| Objective:Retrospective analysis and comparison of the efficacy of two methods of anterior cervical hybrid decompression and fusion(ACHDF,1-level corpectomy combined with 1-level discectomy)and anterior cervical discectomy and fusion(three-level ACDF)for the treatment of three-level cervical spondylotic myelopathy(CSM).Material and methods:A retrospective study of clinical and imaging data of three-level CSM patients who underwent anterior cervical spine surgery in our hospital from January 2014 to January 2017 was included.According to the operation,they were divided into ACHDF group(28 cases)and ACDF group(22 cases).The general conditions,imaging parameters and clinical function evaluation indexes of the two groups were compared and analyzed.Among them,the general indicators include: age,sex composition,blood loss during surgery,operation time,follow-up time,and average postoperative hospital stay;clinical function evaluation indicators include: Japan Orthopaedic Association(JOA)score,JOA score improvement rate,Neck Disability Index(NDI)score,Odom standard score;the imaging parameters before and after operation include: C2-7 Cobb angle,fusion segment Cobb angle,C2-7 sagittal vertical axis(SVA),T1 slope(T1S),T1 slope minus C2-7 lordosis(T1S-CL),bone graft fusion rate,etc.Results:1)Comparison of general conditions of the patients: there was no statistically significant difference in age,gender composition,follow-up time,and average postoperative hospital stay in the two groups(P > 0.05);the intraoperative blood loss in the ACDF group(128.40 ± 12.60)ml was less than that in the ACHDF group(168.76 ± 17.50)ml(P <0.05);the operation time in the ACDF group(136.60 ± 15.20)min was greater than that in the ACHDF group(121.40 ± 10.80)min(P <0.05).2)Comparison of clinical function scores: The JOA score and NDI score of patients in the ACHDF group at the last postoperative follow-up were(13.82 ± 1.72)points and(5.83 ± 2.08)points,respectively,compared with the preoperative scores of(9.39 ± 2.13)points and(22.46 ± 3.56)points,they were significantly improved(P <0.05).In the ACDF group,the JOA score and NDI score of the last postoperative follow-up were(13.96 ± 1.56)points and(6.16 ± 2.14)points,which were significantly improved compared with the preoperative(9.78 ± 1.82)points and(21.58 ± 4.08)points(P <0.05).In the ACHDF group and the ACDF group,the improvement rates of JOA score at the last follow-up were(70.84 ± 9.83)% and(71.15 ± 9.42)%.The comparison between the above data groups was not statistically significant(P> 0.05).Odom criteria excellent rate of ACHDF group and ACDF group were 89.29% and 90.91%,respectively.However,there were no significant differences between the two groups before and after the JOA score,NDI score,and Odom excellent rate(P> 0.05).3)Imaging evaluation: The C2-7 Cobb angle and the segmental Cobb angle of the ACHDF group at the last postoperative follow-up were(14.86 ± 6.54)° and(12.21±7.01)°,respectively,compared with(12.84 ± 8.92)°and(8.90±6.72)° points were significantly improved(P <0.05).In the ACDF group,the C2-7 Cobb angle and the segmental Cobb angle at the last postoperative follow-up were(18.34 ± 7.36)° and(15.70 ± 8.42)°,respectively,which were(12.47 ± 8.72)° and(8.12 ± 7.84))° were significantly improved(P <0.05).But the improvement in the ACDF group was better than that in the ACHDF group(P <0.05).The T1 S and C2-7SVA of patients in the ACHDF group at the last postoperative follow-up were(27.61 ± 6.38)° and(16.16 ± 11.84)mm,respectively,compared with(26.78 ± 7.17)° and(17.13 ± 11.24)mm before surgery(P> 0.05).The T1 S and C2-7SVA of patients in the ACDF group at the last postoperative follow-up were(26.95 ± 6.92)° and(16.24 ± 9.57)mm,respectively,compared with(25.92 ± 8.02)° and(18.16 ± 9.84)mm before surgery(P> 0.05).There were no significant differences in T1 S and C2-7SVA between the two groups before and after operation(P> 0.05).In the ACDF group,the T1S-CL(9.52 ± 6.42)° at the last follow-up was significantly lower than that before the operation(14.72 ± 6.76)°(P <0.05).The T1S-CL(12.96 ± 8.12)° in the ACHDF group at the last postoperative follow-up was not significantly different from that before the operation(13.94 ± 8.98)°(P> 0.05).The improvement of ACDF group was better than that of ACHDF group(P <0.05).At the last follow-up,the fusion rate was 100% in both groups.Conclusion:Both ACHDF and ACDF can be used as safe and effective techniques for the treatment of three-level CSM.However,both methods have their own advantages.Among them,ACHDF has a shorter operation time and is more conducive to intraoperative decompression,while ACDF has less blood loss during operation and is more conducive to maintaining cervical sagittal balance. |
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