15 patients presented with related complications, including 3 cases of cerebral fluid leakage, 2 cases of temporary dysphagia, 1 cases of axial neck pain, 4 cases of C5 palsy, 6 cases of adjacent segment diseases, 2 cases of graft subsidence, 2 cases of looseness and displace of the internal fixation and 1 case of screw extraction. Conclusions: Anterior cervical surgery for 4-level cervical spondylotic myelopathy is a challenging surgical technique, restoring the height of cervical vertebra and the curvature of cervical vertebra, with good results for the mid-term efficacy of clinical effects.