Objective: To investigate the outcome of modified anterior cervical corpectomy and fusion(mACCF) without corpectomy C4 or C5 vertebral body in the treatment of four-level cervical spondylotic myelopathy (CSM). Methods: 34 consecutive patients suffered from 4 level cervical spondylotic myelopathy were definitely diagnosed from July 2013 to June 2017. All 34 patients were treated by mACCF and followed up at least 5 years. Of these 34 patients, the cervical cord compression was observed at disc levels C2–C6 with/without spinal stenosis in 15 patients, which were treated with corpectomy of C3 and C5 vertebrae and preservation of C4 vertebrae; the cervical cord compression was observed at disc levels C3–C7 with/without spinal stenosis in 19 patients. and were treated with corpectomy of C4 and C6 vertebrae and preservation of C5 vertebrae. Then the operation time, blood loss, bone graft fusion rate at the last follow-up, the improvement rate of JOA score and the cervical lordosis were collected for comparison. Results: all 34 patients are followed-up from 61 to 84 months, the mean follow-up time is 66.18±11.79 months; The mean operation time was 148.97±31.51min(range,115-192min), The average blood loss was 742.28±87.89ml(range,580-1080ml). All of 34 cases got bony union without complications such as subsidence of titanium mesh cage, displacement of plate or screw was found at last follow-up. The JOA score was (12.46±2.83) before the operation, got improvement to (15.28±2.17), (15.36±2.25) and (16.17±1.83) after operation 3 months,6months and at the last follow-up respectively. The mean improvement rate was 58.8%(3 months after operation), 61.8%(6 months after operation), and 62.9%(the last follow-up);The average cervical lordosis changed from（9.19±3.11）mm before the operation to（12.79±4.15）mm 3 months after operation and（13.11±3.19）mm at last follow-up; Postoperative complications including temporary hoarseness (2 patients), and C5 nerve root palsy (3patients), and improved after 2-week conservative treatments and had resolved completely at the 6-week follow up. Conclusions: This study demonstrated modified anterior cervical corpectomy and fusion preservation C4 or C5 vertebral body can achieve satisfactory outcome during short and medium-term follow-up in the treatment of 4-level CSM. In this series, neither signifcant subsidence of titanium mesh cage nor signifcant loss of cervical lordosis correction was seen, postoperative lateral radiograph of the cervical spine at last follow-up showing obtaintion of solid fusion.

Objective: Perioperative bleeding volume of posterior spinal surgery is relatively large. This study was aimed to evaluate the hemostatic effect of Hemocoagulase agkistrodon for injection on open lumbar spine surgery. Methods: In this study, a prospective, blinded, randomized, and controlled clinical trial was used to observe the hemostatic effect of 2U intravenous injection of Hemocoagulase agkistrodon 15 minutes before surgery on the posterior lumbar open surgery. A total of 60 cases were included in this experimental study, 30 cases in the study group (2U agkistrodon hemagglutinin for intravenous injection 15 minutes before surgery) and 30 cases in the control group (Inject normal saline 15 minutes before surgery). We use SAS software to simulate and generate random codes. The third-party blinding method is adopted, that is, a specialized nurse is assigned to allocate study drugs in the order of random codes and intravenously according to the plan. We statistically analyzed the bleeding volume and postoperative drainage volume of posterior lumbar spine surgery, and the changes of coagulation indexes in the two groups. Results: All the selected patients successfully completed the operation, their wounds healed and were discharged from the hospital, and no complications such as infection and thrombosis occurred during the hospitalization. The two groups of patients' coagulation function indicators include prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen quantification (FIB), and D2 polymer. The difference was not statistically significant. However, comparing the intraoperative blood loss, 24h postoperative drainage, and postoperative total drainage between the two groups, the experimental group was better than the control group. Conclusion: Intravenous injection of Agkistrodon hemagglutinin 2U 15 minutes before surgery can have a satisfactory hemostatic effect on the posterior lumbar spine surgical incision. It can not only significantly reduce the amount of bleeding from surgical incisions, but also has no significant effect on the body's coagulation function. It is a safe and effective hemostatic drug.