Anterior cervical corpectomy and fusion versus discectomy and fusion for the treatment of two-level cervical spondylotic myelopathy: analysis of sagittal balance and axial symptoms
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To compare the postoperative sagittal balance and occurrence of axial symptoms between anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) for the treatment of two-level cervical spondylotic myelopathy (CSM).
A total of 71 consecutive patients who underwent ACCF or ACDF for two-level CSM in our institution from January 2014 to December 2016 were retrospectively reviewed. Of these patients, 30 (17 males, 13 females) were subjected to ACCF, and 41 (20 males, 21 females) were treated with ACDF. Perioperative data, radiographic parameters, clinical outcomes, and axial symptom occurrence were compared between the two groups.
The average follow-up durations were 13.7 ± 3.9 months in the ACCF group and 13.4 ± 3.3 months in the ACDF group. The volume of blood loss was significantly lower in the ACDF group than in the ACCF group, and the operation time of the former was significantly shorter than that of the latter. The postoperative global lordotic angle and T1 slope were significantly larger in the ACCF group than in the ACDF group in each follow-up. The occurrence of postoperative axial symptoms was significantly lower in the ACDF group than in the ACCF group.
The volume of blood loss was lower and the operation time was shorter in ACDF than in ACCF for the treatment of two-level CSM. Sagittal balance was better in the ACDF group than in the ACCF group, and this observation may lead to a reduced occurrence of axial symptoms.
KeywordsCervical spondylotic myelopathy Anterior cervical discectomy and fusion Anterior cervical corpectomy and fusion Sagittal balance Axial symptoms
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Liu J, Chen X, Liu Z, Long X, Huang S, Shu Y (2015) Anterior cervical discectomy and fusion versus corpectomy and fusion in treating two-level adjacent cervical spondylotic myelopathy: a minimum 5-year follow-up study. Arch Orthop Trauma Surg 135(2):149–153. https://doi.org/10.1007/s00402-014-2123-4 CrossRefPubMedGoogle Scholar
- 5.Burkhardt JK, Mannion AF, Marbacher S, Dolp PA, Fekete TF, Jeszenszky D, Porchet F (2013) A comparative effectiveness study of patient-rated and radiographic outcome after 2 types of decompression with fusion for spondylotic myelopathy: anterior cervical discectomy versus corpectomy. Neurosurg Focus 35(1):E4. https://doi.org/10.3171/2013.3.focus1396 CrossRefPubMedGoogle Scholar
- 6.Guan L, Hai Y, Yang JC, Zhou LJ, Chen XL (2015) Anterior cervical discectomy and fusion may be more effective than anterior cervical corpectomy and fusion for the treatment of cervical spondylotic myelopathy. BMC Musculoskelet Disord 16:29. https://doi.org/10.1186/s12891-015-0490-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Roguski M, Benzel EC, Curran JN, Magge SN, Bisson EF, Krishnaney AA, Steinmetz MP, Butler WE, Heary RF, Ghogawala Z (2014) Postoperative cervical sagittal imbalance negatively affects outcomes after surgery for cervical spondylotic myelopathy. Spine 39(25):2070–2077. https://doi.org/10.1097/brs.0000000000000641 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, Lafage V, Shaffrey CI, Schwab F, Ames CP (2012) The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 71(3):662–669; discussion 669. https://doi.org/10.1227/NEU.0b013e31826100c9 CrossRefPubMedGoogle Scholar
- 10.Paholpak P, Nazareth A, Hsieh PC, Buser Z, Wang JC (2017) Kinematic evaluation of cervical sagittal balance and thoracic inlet alignment in degenerative cervical spondylolisthesis using kinematic magnetic resonance imaging. Spine J. https://doi.org/10.1016/j.spinee.2017.04.026
- 13.Li Z, Huang J, Zhang Z, Li F, Hou T, Hou S (2017) A comparison of multilevel anterior cervical discectomy and corpectomy in patients with 4-level cervical spondylotic myelopathy: a minimum 2-year follow-up study: multilevel anterior cervical discectomy. Clin Spine Surg 30(5):E540–e546. https://doi.org/10.1097/bsd.0000000000000212 CrossRefPubMedGoogle Scholar
- 14.Wang T, Wang H, Liu S, An HD, Liu H, Ding WY (2016) Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy: a meta-analysis. Medicine 95(49):e5437. https://doi.org/10.1097/md.0000000000005437 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Han YC, Liu ZQ, Wang SJ, Li LJ, Tan J (2014) Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy? A systemic review and meta-analysis. PLoS One 9(1):e87191. https://doi.org/10.1371/journal.pone.0087191 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Sakai K, Yoshii T, Hirai T, Arai Y, Shinomiya K, Okawa A (2017) Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty. Eur Spine J 26(1):104–112. https://doi.org/10.1007/s00586-016-4717-8 CrossRefPubMedGoogle Scholar
- 21.Villavicencio AT, Babuska JM, Ashton A, Busch E, Roeca C, Nelson EL, Mason A, Burneikiene S (2011) Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery 68(5):1309–1316; discussion 1316. https://doi.org/10.1227/NEU.0b013e31820b51f3 CrossRefPubMedGoogle Scholar
- 22.Smith JS, Lafage V, Ryan DJ, Shaffrey CI, Schwab FJ, Patel AA, Brodke DS, Arnold PM, Riew KD, Traynelis VC, Radcliff K, Vaccaro AR, Fehlings MG, Ames CP (2013) Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study. Spine 38(22 Suppl 1):S161–S170. https://doi.org/10.1097/BRS.0b013e3182a7eb9e CrossRefPubMedGoogle Scholar
- 23.Du W, Wang L, Shen Y, Zhang Y, Ding W, Ren L (2013) Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy. Eur Spine J 22(7):1594–1602. https://doi.org/10.1007/s00586-013-2741-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Chen H, Liu H, Deng Y, Gong Q, Li T, Song Y (2016) Multivariate analysis of factors associated with axial symptoms in unilateral expansive open-door cervical laminoplasty with miniplate fixation. Medicine 95(2):e2292. https://doi.org/10.1097/md.0000000000002292 CrossRefPubMedPubMedCentralGoogle Scholar