The Effect Of Two Anterior Cervical Surgery Methods On Cervical Sagittal Parameters In The Treatment Of Adjacent Two-level CSM And The Analysis Of The Efficacy

Objective: By comparing the changes and effects of cervical sagittal position parameters in the treatment of adjacent two-level CSM with anterior cervical corpectomy fusion(ACCF)and anterior cervical discectomy fusion(ACDF),this study provides reference for the treatment of two-level CSM.Methods:We conducted a retrospective analysis of patients treated with ACCF and ACDF for two-level CSM in the First Affiliated Hospital of Gannan Medical University from November 2017 to November 2021.All patients were followed up for more than10 months.There were 51 patients in the ACCF group and 30 patients in the ACDF group.We use the independent sample t test and the Chi-square test to compare the following indicators.(1)General indicators included: age,sex,lesion segment,blood loss,operation time and average length of stay;(2)Imaging indicators included: Cobb’s C2-C7 angle(C2-C7Cobb),T1 slope(T1S),C2–7 sagittal vertical axis(C2-7SVA),height of fusion vertebral body;(3)Common clinical indicators: JOA,NDI and VAS scores;(4)Complication indicators: adjacent segment degeneration,revision,Pseudarthrosis,hoarseness,dysphagia,pain in the iliac area,graft or hardware failure,cerebrospinal fluid leakage.We used correlation analysis to compare the correlation between(35)Cobb°、(35)T1S°、(35)SVA(mm)and(35)fusion level vertebral height(mm)with JOA improvement rate.Results: All patients were followed up for more than10 months,and there were statistically significant differences in operating time,blood loss,and average length of hospital stay between the two groups(P<0.05).Postoperative JOA score,NDI score and VAS score were significantly improved in both groups,with statistical significance(P<0.01),but there was no statistical significance between the two groups(P>0.05).There were significant differences in C2-C7 Cobb,T1S and vertebral body height of the fusion segment in the ACCF group before and after follow-up(P<0.05),but no significant differences in C2-C7 SVA before and after follow-up(P=0.34).The C2-C7 Cobb and fusion segments were observed before and at the last follow-up in the ACDF group.There was a statistical difference in vertebral body height(P<0.05),but no statistical difference in C2-C7 SVA and T1S(P>0.05).ACDF has more advantages than ACCF in the recovery of cervical curvature.There was no obvious difference in the incidence of postoperative complications beteeen the two groups,such as degeneration,hoarseness,dysphagia and dural tear,between the two surgical methods.Conclusion: In this study,there were no significant differences in clinical efficacy and incidence of postoperative complications between the two anterior cervical approaches in the treatment of adjacent cervical spondylotic myelopathy,but ACDF was superior to ACCF in terms of blood loss,operation time and hospital stay.Moreover,ACDF has more advantages in restoring sagittal position balance of physiological curvature of patients’ cervical vertebrae.This information will provide spine surgeons with a preliminary understanding of the differences between the two surgical methods in the treatment of adjacent two levels of CSM,and provide a reference for spine surgeons to choose surgical methods.