Clinical Research Of Anterior Cervical Discectomy And Fusion For The Treatment Of Cervical Spondylotic Myelopathy

Objective:To evaluate the clinical efficacy of anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy and study the advantages and disadvantages of various surgical approaches for cervical spondylotic myelopathy.Methods:We collect43patients with cervical spondylotic myelopathy who undergone surgical treatment in our hospital from2012.3to2013.12, including18males and25females,the age of patients range from42to68years old,mean age51.8years; Patients’course of the disease was1month to3years,average course8months;29cases underwent single-level surgery,14cases underwent two-levels surgery, details are as follows:5cases of C3/4,8cases of C4/5,12cases of C5/6,4cases of C6/7,2cases of C3/4-C4/5,4cases of C4/5-C5/6,8cases of C5/6-C6/7.All the patients received anterior cervical discectomy and fusion, we evaluate postoperative complications, clinical efficacy (JOA score, VAS score), cervical lordosis,fusion rate, prognostic indicators.Results:With a mean duration of8.3months follow-up,the mean JOA score increased from9.3±1.8to15.2±1.3,according to MRI signal changes, JOA improve rate was poorer in T1WI low signal/T2WI high signal intensity group when compared with T1WI normal/T2WI high signal intensity group and TIWI normal/T2WI normal group, there is no significant difference between T1WI normal/T2WI high signal intensity group and T1WI normal/T2WI normal group.The VAS score decreased from5.6±2.4to2.1±1.7;Radiologic study showed that the postoperative C2-C7and fusional segment Cobb angle increased significantly compared with preoperation, even final follow-up little decrease, there is no significance. Both the iliac crest graft group and Cage graft group achieved solid fusion at a mean time of4.2months, ranging from3to6months. Perioperative complications include dysphagia (6.9%), hoarseness (2.3%), donor site morbidity (2.3%), deep venous thrombosis (2.3%).Conclusion:Our results suggest that anterior cervical discectomy and fusion is a safe and effective surgical treatment for cervical spondylotic myelopathy,it can significantly improve patients neurologic function, relieve pain symptoms, restore cervical lordosis, effective fusion. On the other hand, decreased signal intensity on preoperative T1WI and increased signal intensity on preoperative T2WI are predictors of poor neurologic outcome.