ABSTRACT
Objective To investigate effect of single anterior decompression and fusion for pinching cervical spondylosis myelopathy.Methods 82 patients with pinching cervical spondylosis myelopathy,treated with single anterior decompression and fusion,were analyzed,including 43 males and 39 females,with an average age of 54.4 years (range,33-79 years).Occupying rate,anterior occupying rate and posterior occupying rate were measured on pre- and post-operative midsagittal MRIs.Multiple regression analysis was performed between preoperative occupying rate,intervertebral space height,postoperative imaging changes and neural function recovery.Results All patients were followed up for an average of 25.8 months (range,9-72 months).Significant differences were found between pre- and postoperative Japanese Orthopaedic Association (JOA) scores,anterior occupying rate,posterior occupying rate,and intervertebral space height,respectively.Pre- and post-operative posterior occupying rate was averagely 29.0％±10.5％ and 19.9％+11.6％,respectively,and improvement rate of posterior occupying rate was 9.0％±6.1％.Regression analysis found that preoperative intervertebral space height did not relate to posterior occupying rate,while preoperative posterior occupying rate related to improvement rate of posterior occupying rate.JOA scores improved significantly after operation in patients with preoperative posterior occupying rate between 20％ and 40％.However,the decompression results were poor in patients with preoperative posterior occupying rate ≥40％.Conclusion Anterior decompression and fusion can achieve satisfactory results in patients with pinching cervical spondylotic myelopathy.For patients with preoperative posterior occupying rate between 20％ and 40％,the decompression results are better.
ABSTRACT
STUDY DESIGN: Cervical corpectomy with preserved posterior vertebral wall (CPW) had been performed by the senior author (Y.W.) since 1999. A prospective study had been conducted to evaluate the efficacy of CPW since 2001. OBJECTIVE: To validate the clinical outcome of CPW against conventional corpectomy (CC). SUMMARY OF BACKGROUND DATA: Anterior surgical managements of cervical spondylotic myelopathy (CSM) include discectomy and corpectomy. Both have significant disadvantages, including low fusion rates and residual symptoms. A procedure incorporating multilevel discectomy, corpectomy with preserved posterior vertebral wall, autograft and plating was described. By keeping the posterior vertebral wall (PW), infringement of the vein plexus and spinal canal was avoided and more fusion site was available. METHODS: From March 2001 to March 2004, 178 cases of CSM were randomized to undergo CPW (n = 89) or CC (n = 89). Arthrodesis was done with autogenous iliac bone graft or titanium cage supplemented with anterior self-lock plates in both groups. Operation time, blood loss, days of hospitalization, the numbers and types of complications, and preoperative and postoperative JOA scores were recorded. Fusion rate, segmental lordosis, and disc height were assessed by roentgenography. Three-dimensional reconstructions of CT scan were used to confirm fusion evidence. RESULTS: Average operation time and blood loss decreased significantly in the CPW group (98.06 +/- 19.42 minutes, and 131.69 +/- 62.41 mL) as compared with those in the CC group (108.45 +/- 22.35 minutes, and 181.57 +/- 82.10 mL) (P < 0.05). There were 2 cases of epidural bleeding and 1 case of CSF leak in the CC group. Other complications were minor. JOA improvement scores were similar in both groups. Roentgenograms showed that the fusion rate was 100% at 6 months postoperatively in both groups. CT scans showed that PW fused with grafts and bone dust in cages. Improvement in segmental lordosis and disc height was similar in both groups. CONCLUSION: CPW is a feasible procedure for anterior decompression and fusion, with safety, complete decompression, and high fusion rate, as long as indicative patients are selected.
