Comparative Study Of Theclinical Outcomes Of Anteriorand Posterior Surgery For Multilevel Cervical Spondylotic Myelopathy

【Objective】 To compare the clinical outcomes and complications ofcervical anterior and posterior surgery for multilevel Cervical Spondyloticmyelopathy.【Methods】The data of36patients who were diagnosed as MCSM and underwentoperation in Fujian provincial hospital from2007Septemberto2012September were analyzedretrospectively, patients were divided into twogroups,22patients underwent anterior cervical corpectomy and fusion(ACCF) or anterior cervical hybrid decompression and fusion (ACHDF) in group Aand14patients underwent laminoplasty(LP) in group B. Compared two groups ofpatients with age, course of disease, duration of follow-up, the compressed segmentslevels, preoperative and postoperative JOA scores, improvement rate of spinalcord function, preoperative and postoperative cervical vertebral physical camber, andpostoperative complications.【Results】There was no significant difference between the two groups in age, courseof disease, duration of follow-up, the JOA scores before operation and thecompressed segments (P>0.05); In group A, preoperative JOA score was8.8±1.2, the follow-up score was13.8±1.4,In group B, preoperative JOA scores was8.6±1.3, the follow-up scores was14.4±1.1. The followed up JOA scores of two groupswere significantly improved, there were a significant difference (P<0.05), there wasno significant statistical difference between spinal cord function recover rate oftwo groups (P>0.05); groupA operation time was155±27.9min, group B was200±22.5min, operation time of group B was longer than group A, there was statisticallysignificant difference (P <0.05); the amount of bleeding in group A was202.7±57.4ml, group B was305±95.1ml, the amount of bleeding in group B was more thangroup A, there was statistically significant difference (P <0.05);group A preoperativecervical vertebral physical camber was10.6±3.12°,follow-up was14.6±4.2°, cervical vertebral physical camber of follow-up were increased, there was statisticallysignificant difference (P <0.05), group B preoperative cervical vertebral physicalcamber was11.2±2.8°, follow-up was9.5±2.6°, cervical vertebral physical camberof follow-up were decreased, there was significant difference (P <0.05); In group A,one patient had cerebrospinal leak, two patients had hoarseness and subsidence oftitanium mesh cage was found in four patients during the follow-up. In group B, onepatient had C5nerve paralysis and three patients had axial pain.【Conclusion】In treatment of multilevel cervical spondylotic myelopathy,Anteriorcervical operation and posterior cervical operation both can effectively improvethe spinal cord function, and there is no Statistical difference. Anterior cervicaloperation with titanium mesh cage and bone graft can effectively restore thecervicalvertebral physical camber, but also has the risk of occurrence of titanium mesh cagesubsidence,which is proportional to the number of corpectomysegments.For thosepatients who have a poor preoperative cervical cervical vertebral physical camber orexist preoperative axial pain, should not be recommended for posteriorcervicaloperation.