| STUDY DESIGN: This retrospective study involves 108 patients withdegenerative cervical myelopathy or cervical radiculopathy. Those who weresurgically treated with anterior discectomy, titanium Inter Fix Cage(IFC) and fusion(C group, 49cases), and by anterior corpectomy, titanium mesh cage(TMC), andanterior titanium plate and fusion (M group, 40cases), were evaluated based on thosetreated by anterior corpectomy, autogenous iliac crest bone graft, and anteriortitanium plates and fusion (G group, 19cases).OBJECTIVES: This study was conducted to determine the stability, fusion,efficacy, and indications associated with performing titanium cages following anteriorcervical discectomy, and meshes following anterior cervical corpectomy.METHODS: One hundred and eight patients with degenerative cervicalmyelopathy or cervical radiculopathy who had surgical treatment and average 13.8months (range, 6-24 months) follow up were included. Preoperative evaluation ofevery patient consisted of anterior-posterior, lateral, flexion, and extensionradiographs, and magnetic resonance imaging of the cervical spine. Degree of pre-and postoperative myelopathy was determined according to the scoring systemsdeveloped by Japanese Orthopedic Association (JOA). Pre- and postoperative termsof D numerical value(lordosis of cervical spine), HAB (height of anterior border),HPB(height of posterior border), Cobb angle (lordosis of the fusion segments), andθangle (the range of the cervical spine) were measured on X-ray images. It wasevaluated that the operative segment was fused or not based on the followingradiographic features: there was less than 2°of segmental movement on lateral viewsand no more than 50% radiolucency covering the implant's outer surfaces; theabsence of lucencies or halo formation around the screws or mesh-bone interface; theabsence of screw backout or plate breakage or migration; and bone growth visualizedaround or in the mesh.RESULTS: Solid fusion were reached in all cases at 6 months postoperatively,and at 3 months postoperatively the fusion rate were 89.5%(G group, 17/19), 85.0% (M group, 34/40) and 83.7% (C group, 41/49), respectively. Their operative time was105.0min(G group, 105.0±22.0), 94.3min(M group, 94.3±26.6), and 75.3min(C group,75.3±31.7), averagely; and the blood loss was 65.3ml(G group, 65.3±22.2), 59.2ml(Mgroup, 59.2±19.5), and 47.8ml(C group, 47.8±20.1), averagely. There was significantdifference between C group and the other two groups(P＜0.05), but no significantdifference between M group and G group was found(P＞0.05). There was significantdifference between pre-and postoperative terms in every groups of D numerical value,HAB, HPB, Cobb angle, andθangle (P＜0.01), and when they were comparedbetween M group and G group, and C group and G group, significant difference wasfound (P＜0.01). The increase of HPB was different between M group and C groupbetween 12 months to 24 months after operation(P＜0.05), but no difference wasfound between 1week to 6 months after operation(P＞0.05). There was no significantdifference between M group and C group in the other terms(P＞0.05).CONCLUSIONS: Both treatments provides good neurologic recovery inpatients with degenerative cervical myelopathy or cervical radiculopathy. There aremore influence on the range of motion of cervical spine when more fusion are made.TMC and anterior titanium plates provides better structural support in HPB. When thecompression exists single segment or when the compressed segments are notadjacent(2 discs), discectomy followed by IFC is better; when the compression existsat more than two adjacent levels or the spinal cannel is narrow, corpectomy followedby TMC is better.
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