| BackgroundsNow, anterior cervical decompression, fusion and internal fixation(ACDF) is in themost common use for the treatment of Cervical Spondylotic Myelopathy, (CSM).With the development of the medicine, people have got more about the pathology andpathophysiology of the CSM. More and more surgeon pay close attention to theclinical outcomes and it's complications, especially the adjacent segmentdegeneration. There are many reports about the ACDF's clinical outcomes andassociated factors, but there is not one same opinion. In order to investigate the factorsassociated the outcomes of surgery and the incidence of adjacent segment degeneration, wetake a retrospective study of the patients who underwent the ACDF from January 2000 toDecember 2006 in NanFang hospital.ObjectivesTo investigate the clinical outcomes of cervical spondylotic myelopathy (CSM) withACDF and the relationship between the outcomes and influential factors (such as age,gender, disease course, surgery segment, surgery opportunity, spinal pathologicalchanges , the height of intervertebral space and the cervical curve), and the incidence ofadjacent segment degeneration, with which we can take reference in the treatment ofCSM.MethodsWe make a retrospective investigation with the patients who underwent ACDF in Nanfang hospital from 2000-2006. The JW-PACS system station was used to measure the cervical curve and the height of fusion segment , make it exactly to 0.01mm. According to 17scores of Japanese Orthopaedics Association(JOA) method for the cervical spondylotic myelopathy, the neurological function of all patients was evaluated respectively gender, age at the time of surgery, course of disease, preoperative JOA score, the number of segment ,the raise of cervical curve and the height of intervertebral to choose the significant factor associated with the therapeutic effect, then make a regression analyze with the choosen factors to make sure the concrete effect to the clinical outcome.The standard of symptomatic adjacent segment degeneration: 1.the patients always feel pain, powerless, stiffness and some sensory disturbance such as stiffneck. 2.There is some sensorimoto disturbance caused by CSM when PE. 3.There is the narrow of the intervertebral space, with or without ostephyma in the x-ray. 4.the disc with low signal in MRI, with or without disc hernation, cervical spinal cord compressed, cervical space narrowing, ostephyma in the vertebra. Adjacent segment degeneration without the clinical syndrome is the image degeneration.ResultsThe participants in this study were 91 patients who underwent surgery treatment for CSM in orthopedic department of NanFang Hospital from December 2000 to December 2006. There were 48 men and 43 women, ranging in age from 37 to 77years, with a mean age of 53.6. years. The mean postoperative follow-up period was 34.1 months. The number of surgery segment is 55 people with 1 segment, 31 patients with 2 segments and 5 people with 3 segments.The total improvement rate over 50% is 70.3%.The effects of patients involved one or two intervertebral discs had no difference each other. The height of anterior interverbral, the height of posterior intervertebral and the cervical curve D value of the post-operative cases were higher than that of pre-operative, P<0.05,and the age, disease course are also I factors impacting the results. The regression equation was: Y=48.574-0.3*age-0.162*disease course+2.067*the height of intervertebral +3.269*D of increased after operation, by the way, the age is the most important factor involved the outcome.The average 34.1 months follow-up of the 91 patients indicates that there were 18 patients developed in 18 patients (19.8%), in which there were 12 patients were symptomatic adjacent segment degeneration(13.2%). And we analyzed the age, gender, the years of post-operation, the number of surgery segment, it was demonstrated that the incidence of ASD correlated with the age of operation, the years of post-operation, the increase of intervertebral space height and cervical curve recovery and the suitable internal fixation.Conclusions1. ACDF is an effective method to the treatment of CSM;2.The height of anterior intervertebral and the age ,disease course, the increase of cervical curve are I factors impacting the results ;3.There was the incidence of ASD in 1 year after the ACDF, the patients'age, post-operation time, the increase of intervertebral space height and cervical curve recovery and the suitable internal fixation are effective to delay the incidence of ASD.
|
PDF Full Text Request