The effect of enlarged anterior cervical intervertebral cone-shape decompression and fusion for treating cervical spondylosis with severe intervertebral space narrowing

English Keywords:Cervical spondylosis  Anterior cervical disectomy and fusion surgery  Intervertebral space narrowing  Uncinate vertebral joint  Effect

English Abstract:

  【Abstract】 Objectives: To observe the clinical effect of the enlarged anterior cervical intervertebral cone-shape decompression and fusion(EACDF) for treating cervical spondylosis with severe intervertebral space narrowing. Methods: A retrospective case study of 135 patients suffered from cervical spondylosis with severe intervertebral narrowing treated with anterior cervical decompression and fusion in our hospital between January 2015 and July 2020 was conducted. Among them, 53 patients underwent anterior cervical corpectomy and fusion(ACCF) were included in ACCF group, and 82 patients who underwent EACDF with expanded decompression by distracted intervertebral space, partial resections of posterior edge of vertebral body and uncinate vertebral joint were included in EACDF group. The age, gender, and body mass index(BMI) of patients between the two groups were compared. The operation duration, blood loss, average length of hospital stay of the two groups of patients were recorded. The visual analog scale(VAS), neck disability index(NDI) and Japanese Orthopaedic Association(JOA) score were recorded before operation, immediately after operation, at 2 months and 12 months after operation, and final follow-up. The radiological parameters like C2-C7 Cobb angle of cervical global curvature, Cobb angle at the operative segment, intervertebral height of operative segment, height and area of intervertebral foramen in narrow segment were measured before operation, immediately after operation, at 2 months and 12 months after operation, and final follow-up. The fusion rate and operative complications were also recorded. Results: No significant differences were found between the two groups in age, gender, and BMI(P>0.05). The postoperative follow-up ranged from 24 to 78 months, with an average of 47.74±20.36 months. The operation duration, blood loss, and average length of hospital stay were similar in the two groups(P>0.05). There was no significant difference in neck and arm pain VAS, NDI, and JOA scores before operation between the two groups(P>0.05), while these parameters of both groups significantly improved respectively immediately after surgery, at 2 and 12 months after surgery, and final follow-up than preoperation(P<0.05). The arm pain VAS scores immediately after operation in the EACDF group was significantly lower than that in the ACCF group(P＜0.05). However, no significant differences were found between the two groups in the neck pain and arm pain VAS, NDI, and JOA scores at 2-month, 12-month and final follow-up(P>0.05). Besides, all radiological parameters in the EACDF group were improved after surgery at immediately after operation, 2-month, 12-month and final follow-up(P<0.05). The C2-C7 Cobb angle, Cobb angle at the operative segment, and the area of intervertebral foramen of narrow segment in the ACCF group were significantly improved immediately after operation, at 2-month, 12-month, and final follow-up, comparing with those before operation(P<0.05). In the ACCF group, the intervertebral height of operative segment and the height change of intervertebral foramen of narrow segment were significantly improved immediately after operation(P<0.05). However, there was no significant difference in the height of intervertebral foramen in narrow segment 12 months after operation and final follow-up compared with that before operation(P>0.05) There was no significant difference between the two groups in preoperative C2-C7 Cobb angle of cervical global curvature, Cobb angle at the operative segment, intervertebral height of operative segment, height and area of intervertebral foramen in narrow segment(P>0.05). These parameters in the EACDF group were significantly greater than those in the ACCF group immediately after operation, at 2-month, 12-month and final follow-up(P<0.05). At final follow-up, both groups of patients had bone graft fusion, and the incidence of titanium mesh subsidence in ACCF group was 20.75%. Conclusions: EACDF can achieve similar clinical effects with ACCF, and it's superior in restoring the height of intervertebral space, correcting the curvature of cervical spine, and decompressing the foraminal stenosis.