| Subject To compare between the dynamic anterior cervical plate system versus the rigid anterior cervical plate system on the effect on the rate of cervical curvature loss in the anterior cervical discectomy and fusion(ACDF) treatment of multilevel cervical spondylosis. Methods Sixty-seven multilevel cervical spondylosis patients including 38 males and 29 females aging from 41-69 years old(mean age 51 years old)who received anterior cervical discectomy and fusion(ACDF) treatment in our department from February 2011 to December 2013 were recruited. They were randomly divided into A group in which constrained anterior cervial plates were plated and B group with dynamic plates.A group consisted 29 cases of two-level and 6 cases of three-level and B group consisted 24 cases of two-level and 8 cases of three-level. The data about cervical spine radiographies in pre-operation,one month, six months, one year after the operation and JOA score of all patients were gathered and analyzed by paired T test within group and chi-square test between groups with SPSS19.0 software and P <0.05 was defined as statistically significant. Result Complete follow-up data of all patients were obtained, all patients were discharged 3-4 days post operation and followed-up for 12 to 18 months(average 14.2 months). The post operation intervertebral bone graft fusion was 100% in both groups. None patients were found to have screw out or steel plate shift or fracture. Nerve function was markedly improved after the operation in both groups. JOA score increased from(8.7± 1.4) points preoperation up to(14.7 ± 1.2) postoperation in A group and(8.6 ± 1.5) up to(14.1 ± 1.5) in B group. The rate of JOA improvement after 1 year’s follow-up: A group was 74.43% while B group was 68.75%. Hence there was no significant statistical difference between them.The physiological curvature of cervical vertebra was improved after surgery in both groups. The rate of physiological curvature loss was(1.33 ±0.28) ° in two-level spondylosis patients and(1.91 ±0.58) ° in three-level patients in a year after the operation in A group. In B group, the rate was(5.42±1.68) ° and(5.53±1.71)°, respectively. There lack statistical significance in the physiological curvature of cervical vertebra and the rate of loss between these two groups. Yet the average rate of physiological curvature loss was slightly smaller in A group.The intervertebral height was improved after the operation as well in both groups. The amount of intervertebral height loss was(1.81 ±0.47)mm in two-level spondylosis patients and(2.17±0.61)mm in there-level patients. In B group, the amount was(2.62±0.46)mm and(2.93±0.37)mm, respectively. The amount of intervertebral height loss was not statistical different between these two groups. But the average intervertebral height loss in A group was smaller. The incidence of postoperative neck axial symptoms was 5.07% in A group compared to 12.50% in B group, but there is no statistical significance. Conclusions Satisfactory clinical efficacy could be achieved with the application of either rigid steel plates or non-rigid steel plates in the anterior cervical discectomy and fusion(ACDF) treatment of multilevel cervical spondylosis. But the rigid plate had advantages over the dynamic plate in retaining cervical curvature and intervertebral height and reducing the incidence of axial symptoms. |
