Fixation For The Treatment Of Cervical Spondylotic Myelopathy In 287 Patients With Anterior Decompression, Titanium Analysis

Objective: The objective of this study is to analyze the clinical therapeutic effects of anterior cervical decompression and titanium screw plating, and to study the clinical effectiveness of titanium anterior cervical screw plate fixation in anterior cervical operation on patients with cervical spondylotic myelopathy.Methods: 287 patients with cervical spondylotic myelopathy were retrospectively reviewed and followed up who underwent cervical decompression and titanium plating operation from June, 2001 to October, 2005. One-level or two-level fusion was performed visa right-sided anterolateral transverse incision according to the dermatoglyph, whereas right-sided anterolateral oblique incision was employed to three-level discectomy. The interval between the carotid sheath and the esophagus was developed bluntly, thereby the front of cervical vertebral bodies and discs were exposed. When vertebral levels were verified radiographically , self-retaining retractors were used. Once the operative vertebral level was identified, the affected discs and osteophyte were removed with curettes , or the central three-fifths of the anterior vertebral body were then excised using a Lexell rongeur or osteotome. All cartilaginous endplates were removed down to the level of bleeding subchondral bone with curettes. After selecting the titanium mesh or CERVOIOS to fit the graft site, corticocancellous bone obtained as a by-product of anterior cervical decompression was morselized and packed into the titanium mesh or CERVIOS. The titanium mesh or CERVIOS which packed with local autograft or ilium autograft was then inserted into the intervertebral space under distraction 1—2mm below the exterior edge of consecutive cervical spine. Osteophyte of the exterior edge of consecutive cervical spine must be removed. Finally, internal fixation was accomplished by using a titanium anterior cervical screw plate fixation across the segments to be fused. The patients were placed in a soft cervical collar for comfort for a few postoperative days. Isometric muscle exercises were then encouraged, and no daily activities were restricted. Anterior cervical decompression and anterior titanium screw plating was employed in all patients. 199 cases with anterior cervical fusion using their autogenous iliac crest were reviewed, and 47 cases with a titanium mesh, and 27cases with the central three-fifths of the anterior vertebral body were excised, and 14 cases with CERVIOS. We gave a mark to all patients at pre-operation and post-operation strictly regulating to JOA standard of cervical spondylotic myelopathy, and followed up the cervical fusion status.Results: The highest JOA scores was 15, the lowest was 10, the mean mark was 12.64±1.25 at pre-operation; The highest JOA scores was 16, the lowest was 13, the mean scores was 14.95±0.94, in about a week after operation. The mean score at post-operation is 2.31 high than pre-operation. Postoperative symptoms of all cases were obtained aniso-improvement, the highest improved rate was 83%, the lowest was 25%. All patients had foreign sensation in their cervicum. 14 cases (7%) were remained pain at iliac donor site. No other implication occurred ,such as infection of incisional wound, haematoma, injury of spinal marrow and nerves, dura mate of spinal cord disrupt and leakage of cerebrospinal fluid, incision disunion, and so on. Titanium mesh subsidence was detected in 2 cases (4%) at 3 months postoperatively, but their symptoms had not aggravated. Bony fusion was achieved in three months. No breakages were observed in this series.Conclusions: Anterior cervical decompression and titanium screw plating is a safe and effective surgical treatment of cervical spondylotic myelopathy with a high percentage of good clinical outcomes. It offers advantages including direct decompression of neural tissue, restoration of intervertebral spacing and the cervical physiologic curve, enlargement of a stenotic neural foramen, and stabilization of the degenerative disc, elevation of the patients' quality of life; it can also decrease the cervical collar fixed days, and the days in hospital, and the rate of graft subsidence or absorbed; the patients could exercise on the floor in the early post-operative period, their anguish and psycho-burden was alleviated. The role of titanium anterior cervical screw plate internal fixation and any graft is necessary in anterior cervical operation on patients with cervical spondylotic myelopathy.