Comparison of Anterior Cervical Discectomy and Fusion with Cervical Laminectomy and Fusion in the Treatment of 4‐Level Cervical Spondylotic Myelopathy

Orthopaedic Surgery

Wei Zhang¹  Xian‐zheng Wang¹  Lei Guo¹  Chen‐hao Dou¹  Yapeng Sun¹  Fei Zhang¹  Huanan Liu¹  Jia‐qi Li¹  Peng Zhang¹ 

[1] Department of Spinal Surgery The Third Hospital of Hebei Medical University Shijiazhuang China;

关键词: Anterior cervical discectomy and fusion;    Cervical laminectomy and fusion;    Cervical spondylotic myelopathy;   

DOI  :  10.1111/os.13058

来源: DOAJ

【 摘 要 】

Objective To assess and compare the therapeutic effects of Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Laminectomy and Fusion (CLF) in the treatment of 4‐level cervical. Methods We performed a retrospective review on 39 patients with 4‐level CSM who underwent ACDF or CLF in the Third Hospital of Hebei Medical University from January 2010 to December 2018. The patients were divided into ACDF group and CLF group according to the treatment. The operative index was evaluated based on intraoperative blood loss and operation time. The functional outcomes including Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) of axial pain were compared. The Cobb angle, Cobb angle improvement rate, range of motion (ROM) and ROM loss ratio were measured for radiographic evaluation. Results No major complications or deaths occurred. The average age at baseline was 55 years. There was no significant difference between the ACDF and CLF group in follow‐up time (26.29 months, 25.39 months, P > 0.05). The intraoperative blood loss was higher in the CLF group than in the ACDF group (692.67 ± 38.68 vs 392.14 ± 128.06, P < 0.05). The operation time was longer in the CLF group than in the ACDF group (206.60 ± 49.37 vs 172.64 ± 31.96, P < 0.05). Significant improvements in the VAS and JOA scores were observed in both groups (P < 0.05). No significant difference in VAS was found between the ACDF and CLF groups (P < 0.05). There was a significantly larger improvement rate of JOA score in the ACDF group than in the CLF group (60.9% ± 9.57% vs 31.5% ± 15.70%, P < 0.05). There were two (9.6%) cases with complications In the ACDF group, including one (4.8%) case of dysphagia and one (4.8%) case of pharyngodynia. In the CLF group, two patients (11.1%) developed C5 palsy. No significant difference in the incidence of complications, ROM loss ratio and Cobb angle improvement rate was found between group ACDF and group CLF (all P < 0.05). Conclusion Both ACDF and CLF were effective in the treatment of multi‐level cervical spondylosis and ACDF is more suitable for patients with 4‐level CSM.

【 授权许可】

Unknown