| Objective To study the application of anterior cervical discectomy and fusion with zero-profile anchored spacer(ROI-C) to treat multilevel cervical spondylotic myelopathy.Methods From April 2012 to February 2015, A total of 65 patients who had multilevel cervical spondylotic myelopathy(MCSM) were operated on using anterior cervical discectomy and fusion(ACDF). Thirty-one patients underwent ACDF with the zero-profile anchored spacer(ROI-C) were classified as the ROI-C group, among of them there were 10 male and 21 female, aged from 44-70 years( average 56.5±9.5 years), the levels to be treated included two levels(20patients), three levels(10patients), four levels(1patients). Thirty-four patients received PEEK cages with anterior plating served as the titanium plated group, among of them there were 15 male and 19 female, aged from 40-75years( average 57.0±9.6 years), the levels to be treated included two levels(22patients),three levels(10patients), four levels(2 patients). The clinical outcomes were evaluated by Japanese Orthopaedic Association( JOA) scores and neck disability index( NDI) scores and related indicators, such as operation time, intraoperative blood loss, intraoperative fluoroscopy, incidence of postoperative dysphagia and ratio of bone graft fusion were recorded. The pre- and postoperative JOA scores, NDI scores, cervical lordosis and disk height were compared with repeated measures analysis of variance.Results The mean follow up time was( 23.8±6.4) months( 12-34 months). At the first month and the last follow-up, The JOA scores were significantly increased, and the NDI scores were decreased, compared with the presurgical measurements in both groups.The mean JOA scores increased from 10.7 ± 2.2 preoperatively to 14.8 ± 1.8postoperatively in the ROI-C group and from 10.8 ± 1.8 preoperatively to 14.4 ± 1.8postoperatively in the cage-plate group. The mean NDI scores increased from 35.4±2.5preoperatively to 13.4 ± 2.9 postoperatively in the ROI-C group and from 34.8 ± 2.6preoperatively to 13.8±3.0 postoperatively in the cage-plate group. The disk height and cervical Cobb angle showed significant corrections, compared to those parameters before the operation. The disk height increased from 4.5±0.7 mm preoperatively to 6.2±0.8 mm postoperatively in the ROI-C group and from 4.4±0.6 mm preoperatively to 5.7±0.9 mm postoperativelyin the cage-plate group. The cervical lordosis increased from 11.6 ° ±6.8 ° preoperatively to 19.0 ° ± 7.5 ° postoperatively in the ROI-C group and from11.9 ° ± 7.1 ° preoperatively to 18.6 ° ± 7.6 ° in the cage-plate group at the final follow-up. There were no significant differences in NDI scores, JOA scores, disk height and cervical Cobb anglebetween the two groups(P>0.05). But there were significant differences in the operation time, blood loss and the presence of dysphagia(P<0.05). In addition, bony fusion was obtained in all cases at the last follow up.There was no significant difference on ration of bone graft fusion between two group(P>0.05).Conclusion The primary clinical and radiographic efficacies of both ROI-C and cages with plates in ACDF for MCSM were satisfactory; both approaches could improve and maintain cervical lordosis and disk height. However, the ROI-C was associated with a simpler operation, a shorter operation time, less blood loss, less exposure times to the X-ray and a lower risk of long-term postoperative dysphagia compared to the PEEK cage with an anterior plate. So, the ROI-C can be considered as a new choice for multilevel cervical spondylotic myelopathy. |
PDF Full Text Request