The Clinical Outcomes Of Anterior Cervical Discectomy And Fusion With The Use Of An Intra-operative Microscope To Treat Cervical Spondylotic Myelopathy

Obiective To compare the clinical outcomes of anterior cervical discectomy and fusion with and without the use of an intra-operative microscope to treat single-level cervical spondylotic myelopathy.Thus,the choice of surgical options is more favorable to patients.Methods From January 2013 to August 2016,140 patients with single-level cervical spondylotic myelopathy,undewent anterior cervical discectomy and fusion were reviewed.59 of them,underwent the anterior cervical discectomy and fusion with the use of an intra-operative microscope were divided into group A.In addition,another 81 patients were divided into group B,which underwent anterior cervical discectomy and fusion without the use of an intra-operative microscope.The general data,operation and clinical effect of patients were statistically analyzed.All patients with preoperative short-form 12(SF-12PCS、SF-12 MCS)and Japanese Orthopaedics Association(JOA)score,and the two groups of patients were with postoperative 3 months,12 months follow-up,improve quality of life and related complications were observation and calculating the postoperative neurological function improvement rate.The average blood loss,average postoperative drainage,average operative time,Incision length,Postoperative swallowing,and surgical complications were compared between the two groups.Results The general data of the two groups were similar and the difference was not statistically significant.There was no statistically significant difference(P > 0.05)between the average operative time in group A(74.92±18.98min)and group B(71.75±10.17min).The average blood loss of group A(60.76±10.61ml)was less than that of group B(83.10±13.08ml),and the difference was statistically significant(P < 0.05).There was no statistically significant difference(P > 0.05)in the average postoperative drainage between group A(27.47±10.06ml)and group B(29.93±9.23ml).In group B,three cases of dural injury occurred,in group A,only one case of dural injury occurred,and there was no statistically significant difference(P>0.05),no nerve root injury occurred in the two groups.In group B,2 patients suffered from transitional nerve dysfunction,there was no transitional nerve dysfunction in group A,but the difference was not statistically significant(P > 0.05).There was no significant difference in incision length between the two groups(P > 0.05).In group A,there was 1 patient with mild dysphagia after operation,and 3 cases of mild dysphagia after operation in group B,the difference was not statistically significant(P > 0.05).Comparing to pre-operation,postoperative JOA score and JOA improvement rate of group A were significantly improved,and the difference was statistically significant(P<0.05).Comparing to pre-operation,postoperative JOA score and JOA improvement rate of group B were significantly improved,and the difference was statistically significant(P < 0.05).Three months after operation,the differences of two groups in SF-12PCS(P=0.69),SF-12 MCS(P=0.55),JOA(P=0.10)and JOA improvement rate(P=0.27)were not statistically significant.The differences of two groups of patients with postoperative after 1 year were no statistically significant in the following indicators,including: SF-12PCS(group A:44.93±11.88,group B:41.91±8.74,P=0.41),SF-12 MCS(group A: 46.22±13.26,group B: 48.65±10.66,P = 0.59).JOA score(group A:14.34±0.96,group B:14.05±0.80,P=0.06).JOA mean neurological improvement rate(group A(%):63.83±3.64,group B(%):64.70±3.65,P=0.16).Conclusion Through the use of the microscope good light illumination,the magnification of the field and three-dimensional visual images and other advantages,anterior cervical discectomy and fusion with the use of an intra-operative microscope can achieve better decompression and less bleeding by enhancing the visualization of surgical anatomy in the operation.The surgical safety was significantly improved compared with traditional surgery.Anterior cervical discectomy and fusion with the use of an intra-operative microscope was the preferred choice for the treatment of singlelevel cervical spondylotic myelopathy.