Modified anterior cervical corpectomy fusion in the treatment of four-level cervical spondylotic myelopathy: a retrospective study with 5-year follow-up

Abstract

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.