The clinical efficacy of anterior X-shape-corpectomy and fusion in the treatment of two-level cervical spondylosis

English Keywords:Two-level cervical spondylosis  Anterior X-shape-corpectomy and fusion  Anterior cervical corpectomy and fusion  Vertebral stenosis

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy of anterior cervical X-shape-corpectomy and fusion(ACXF) in the treatment of two-level cervical spondylosis. Methods: The clinical data of two-level cervical spondylosis patients treated with ACXF in the department of Orthopedic Surgery, West China Hospital of Sichuan University from January 2019 to December 2020 were retrospectively analyzed and compared with those treated with anterior cervical corpectomy and fusion(ACCF) at the same time. The baseline data, operation time, blood loss and hospital stay of the two groups of patients were collected. The Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) preoperatively, immediate postoperatively, at 3 and 6 months, and 1-year postoperatively, and neck disability index(NDI) preoperatively, at 3 and 6 months, and 1-year postoperatively were used to evaluate the efficacy. Anterior osteotomy distance of ACXF group during operation and imaging parameters such as cervical curvature, range of motion(ROM) and height of functional spine unit(FSU), posterior decompression range, anterior-posterior diameter(APD) of spinal canal, and spinal canal area(SCA) of the two groups during follow-up were measured to evaluate the intervertebral fusion. Meanwhile, relevant complications of patients in both groups were recorded. Results: A total of 46 patients were enrolled, including 17 in ACXF group and 29 in ACCF group. All the patients successfully underwent surgery. The operation time, blood loss, and hospital stay were 144.71±30.44min, 109.41±55.51ml, and 8.35±1.46d respectively in ACXF group, and 155.17±27.86min, 126.90±51.55ml, and 12.03±3.34d respectively in ACCF group. There was no significant difference in operation time and blood loss between the two groups, while the hospital stay in ACXF group was significantly shorter than that in ACCF group(P<0.001). The JOA score and VAS score immediate postoperatively, and at postoperative 3 and 6 months and 1 year, and NDI at postoperative 3 and 6 months and 1 year of both groups all significantly improved than those before operation, while no significant difference in JOA score, VAS score or NDI was found at the same time point between the two groups(P＞0.05). There was no significant difference in cervical curvature between the two groups before surgery, and ACXF group was significantly greater than ACCF group at immediate postoperation, 6 months, and 1 year after surgery (P<0.05). The postoperative ROM of FSU at each time point in both groups was significantly reduced than that before surgery(P<0.01), and there was no significant difference between the two groups at the same time point (P>0.05). The height of FSU immediately after surgery in both groups significantly increased than that before surgery(P<0.01), and that at postoperative 3 months in ACXF group was significantly different from that before surgery(P<0.05); There was no significant difference between the two groups at the same time point(P>0.05). The posterior decompression range of ACXF group(11.66±1.31mm) was smaller than that of ACCF group(16.32±2.00mm)(P＜0.001); The APD and SCA of spinal canal at each time point after surgery in both groups were significantly increased than those before surgery, and ACXF group was smaller in SCA at all postoperative time points and APD at 1 year after surgery than those in ACCF group at the same coressponding time points(P<0.05). There was no significant difference in the fusion rate between the two groups at 3 and 6 months and 1 year after surgery(P＞0.05). The incidence of implant subsidence of ACXF group was 17.65%(3/17), 23.53%(4/17) and 23.53%(4/17) at 3 months, 6 months and 1 year after surgery, which was significantly lower than that of ACCF group at each time point(P＜0.05). In ACXF group, 1 patient developed mild dysphagia after surgery, and symptoms significantly relieved after conservative treatment and disappeared at discharge. In ACCF group, 4 patients developed mild dysphagia after operation, and symptoms improved significantly at discharge after rehabilitation training and disappeared at 3-month follow-up; And 3 were found with cerebrospinal fluid leakage, cured at discharge after treated with delayed removal of drainage tube. Conclusions: ACXF can significantly improve the clinical symptoms and neurological function of patients with cervical spondylosis, which has a same clinical efficacy as ACCF and can further reduce the occurrence of postoperative subsidence of implant while ensuring sufficient decompression range. ACXF is an alternative surgical strategy for the treatment of two-level cervical spondylosis combined with vertebral stenosis.