ABSTRACT
OBJECTIVE@#To explore the clinical effects of anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) in treating adjacent two-segment cervical spondylotic myelopathy (CSM).@*METHODS@#The clinical data of 37 patients with adjacent two segment CSM treated from January 2016 to December 2017 were retrospectively analyzed, including 15 males and 22 females, aged from 43 to 69 years old with an average of 54.6 years. The patients were divided into ACDF group (group A, =17) and ACCF group (group B, =20) according to the different surgery. The operation time and intraoperative blood loss were recorded;the Cobb angle and cervical curvature in the cervical fusion segments before surgery and 1, 12 months after surgery were observed;Japanese Orthopaedic Association (JOA) score was used to evaluate the surgical efficacy, and the postoperative complications were analyzed.@*RESULTS@#All patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time and intraoperative blood loss in group A were (106.3±22.6) min, (52.2±26.4) ml, respectively, while were (115.6±16.8) min, ( 61.7±20.7) ml in group B. There was no statistically significant in operation time between two groups(>0.05);intraoperative blood loss in group B was larger than group A(0.05). At the final follow up, in group A, dysphagia occurred in 2 cases, cage displacement in 1 case, and no titanium plate screw loose was found;and in group B, dysphagia occurred in 4 cases, titanium mesh collapse in 2 cases, titanium plate screw loose in 1 case.@*CONCLUSION@#Two types of anterior cervical decompression and fusion for the treatment of two segment cervical spondylotic myelopathy can effectively decompress and improve the Cobb angle and cervical curvature of the affected vertebra. The ACDF surgical procedure can directly removethe compressive thing at intervertebral level, which will lead to little vertebral body damage and favorably recovered cervical curvature. The ACCF surgical procedure has a large operation space, which can easily remove the posterior vertebral osteophyte and the calcified posterior longitudinal ligament. Long-term follow-up shows that ACDF and ACCF have good surgical procedures, mature technology, and close efficacy.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cervical Vertebrae , General Surgery , Diskectomy , Retrospective Studies , Spinal Cord Diseases , General Surgery , Spinal Fusion , Spondylosis , General Surgery , Treatment OutcomeABSTRACT
Introduction: This study was conducted on 40 patients withsymptomatic cervical disc disease with one or two level discpathology. Clinical and radiological outcome was compared todetermine which technique was advantageous for treatment ofpatients with disc disease. Complications related to graft fusionfailures; subsidence, infection etc and donor site chronic painhave stimulated neurosurgeons to revert back to surgeries toavoid fusion.Methods: Patients were allocated to either ACD (n=21) orACDF (n=19) procedures. The standard Smith Robinsontechnique was performed in all patients in this study. Patientswere followed up clinically and radiologically according to thestudy protocol.Results: The clinical long term outcome was comparable inboth groups. Kyphosis and slow rate of fusion was noted withACD, but on long term follow up, patients were overallsatisfied. Donor site pain and graft related problems weremajor issues with ACDF. The issue of whether to fuse or not tofuse has not come to an end yet. This will require furtherrefinements in surgical technique, graft harvesting, and furtherstudies. Till then, both of these methods will be used forspecific indications.