Application Of ROI-C In Skip-level Anterior Cervical Discectomy And Fusion For The Treatment Of Noncontiguous Bilevel Of Cervical Spondylosis

Objective To investigate the early clinical and radiographic efficacy of ROI-C in skip-level anterior cervical discectomy and fusion for the treatment of noncontiguous bilevel of cervical spondylosis.Methods A retrospective analysis of 11 patients with diagnosis noncontiguous bilevel of cervical spondylosis were treated ROI-C-assisted skip-level ACDF procedure at the900th Hospital of the Joint Logistics Support Force from June 2017 to April 2019.The operative time,intraoperative blood loss,hospitalization time,improvement of functional symptoms and complications were recorded.The Visual Analogue Scale,Japanese Orthopaedic Association and Neck Disability Index were assessed at baseline and postoperatively,The radiological outcomes were evaluated by C₂-C₇range of motion,C₂-C₇cobb angle,disc height,C₂-C₇sagittal vertical axis distance and T₁slope angle.Results All the 11 cases were successfully operated and followed up for 12-24 months,with an average of（16.91±3.36）months,The average operation time was（68.18±6.98）min,the average intraoperative bleeding volume was（42.2±11.04）ml and the average hospitalization time was（4.45±0.69）d.VAS scores were significantly lower at 3 month（1.55±0.47）and the last follow-up（1.32±0.33）post-operatively comparing with those pre-operatively（6.23±1.35）（P<0.05）.JOA scores at 3 month（13.64±1.43）and the last follow-up（15.36±1.03）were significantly higher post-operatively comparing with those pre-operatively（9.09±1.30）（P<0.05）.NDI scores 3 month post-operatively and at the last follow-up were（12.91±2.63）and（7.82±3.28）respectively,which were significantly lower comparing with those pre-operatively（30.82±4.79）.The intermediate segment of DH was（4.92±0.54）mm,which was not significantly different from that pre-operatively（5.07±0.52）（P>0.05）.The C₂-C₇Cobb angle significantly increased from（11.42±1.77）°pre-operatively to（16.17±2.41）°3 month post-operatively and（15.48±2.42）°at the final follow-up examination（P<0.05）.The surgical segment of DH significantly increased from（4.23±0.35）mm pre-operatively to（6.09±0.34）mm 3 month post-operatively and（5.91±0.38）mm at the last follow-up（P<0.05）.The pre-operative C₂-C₇SVA（22.0±4.48）mm significantly improved at 3 month post-operatively（25.14±4.43）mm and last follow-up（23.36±4.58）mm post-operatively（P<0.05）.The pre-operative T₁-slope（22.37±5.30）also significantly improved at 3 month post-operatively（27.05±6.00）and the last follow-up（26.13±5.95）（P<0.05）.Complications:There were no incision infection,cerebrospinal fluid leakage,neck hematoma,esophageal rupture,and difficulty swallowing.One patient had a transient hoarseness and recovered without special treatment after 2 weeks.At the last follow-up,11 cases of intervertebral fusion were ossified.There were no complications such as subsidence,displacement of the cage,cervical kyphosis,and pseudoarticular formation.1 case had asymptomatic adjacent segment degeneration.Conclusion The primary clinical and radiographic efficacies of ROI-C in skip-level ACDF for noncontiguous bilevel of cervical spondylosis were satisfactory.The process of intermediate segment degeneration is not accelerated in the near future.However,the long-term efficacy and safety still need to be verified by long-term follow-up.