Research Of The Correlation Between Different Imageological Characteristics And Clinical Outcomes Of Multilevel Cervical Spondylotic Myelopathy

Part I Research of the correlation between different imageological characteristics and clinical outcomes of multilevel cervical spondylotic myelopathyObjective: To investigate multilevel cervical spondylotic myelpathy(MCSM) with different complexities of imageological characteristics and explore the correlation among imageological characteristics, surgical approaches and clinical outcomes.Methods: 139 consecutive patients with MCSM between Jan 2012 and Jan 2014 from Shanxi Academy of Medical Sciences & Shanxi Da Yi Hospital were involved in this study. Patients were distributed into three groups based by imageological characteristics with different degree of complexity namely mild group(Group A, 10 males and 8 females, mean age 56.6±8.8 yrs), moderate group(Group B, 42 males and 24 females, mean age 61.9±7.4 yrs) and severe group(Group C, 38 males and 17 females, mean age 62.9±7.4 yrs). Then preoperative and final-follow-up JOA(Japanese Orthopedic Association score for patients with cervical spondyotic myelopathy) recovery rate were collected to evaluate the clinical outcomes. Fundamental statistical data and imageological characteristics of the three groups were recorded: to explore the relationship between JOA recovery rate and age, gender, course of disease, imageological variables by analysis of variance or chi-square test; to investigate the major influence factors of JOA recovery rate by Logistic regression analysis.Results:There was no significant difference in gender, duration of course between the three groups. There was significant difference in age and improvement rate between Group A and Group B, Group A and Group C, and significant difference in preoperative and final-follow-up JOA score between the three groups.The mean preoperative JOA score and recovery rate of the three groups was7.9±0.8 and 66.2%±8.3%, 6.6±0.8 and 57.5%±9.9, 6.1±0.7 and 53.6%±5.6% respectively.The ratio of posterior approach in the three groups was 16.7%, 50% and 70.9% respectively. And the recovery rate was mainly relevent to age(>60), preoperative JOA score, T2 WI intramedullary hyperintensity signal, developmentalstenosis of cervical spinal canal, imageological variables by Logistic regression analysis.Conclusion:The recovery rate was mainly relevent to age(>60), preoperative JOA score, T2 WI intramedullary hyperintensity signal, developmental stenosis of cervical spinal canal and imageological variables.Proper surgical procedure on the basis of different imageological variables is able to obtain satisfying postoperative outcomes.Part II Complex cervical spondylotic myelopathy: a report of two cases and literature reviewBackground: Complex cervical spondylotic myelopathy(CCSM) due to simultaneous anomalies as anteroposterior compressions of the spinal cord in both upper and lower cervical spine, caused by hypertrophic transverse ligament of atlas(TLA), dysplasia of the posterior arch of atlas, disc herniation, instability, hypertrophic ligamentum flavum and osteophytes is rarely encountered by spine surgeons and has not been reported earlier.Objectve: To report two cases with CCSM and review the literature. Providing an operative alternative for patients with such disease.Methods: We present such two cases with clinical, imageological presentations, and describe the surgical procedure, to which both patients responded favorably.Results: The neurological functions of both patients gradually improved according to the JOA scores and VAS scores in preoperative clumsiness and gait disturbance during the follow-up period lasted for 2 years. The latest plain radiographs and computed tomography(CT) revealed good fusion without instrumental failure and magnetic resonance imaging(MRI) showed good decompression of C1-7 spinal cord of both patients who are progressively followed-up.Conclusion: Posterior surgical approach as C1-7 laminectomy with fixations or occipital-cervical fusions may obtain better reconstructions of the cervical spine and good neurological recovery for the patients with complex CSM we present. However, the incidence and ethnic predisposition for the patients with complex CSM are still unclear.Part III Anterior cervical discectomy and fusion versus cervical arthroplasty in the treatment of patients with cervical spondylosis: A meta-analysisPurpose: The aim of this work was to compare the efficacy and safety of anterior cervical discectomy and fusion(ACDF) and cervical arthroplasty for patients with cervical spondylosis.Methods: Pub Med, Embase, and Cochrane Library were used to search for relevant articles which published prior to April 2016 to identify studies of comparison of ACDF and cervical arthroplastyin of patients with cervical spondylosis. Relative risk(RR) and mean difference(MD) were used to measure the efficacy and safety of ACDF and cervical arthroplasty by using the random effect model.Results: Data on 3,122 patiente with cervical spondylosis from 17 studies was included in this study. Overall, patients received ACDF was associated with lower overall success rate(RR, 0.84; 95%CI: 0.77-0.92; P<0.001), higher vasual analogue system(VAS) score(MD, 0.36; 95%CI: 0.08 to 0.64; P=0.011), and lower mean surgery time(MD,-1.62; 95%CI:-2.80 to-0.44; P=0.007) as compared to cervical arthroplasty. However, the results showed that there is no statistical significance on the association about ACDF therapy and the risk of mean blood loss(MD,-0.16; 95%CI:-0.34 to 0.02; P=0.082), mean hospitalization(MD, 0.02; 95%CI:-0.31 to 0.36; P=0.901), patient satisfaction(RR, 0.96; 95%CI: 0.92-1.00; P=0.066), Neck Disability Index(MD, 0.20; 95%CI:-0.05 to 0.44; P=0.113), reoperation(RR, 1.25; 95%CI: 0.64-2.41; P=0.514), or complication(RR, 1.17; 95%CI: 0.90-1.52; P=0.242).Conclusions: Patients who had received ACDF therapy tended to exhibit lower overall success rate, higher VAS score, and decreased mean surgery time when compared to patients received cervical arthroplasty.