Comparison of the efficacy of anterior intervertebral osteotomy and fusion assisted with the inflection point of the Luschka joint with anterior cervical corpectomy and fusion for the treatment of cervical spondylosis with intervertebral space stenosis

English Keywords:Cervical spondylosis  Inflection point of Luschka joint  Osteotomy decompression  Anterior intervertebral osteotomy and fusion  Anterior cervical corpectomy and fusion

English Abstract:

  【Abstract】 Objectives: To compare the clinical outcomes between anterior intervertebral osteotomy and fusion(AlOF) assisted with the inflection point of the Luschka joint as an auxiliary localization landmark and anterior cervical corpectomy and fusion(ACCF) in the treatment of cervical spondylosis with intervertebral space stenosis. Methods: A retrospective analysis was conducted on 80 cervical spondylosis patients with intervertebral space stenosis who underwent surgical treatment in our department between June 2016 and June 2021. The patients were divided into the AIOF group and ACCF group based on the surgical approach. The AIOF group included 38 patients with a mean age of 51.2±16.3 years and a mean follow-up duration of 21.2±7.2 months. The ACCF group included 42 patients with a mean age of 54.0±13.2 years and a mean follow-up duration of 24.3±8.1 months. Statistical analysis revealed no significant differences in preoperative baseline characteristics, including age, gender, follow-up duration, and surgical levels, between the two groups(P>0.05). The perioperative conditions of the patients were analyzed by comparing the operation time and intraoperative blood loss between the two groups. The Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) score of neck and upper limb pain before operation, at postoperative 1 week, 3 months, 6 months, and the final follow-up were compared between the two groups to assess the surgical outcomes. The spinal cord diameter, spinal canal area, intervertebral foraminal area, cervical lordosis angle, and cervical range of motion(ROM) were measured on X-ray, CT and MRI before operation, and at postoperative 3 months, 6 months, and final follow-up. The incidence of postoperative complications and bone graft fusion conditions were recorded and evaluated. Results: Both groups of patients underwent surgery successfully. The operation duration and intraoperative blood loss were 106.1±35.4min and 50.6±12.3mL in the AIOF group, which were 121.4±42.3min and 150.3±37.7mL in the ACCF group, respectively. There was no significant difference in the operation duration between the two groups(P>0.05), but intraoperative blood loss was significantly less in the AIOF group than in the ACCF group(P<0.05). Both groups showed significant improvements in JOA and VAS scores after surgery(P<0.05). At the final follow-up, in the AIOF group and ACCF group, the improvement rates of JOA score were (72.3±10.4)% and (63.7±12.1)%, and the VAS scores were 0.8±0.6 and 1.2±0.7, respectively, and there was statistically significant differences between the two groups at each postoperative time points(P<0.05). At the final follow-up, the spinal cord diameter, spinal canal area, and cervical ROM were 5.4±1.1mm, 128.2±10.1mm2, and 25.3°±6.3° in the AIOF group, and 5.2±0.7mm, 126±12.0mm2, and 24.2°±4.4° in the ACCF group, respectively, with no significant differences between the two groups(P>0.05). However, there were statistically significant differences in intervertebral foraminal area and cervical lordosis angle between the AIOF group(49.7±8.8mm2, 14.8°±4.8°) and the ACCF group(35.9±7.6mm2, 6.7±4.8°)(P<0.05). The AIOF group had one patient developed dysphagia after operation, while the ACCF group had one case of cerebrospinal fluid leakage, two cases of C5 nerve root palsy, one case of dysphagia, and two cases of fusion failure. The incidence of postoperative complications between the two groups was statistically significant(P<0.05). Conclusions: For patients with cervical spondylosis accompanied by intervertebral space stenosis, compared to ACCF, AIOF assisted by the inflection point of the Luschka joint can more safely achieve decompression within the spinal canal and intervertebral foramina and reconstruct cervical lordosis with the advantages of less trauma, lower incidence of complications, adequate intervertebral foraminal decompression, and better cervical lordosis after surgery.