Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for treating two-level contiguous cervical spondylotic myelopathy

doi:10.3969/j.issn.2095-4344.2016.48.005

Abstract

Abstract:

BACKGROUND: Anterior cervical discectomy and fusion with stand-alone cages and anterior cervical corpectomy and fusion with plate-mesh are widely used techniques in the treatment of cervical spondylotic myelopathy. There were less comparative studies about these two techniques in surgical treatment of two-level contiguous cervical spondylotic myelopathy patients based long-term follow-up.

OBJECTIVE: To compare the efficacy between the anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion procedures in patients with two-level contiguous cervical spondylotic myelopathy in clinical and radiological findings.

METHODS: Between December 2006 and December 2009, 80 consecutive patients with two-level contiguous cervical spondylotic myelopathy were randomized into anterior cervical discectomy and fusion group and anterior cervical corpectomy and fusion group. The clinical and radiographic results were compared between the two groups.

RESULTS AND CONCLUSION: The overall follow-up period of the patients ranged from 62 to 98 months (average 83.6 months). There were no significant differences between the two groups in Japanese Orthopedic Association score, Visual Analog Scale score, Odom’s criteria, fusion rates and complications. There were no significant differences between the two groups in the segmental and C₂_-₇Cobb angles at post-operation and 5-year follow-up. In anterior cervical discectomy and fusion group, both post-operative and 5-year follow-up segmental height was significantly larger than pre-operative segment height; in anterior cervical corpectomy and fusion group, only post-operative segmental height was significantly larger than pre-operative segmental height, not 5-year follow-up segmental height. More significant incensement of the segmental height was observed in anterior cervical discectomy and fusion cage group than that in anterior cervical corpectomy and fusion group at post-operative and 5-year follow-up. The instrument subsidence rates were similar between the two groups. In surgical treatment of two-level cervical spondylotic myelopathy, anterior cervical discectomy and fusion with stand-alone cage technique resulted in the same excellent clinical outcome as anterior cervical corpectomy and fusion with plate-mesh. However, anterior cervical discectomy and fusion with stand-alone cage technique exhibited better restoration of intervertebral height than that of anterior cervical corpectomy and fusion with plate-mesh technique.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Bone Transplantation, Spinal Fusion, Tissue Engineering

CLC Number:

R394.2

Shen Qiang, Ding Hao, Zhu Zong-hao, Zhu Liang, Wei Xiao-kang, He Xu-feng. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for treating two-level contiguous cervical spondylotic myelopathy[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(48): 7175-7184.

Figures/Tables 6

Clinical outcome The JOA scores significantly increased in the ACDF group and ACCF group (P < 0.01). The corresponding VAS scores significantly decreased in the ACDF group and ACCF group (P < 0.01). According to Odom’s criteria, the percentage of patients with excellent and good clinical outcomes was 85% in the ACDF group and 81% in the ACCF group. Although significant JOA scores and VAS scores improvement have been achieved in each group at the final follow-up, there were no significant differences between groups (P > 0.05; Table 3). Radiological analysis results The mean operated segmental Cobb angles at pre-, post-operation and 5-year follow-ups were 6.54, 16.65, and 10.48 degrees for ACDF group and 6.63, 10.83, and 9.88 degrees for ACCF group, respectively. There were significant differences in operated segmental Cobb angel between pre-operation and post-operation or 5-year follow-up in each group (P < 0.05). There was no significant difference in the operated segmental Cobb angle between these two groups at 5-year follow-up. The mean C2-7 Cobb angles at pre-, post-operation and 5-year follow-ups were 18.67, 20, and 21.96 degrees for ACDF group and 20.67, 17.63, and 19.88 degrees for ACCF group, respectively. There were no significant differences in C2-7 Cobb angel between pre-operation and post-operation or 5-year follow-up in each group. There was no significant difference in C2-7 Cobb angle between these two groups (Table 4). In the ACDF group, both post-operative and 5-year follow-up segmental height was significantly larger than pre-operative segmental height (P < 0.05); in the ACCF group, only post-operative segmental height was significantly larger than pre-operative segmental height (P < 0.05), not 5-year follow-up segmental height. At both post-operation and 5-year follow-up, segmental height of the ACDF group was significantly larger than that of ACCF group (P < 0.05). The loss of correction of segmental height in the ACDF group was significantly larger than that in the ACCF group at 5-year follow-up (P < 0.05; Table 4). The subsidence rates were 31% and 13% in the ACDF group and ACCF group, respectively. There was no significant difference between them. Solid fusion and bone union in the operated segments were observed in all patients at 5-year follow-up. No patient presented with instrumentation displacement. "

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