Abstract
Purpose
We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM).
Methods
A total of 40 patients who underwent ACDF or ACCF for multilevel CSM were divided into two groups. Group A (n = 25) underwent ACDF and group B (n = 15) ACCF. Clinical outcomes (JOA and VAS scores), perioperative parameters (length of hospital stay, blood loss, operation time), radiological parameters (fusion rate, segmental height, cervical lordosis), and complications were compared.
Results
Both group A and group B demonstrated significant increases in JOA scores and significant decreases in VAS. Patients who underwent ACDF experienced significantly shorter hospital stays (p = 0.031), less blood loss (p = 0.001), and shorter operation times (p = 0.024). Both groups showed significant increases in postoperative cervical lordosis and achieved satisfactory fusion rates (88.0 and 93.3 %, respectively). There were no significant differences in the incidence of complications among the groups.
Conclusions
Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.
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References
Oh MC, Zhang HY, Park JY et al (2009) Two-level anterior cervical discectomy versus one-level corpectomy in cervical spondylotic myelopathy. Spine 34:692–696
Rao RD, Gourab K, David KS (2006) Operative treatment of cervical spondylotic myelopathy. J Bone Surg Am 88:1619–1640
Lin Q, Zhou X, Wang X et al (2012) A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J 21(3):474–481
Gore DR (2001) The arthrodesis rate in multilevel anterior cervical fusions using autogenous fibula. Spine 26:1259–1263
Hilibrand AS, Fye MA, Emery SE et al (2002) Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression. Spine 27:146–151
Hwang SL, Lee KS, Su YF et al (2007) Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease. J Spinal Disord 20:565–570
Iwasaki M, Kawaguchi Y, Kimura T et al (2002) Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg 96:180–189
Ellison TS, Hartman MB, Brigham CD (1997) Fusion rates for two-level ACDF+ plating versus subtotal corpectomy and fusion. Presented at the annual meeting of the North American Spine Society, New York, October 25
Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 6:496–511
Matz PG, Pritchard PR, Hadley MN (2007) Anterior cervical approach for the treatment of cervical myelopathy. Neurosurgery 60:S64–S70
Orr RD, Zdeblick TA (1999) Cervical spondylotic myelopathy. Approaches to surgical treatment. Clin Orthop Relat Res 359:58–66
Hilibrand AS, Carlson GD, Palumbo MA et al (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528
Bazaz R, Lee MJ, Yoo JU (2002) Incidence of dysphagia after anterior cervical spine surgery. Spine 27:2453–2458
Wada E, Suzuki S, Kanazawa A et al (2001) Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy. A long-term follow up study over 10 years. Spine 26:1443–1447
Wang JC, McDonough PW, Endow KK et al (2001) A comparison of fusion rates between single-level cervical corpectomy and two-level discectomy and fusion. J Spinal Disord 14:222–225
Papadopoulos EC, Huang RC, Girardi FP et al (2006) Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Spine 31:897–902
DePalma AF, Rothman RH, Lewinnek GE et al (1972) Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet 134:755–758
Sasso RC, Ruggiero RA Jr, Reilly TM et al (2003) Early reconstruction failures after multilevel cervical corpectomy. Spine 28:140–142
Ikenaga M, Shikata J, Tanaka C (2006) Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy. Spine 31:1568–1574
Vaccaro AR, Falatyn SP, Scuderi GJ et al (1998) Early failure of long segment anterior cervical plate fixation. J Spinal Disord 11:410–415
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This study was approved by the Institutional Review Board of Chonbuk National University Research Council (IRB-2009-81).
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Song, KJ., Lee, KB. & Song, JH. Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study. Eur Spine J 21, 1551–1557 (2012). https://doi.org/10.1007/s00586-012-2296-x
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DOI: https://doi.org/10.1007/s00586-012-2296-x