A Comparison Of Two Methods Of Operation In Patients With Multilevel Cervical Spondylotic Myelopathy

?Background Data?Cervical spondylosis is due to cervical disc degeneration,neck injury or mechanics disequilibrium caused by long-term muscular strain.It may also because of constrict or irritate cervical nerve root,spinal cord,vertebral artery or sympathetic nerve.These causes will lead to pain and numbness in the neck,shoulder,back and arm and a series of clinical symptoms and even paralysis.Among them,the incidence of cervical spondylotic myelopathy of the cervical spondylosis accounted for 10% ~ 15%,which belongs to one of the most common types of diseases in the Orthopedics.With the changes of people's life and work style in modern society,the incidence of CSM is increasing year by year.With degeneration of intervertebral disc texture,the water content reduces,especially in peripheral and prominent,which lead to the thickening of the ossification of posterior longitudinal ligament posterior disk coated,the edge of the vertebral bone hyperplasia,corresponding lamina of yellow ligament and intervertebral joint stress increased capsular ligament thickening,flexibility decreases,spinal canal diameter reduce,then spinal cord compression.Chronic injury in the pathogenesis of cervical spondylosis of the spinal cord as a predisposing factor.This disease is more common in the elderly.Their cervical disc will underwent degeneration,cervical osteoarthritis and other pathological changes in the nerve root,spinal cord or vertebral artery and finally lead to Cervical spondylosis.Multilevel cervical spondylotic myelopathy(MCSM)refers to the patients with bone hyperplasia,osteophyte occurred and intervertebral disc degeneration due to a variety of pathological changes in multiple stages of vertebral and subsequent compression of the spinal cord and further lead to cervical vertebra disease.The optimal surgical strategy for multilevel CSM(MCSM)remains undefined.Methods of surgical treatment include anterior cervical discectomy and fusion(ACDF);anterior cervicalcorpectomy and fusion(ACCF)and posterior cervical laminoplasty(PCL).Studies have shown that patients with MCSM in long segment of intervertebral disc replacement surgery for the treatment of spinal cord compression symptoms can be significantly improved,but pathogenic segment cervical activity degree of loss which brings degree decreased and the adjacent segments compensatory activity increases and stress of composite increase of activity of cervical vertebra,so that adjacent segment degeneration(ADJ)leading to protrusion of cervical intervertebral disc which may need surgical treatment again in some cases.C-ADR maintains motion at the level of the surgical procedure and decreases strain on the adjacent segments.The clinical results of multilevel C-ADR were not yet fully elucidated.ACCF combined with 1-level C-ADR for the treatment of consecutive3-level CSM may be a proper alternative to 3-level fusion.?Objective?The aim of this study was to compare clinical and radiological outcomes of anterior cervical corpectomy and fusion(ACCF)combined with artificial disc replacement(C-ADR)vs.ACCF combined with anterior cervical discectomy and fusion(ACDF)in patients with consecutive 3-level cervical spondylotic myelopathy(CSM).?Methods?.We retrospectively reviewed patients who underwent surgery for consecutive3-level CSM between C3–4 and C6–7 from June 2007 to August 2011.A total of 42 patients were divided into 2 groups.Patients in Group A(n = 19)underwent ACCF combined with 1-level C-ADR and patients in group B(n = 23)underwent ACCF combined with 1-level ACDF.We compared perioperative parameters,clinical parameters,and radiological parameters.?Results?There were no significant differences in the average age,sex ratio,the preoperative heights of the disc space or average blood loss between the 2 groups.Group A had longer operation time than group B(P < 0.05).During the follow-upperiod,group A showed a better Neck Dysfunction Index recovery(P < 0.05)at 24 months postoperatively,and less visual analogue scale scores at 12 and 24 months postoperatively(P < 0.05 and P < 0.001,respectively).Moreover,group A exhibited better range of motion recovery of C2–C7 at 6,12,and 24 months postoperatively(all P < 0.05).?Conclusion?Group A was superior to Group B in terms of Neck Dysfunction Index recovery,intermediate term pain,and C2–C7 ROM recovery.ACCF hybrid 1-level C-ADR may be a suitable choice for the management of 3-level CSM in appropriate patients.