The Clinical Investigation For Anterior Cervical Double Levels Discectomy With Titanium Mesh And Locking Plate System And The Influence On Adjacent Segment

[Objective]To investigate the clinical therapeutic efficacy of anterior cervical double levels subtotal corpectomy using titanium mesh and locking plate system and its influence on adjacent segment.[Participants]Retrospective analysis the cases of the patients with anterior cervical double levels subtotal corpectomy using titanium mesh and locking plate system for treatment in Fuzhou General Hospital from March2006to March2009,43patients were follow-up.There were28male patients and15female patients,whose average age was51.56±11.57-year-old.29to63monthes were followed,averaged41.95±8.06monthes.[Methods]All patients were operated with anterior cervical double levels subtotal corpectomy using titanium mesh and locking plate system in general anesthesia.The patients’ neurological findings were graded by the JOA score preoperatively,one week postoperatively and at last follow-up.Cobb’s angle and D numerical value measured by the tools of PACS system used in our hospital were evaluated Lordosis of the fusion and lordosis of the cervical spine respectively.Adjacent segment degeneration was diagnosed based on the hyperplasia of adjacent segment.Statistic analysis were used to evaluate by SPASS18.0.[Results]The preoperative JOA score of all the patients was7.02±3.20,the one week postoperative JOA score was10.16±2.99,and its JOA recovery rate was45.91%,which has a significant statistical difference against the preoperative JOA score.The JOA score of the last follow-up was13.77±3.24and its JOA recovery rate was67.64%,,which has a significant statistical difference against the preoperative JOA score.There were18patients evaluated excellently by JOA score,17patients evaluated well and8patients evaluated generally until last follow-up.The preoperative D numerical value of43patients was4.27±2.23mm,the one week postoperative D numerical value was9.08±2.93mm,,,which has a significant statistical difference against the preoperative D numerical value,and the D numerical value of the last follow-up was8.92±3.30mm,,which has a significant statistical difference against the preoperative D numerical value.The general preoperative Cobb’s angle was4.13±1.94°, one week postoperative Cobb’s angle was11.49±2.91°,which has a significant statistical difference against the preoperative Cobb’s angle,and the general Cobb’s angle of the last follow-up was11.09±2.76°,which has a significant statistical difference against the preoperative Cobb’s angle. Adjacent segment degeneration was found in9patients included6males and3females,averaged51.78±7.89year-old.There are2patients in whom the degenerative changes was seen at the superior level,1patients at the inferior level and6patient at the superior and inferior levels.The age,preoperative JOA score, one week postoperative JOA score,preoperative Cobb’s angle and one week postoperative Cobb’s angle between the patients with adjacent segment degeneration and without it were not of significant statistical difference.However, the preoperative D numerical value and postoperative D numerical value between them has statistical difference.[Conclusion]The medium-term and short-term therapeutic efficacys of anterior cervical double levels subtotal corpectomy using titanium mesh and locking plate system are obvious, neurological function recovers well,and the cervical lordosis can be restored and maintained effectively.The adjacent segment degeneration after anterior cervical double levels subtotal corpectomy using titanium mesh and locking plate system is likely to have a relation with preoperative lordosis of the cervical spine, restored inadequately, the postoperative lose and the location of fusion. It maybe relations with preoperative adjacent segment degeneration.But it is not to be with age.