Combined Anterior-posterior Surgery For The Treatment Of Clamp-type Multilevel Cervical Spondylotic Myelopathy:an Analysis On The Surgical Outcomes

Objective To explore the clinical and radiological outcomes and indications of combined anterior-posterior surgery(CAPS) for the treatment of clamp-type multilevel cervical spondylotic myelopathy (MCSM).Methods Fifty-three patients with clamp-type multilevel cervical spondylotic myelopathy were included in this case series study. They were treated with combined anterior-posterior surgery, the preoperative and postoperative data were recroded. The clinical and radiological outcomes were analyzed by the length of hospital stay, complication rate, blood loss, operation time, Japanese orthopedic association scores (JOA), the neck disability index (NDI), cervical curvature index(CCI) and sagittal cervical range of motion (CROM), the clinical and radiological outcomes and indications of combined anterior-posterior surgery was analyzed according to the research domestic and overseas.Results Fifty-three patients went through the operation successfully,2 of them lost to follow-up less than 1 year and were excluded, with 33 male and 18 female were left in this study. They were followed up with a period range 12 to 36 months. The length of hospital stay were (16.18±3.49) day, blood loss was (506.78±136.56) ml and operation time was (222.55±36.23) min. The preoperative JOA score was (8.51±1.57) and postoperative score (13.67±1.70), JOA score was improved after operation(P<0.05), the JOA recovery rate averaged was (62.48±13.83)%. The preoperative NDI score was (38.10±4.14) and postoperative score (21.39±3.97), there was a significant decrease in NDI score after surgery(P<0.05), the improved score averaged was (16.65±3.70). The preoperative CCI was (11.30±1.68)% and postoperative (15.92±1.43)%, CCI was improved after surgery(P<0.05). The preoperative sagittal CROM was (75.63±8.55)° and postoperative (50.69±5.76)°, there was a significant decrease in sagittal CROM after surgery(P<0.05), the decreased degree averaged was (26.35±5.56)°.2 of them had cerebrospinal fluid leakage,6 had C5 nerve root palsy,2 had incision problem,8 had dysphagia,1 had recurrent laryngeal nerve injury. No close-door or nonunion in bone graft were found.Conclusions Combined anterior-posterior surgery is a good strategy for the treatment of clamp-type multilevel cervical spondylotic myelopathy by having good effect in neurological decompression, neurological function recovery and cervical stability, but causing big loss of CROM and high complication rate. Application of combined anterior-posterior surgery should follow the surgical indications.