Comparison of 3 Reconstructive Techniques in the Surgical Management of Multilevel Cervical Spondylotic Myelopathy

Yang, Lei; Hou, Yang; Yang, Lili; Chen, Huajiang; Wang, Xinwei; Wu, Xiaodong; Gao, Rui; Wang, Ce; Yuan, Wen

doi:10.1097/brs.0b013e31826c72b4

Cited by 100 publications

(108 citation statements)

References 20 publications

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“…Some reports suggested that 2-level ACCF is associated with complication rates that are as much as 22% higher than that of ACDF. 6,14 Other studies, however, have shown no difference in complication rates between ACCF and ACDF. 13,20 However, one must emphasize again that drawing conclusions from these studies is limited because they do not specifically address the utilization of PSF.…”

Section: Discussionmentioning

confidence: 95%

“…6,13,14,20 Although multiple studies have shown increases in blood loss associated with ACCF, the clinical significance is questionable because the amount of additional blood loss is relatively small (ranging from an additional 46 ml to 273 ml). This volume usually does not warrant blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…6,14 Both studies compared similar perioperative and radiological outcomes following ACDF alone versus hybrid ACDF-ACCF versus ACCF alone. The 2 studies differed mainly by evaluating patients during different time periods.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies that compare ACCF versus ACDF for multilevel CSM do not report or address the utilization of PSF. 6,8,13,14,20 This is a major confounder because a staged procedure days after the initial ACDF or ACCF predictably lengthens a hospital stay.…”

Section: Discussionmentioning

confidence: 99%

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Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes

Lau¹,

Chou²,

Mummaneni³

2015

SPI

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OBJECT In the treatment of cervical spondylotic myelopathy (CSM), anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) are effective decompressive techniques. It remains to be determined whether ACCF and ACDF offer equivalent outcomes for multilevel CSM. In this study, the authors compared perioperative, radiographic, and clinical outcomes between 2-level ACCF and 3-level ACDF. METHODS Between 2006 and 2012, all patients at the authors' hospital who underwent 2-level ACCF or 3-level ACDF performed by 1 of 2 surgeons were identified. Primary outcomes of interest were sagittal Cobb angle, adjacent-segment disease (ASD) requiring surgery, neck pain measured by visual analog scale (VAS), and Nurick score. Secondary outcomes of interest included estimated blood loss (EBL), length of stay, perioperative complications, and radiographic pseudarthrosis rate. Chi-square tests and 2-tailed Student t-tests were used to compare the 2 groups. A subgroup analysis of patients without posterior spinal fusion (PSF) was also performed. RESULTS Twenty patients underwent 2-level ACCF, and 35 patients underwent 3-level ACDF during a 6-year period. Preoperative Nurick scores were higher in the ACCF group (2.1 vs 1.1, p = 0.014), and more patients underwent PSF in the 2-level ACCF group compared with patients in the 3-level ACDF group (60.0% vs 17.1%, p = 0.001). Otherwise there were no significant differences in demographics, comorbidities, and baseline clinical parameters between the 2 groups. Two-level ACCF was associated with significantly higher EBL compared with 3-level ACDF for the anterior stage of surgery (382.2 ml vs 117.9 ml, p < 0.001). Two-level ACCF was also associated with a longer hospital stay compared with 3-level ACDF (7.2 days vs 4.9 days, p = 0.048), but a subgroup comparison of patients without PSF showed no significant difference in length of stay (3.1 days vs 4.4 days for 2-level ACCF vs 3-level ACDF, respectively; p = 0.267). Similarly, there was a trend toward more complications in the 2-level ACCF group (20.0%) than the 3-level ACDF group (5.7%; p = 0.102), but a subgroup analysis that excluded those who had second-stage PSF no longer showed the same trend (2-level ACCF, 0.0% vs 3-level ACDF, 3.4%; p = 0.594). There were no significant differences between the ACCF group and the ACDF group in terms of postoperative sagittal Cobb angle (7.2° vs 12.1°, p = 0.173), operative ASD (6.3% vs 3.6%, p = 0.682), and radiographic pseudarthrosis rate (6.3% vs 7.1%, p = 0.909). Both groups had similar improvement in mean VAS neck pain scores (3.4 vs 3.2 for ACCF vs ACDF, respectively; p = 0.860) and Nurick scores (0.8 vs 0.7, p = 0.925). CONCLUSIONS Two-level ACCF was associated with greater EBL and longer hospital stays when patients underwent a second-stage PSF. However, the length of stay was similar when patients underwent anterior-only decompression with either 2-level ACCF or 3-level ACDF. Furthermore, perioperative complication rates were similar in the 2 groups when patients underwent anterior decompression without PSF. Both groups obtained similar postoperative cervical lordosis, operative ASD rates, radiographic pseudarthrosis rates, neurological improvement, and pain relief.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes

Lau¹,

Chou²,

Mummaneni³

2015

SPI

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“…In the past few years, cervical motion preserved through implantation of artificial disc prosthesis has been proved to be an effective and safe alternative option in 1 and 2 level pathologies [10,17,23,39]. However, anterior cervical discectomy and fusion (ACDF) remains the gold standard in the surgical treatment of the patients with multilevel CSM, resulting in well established results and less complications [19,28,36]. The use of stand-alone cage technology in cervical spondylosis was first introduced by Bagby [1].…”

Section: Discussionmentioning

confidence: 99%

Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up

et al. 2013

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Cervical Disc Herniation

Kido,

Sola

2024

Orthopaedics and Trauma

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Comparison of 3 Reconstructive Techniques in the Surgical Management of Multilevel Cervical Spondylotic Myelopathy

Abstract: The HDF can be considered an effective and safe alternative procedure compared with ACDF in the treatment of the multilevel CSM, and ACCF should be the last option.

Cited by 100 publications

References 20 publications

Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes

Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes

Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up

Cervical Disc Herniation

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