To evaluate the efficacy of anterior cervical trans-intervertebral decompression with segmental distraction and fusion in treating degenerative cervical kyphosis

English Keywords:Degenerative cervical kyphosis  Cervical sagittal balance  Uncovertebral joint resection

English Abstract:

  【Abstract】 Objectives: To investigate the efficacy uncinate process resection combined with anterior cervical discectomy and fusion(ACDF) in the treatment of degenerative cervical kyphosis. Methods: This study retrospectively reviewed a total of 41 cases of degenerative cervical kyphosis(24 cases with rigid kyphosis and 17 cases with flexible kyphosis) ACDF and uncovertebral joint reduction. There were 17 males and 24 females，there were 3 patients with 2 surgical segments, 28 patients with 3surgical segments and 10 patients with 4 surgical segments. The neurological functions of the patients were evaluated by the Japanese Orthopaedic Association(JOA) score, neck disability index(NDI), and visual analogue scale(VAS) score before and at the final follow-up respectively. X-ray images before and at the final follow-up were collected, and the C2-C7 Cobb angle, the surgical segment Cobb angle, and the C2-C7 sagittal vertical axis(C2-C7 SVA) were measured. A paired-sample t-test was used for statistical analysis before and after the surgery. Results: The average operative time was 124-210min(162.5±28.6min), the blood loss was 70-200ml(121.1±34.2ml), and the follow-up period was 35.5±7.7months(23-48months). The neurological functions of all the patients were significantly improved after surgery. The JOA score was 10.7±2.4 before operation, and it was 15.6±1.3 at the final follow-up(P<0.05) with an average improvement rate of (75.5±27.4)%(0-100%). The NDI at the final follow-up was 8.7±3.9 points, which was improved (65.7±21.4)%(30-100%) from 24.4±7.9 preoperatively(P<0.05). The VAS score was 4.3±1.9 before operation, and it was 1.9±1.3 at the final follow-up, which significantly improved(P<0.05). The sagittal parameters of the cervical spine were significantly improved. The overall Cobb angle (C2-C7) was -16.5°±5.3° before surgery and 10.2°±5.1° at the final follow-up(P<0.05). SVA improved from 33.2±13.7mm preoperatively to 17.5±7.8mm at the final follow-up(P<0.05). The surgical segment cobb angle was significantly improved from preoperative -19.8°±5.7° to 11.3°±2.2° at the last follow-up(P<0.05). Perioperative complications occurred in 4 cases, which included postoperative hematoma in 1 case, hoarseness in 1 case, and mild dysphagia in 2 cases. The symptoms were all relieved after conservative treatments. Another 18 patients had imaging manifestations of adjacent segment degeneration at the final follow-up. Conclusions: The use of uncovertebral joint reduction via ACDF in the treatment of degenerative cervical kyphosis can achieve satisfactory clinical results, and it can significantly reconstruct cervical spine curvature and cervical spine sagittal balance.