A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy

Qiu-shui, Lin; Zhou, Xuhui; Wang, Xinwei; Cao, Peng; Tsai, Nicholas; Yuan, Wen

doi:10.1007/s00586-011-1961-9

Cited by 136 publications

(143 citation statements)

References 29 publications

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“…In that study, there were three patients with non-fusion levels, all of whom underwent three-or four-level fusion surgery rather than one-or two-level fusion surgery. This phenomenon is consistent with previous reports [10][11][12] that additional plate augmentations enhance the fusion rate in cervical fusion with autograft alone. Therefore, plate augmentation is better than the cage alone procedure in cases of multilevel cervical fusion because plate fixation may decrease the micromovement of the surgical area.…”

Section: Discussionsupporting

confidence: 93%

“…However, instrumented multilevel ACDF allows restoration of cervical lordosis and offers a greater biomechanical stability than long strut graft [5][6][7][8]. Three-or four-level anterior cervical discectomy with autograft and plate fixation has produced relatively good fusion rates and outcomes [9][10][11], but donor site morbidity and the limitations of autograft harvest remain problematic [6]. Equivalent fusion rates have been reported after allografting and autografting are combined using anterior plates and segmental screws [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

2012

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Introduction Three-or four-level anterior cervical discectomy and fusion with autograft and plate fixation have demonstrated relatively good fusion rates and outcomes, but donor site morbidity and the limitations of autograft harvest remain problematic. The purpose of this study is to assess the radiographic and clinical outcomes of three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct. Methods This retrospective review included 43 consecutive patients who underwent three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct (three level: 39 cases, four level: 4 cases). The fusion rate, time to fusion, Cobb angle and disc height were assessed radiographically. Clinical outcomes were evaluated with the VAS, NDI, and SF36 scores. Complications were also recorded. Results Solid fusion was achieved in all the patients, and mean time to fusion was 13.7 ± 5.1 weeks. The postoperative Cobb angle, lordotic angle, and disc height (5.6°, 10.5°a nd 3.15 mm, respectively) increased significantly compared to preoperative values (p = 0.038, p = 0.032, and p = 0.0004, respectively), and these improvements were maintained through final follow-up. The postoperative NDI (17.2), VAS (2.8), and SF36 (13.1) scores increased significantly compared to the preoperative scores (p = 0.026, p = 0.0007 and p = 0.041, respectively). Complications included three cases of respiratory difficulty, four cases of dysphagia and one case of hoarseness. There were no cases of donor site morbidity. Conclusions Three-or four-level anterior cervical discectomy and fusion with a PEEK cage, and plate construct provide good clinical and radiographic outcomes including high fusion rates, low complication rates, low donor site morbidity, and good maintenance of the lordotic angle and disc height in the treatment of multilevel cervical spondylosis.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

2012

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“…The neurological condition of our patients was also significantly improved postoperatively, which is in accordance with the relevant literature [15,16]. Lin et al [17] recently published a retrospective series of 120 patients who underwent ventral decompression for the treatment of symptomatic spondylotic myelopathy. The mJOA was significantly improved from 9.25 preoperatively to 13.86 at 2 years postoperatively.…”

Section: Clinical Improvementsupporting

confidence: 91%

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Zaïri

Aboukaïs²,

Thines³

et al. 2012

Eur Spine J

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Background In patients with cervical spondylotic myelopathy, ventral disease and loss of physiological cervical lordosis are indications for anterior approach. As bone graft and titanium cage present many drawbacks, expandable titanium cage has been recently introduced for this indication. The authors present the clinical and radiological outcomes in patients undergoing the placement of an expandable cage in the treatment of spondylotic myelopathy with straight or kyphotic cervical spine alignment. Methods This was a retrospective review of prospectively collected data. A total of 26 patients underwent cervical corpectomy and reconstruction using an expandable titanium cage and anterior plate between 2005 and 2008. Pain and functional disability were measured using VAS and mJOA preoperatively and at 3 months, 6 months, 1 year and 2 years. Kyphosis was measured using lateral radiographs at the same points of follow-up. Fusion was evaluated on flexion-extension radiographs at 2 years. Results The mean VAS improved from 4.2 to 1.7 and the mean mJOA increased from 12.85 to 16.04 at 2 years postoperatively (p \ 0.05). The mean kyphosis angle decreased from 17°to 2°at the last follow-up (p \ 0.05). The fusion rate was 100 % at 2 years. Three complications were reported including a transient dysphagia, an epidural hematoma and an early hardware migration.Conclusion Expandable titanium cage is an effective device, which achieves good clinical and radiological outcomes at a minimum 2-year follow-up.

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“…Among several anterior and posterior techniques that have been suggested, controversy exists regarding the optimal approach for surgical treatment of cervical spondylotic myelopathy (CSM) [1][2][3]. Distinctions between anterior, posterior, and combined approaches for decompression are primarily based on the sagittal alignment of the spinal column, extent of disease, location of the compressive abnormality, presence of preoperative neck pain, and previous operations [2].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

2012

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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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A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy

Cited by 136 publications

References 29 publications

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

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