Objective: To investigate the efficacy and possibly prognositic factors of anterior approach on two-level cervical spondylotic myelopathy. Methods:A retrospective review was performed on 44 cases of two-level cervical spondylotic mydopathy from Jun. 2007 to Sep. 2009. Among the patients,24 cases were male and 20 cases female,with an average age of (60.07±10.77) years (ranged from 39 to 80 years). The affected segments ranged from C3.4-C6.7. Improvements of cervical curvature and segmental height,preoperative sagittal diameter of the spinal cord at the site of maximal compression and signal intensity changes on T2WI were respectively measured. Function of nerves was assessed according to Japanese orthopaedic association system (JOA:17 score) before and after surgery. Operation by anterior approach including:anterior corpectomy and titanium cage fusion with internal fixation ,anterior corpectomy body and auto iliac bone fusion with internal fixation. Statistical analysis was made on the correlation between JOA recovery rate and prognostic factors. Results: Improvements of cervical curvature was -9.1° to 16.6° with the mean of (1.30±5.77)° and improvements of segmental height was -0.3 to 12.3 mm with the mean of (4.23±3.08) mm. Sagittal diameter of the spinal cord at the site of maximal compression was 1.6 to 7.2 mm with the mean of (4.01±1.25) mm. T2WI with high signal changes was in 29 cases,no change in 15 cases. Bleeding amount was 50 to 700 ml with the mean of (242.05±148.22) ml. Operative time was 90 to 250 min with the mean of (153.75±34.54) min. All patients were followed up from 6 to 31 months with an average of (17.18±7.41) months. The mean JOA score preoperatively was (12.73±2.23) ;at the final follow-up,the JOA score was( 15.09±1.91 ) ;and the recovery rate was (60.01±26.98)％. According to standard of JOA scoring, 16 cases obtained excellent result, 12 good, 15 fair and 1 poor. The effect of anterior approach had correlations with age, time of course, preoperative JOA score, sagittal diameter of the spinal cord at the site of maximal compression and signal intensity changes on T2WI, but had no correlations with operation time,bleeding amount and improvements of cervical curvature and segmental height. Conclusion:Two-level cervical spondylotie myelopathy can achieve good effect through anterior approach. The extent of the spinal cord compression may be a reliable and direct factor to judge effect.%目的:探讨双节段脊髓型颈椎病的前路手术疗效及可能的预后因素.方法:回顾性分析2007年6月至2009年9月手术治疗并获得随访的双节段脊髓型颈椎病患者44例,其中男24例,女20例;年龄39～80岁,平均(60.07±10.77)岁;病程1～120个月,平均(27.14±38.97)个月;病变累及椎间隙为C3.4-C6.7.分别测量颈椎弧度改善值和融合节段椎体高度的增加值,以及术前颈髓最大受压部位的矢径和T2加权像的信号强度改变.按JOA评分(17分制)法评定患者术前及术后随访时的神经功能状况.手术方式采用颈前路椎体次全切钛网植骨融合内固定术与颈前路椎体次全切植骨融合内固定术.对JOA评分改善率与可能的预后因素进行统计学分析.结果:颈椎弧度改善值为-9.1°～16.6°,平均(1.30±5.77)°.融合节段椎体高度增加值为-0.3～12.3mm,平均(4.23±3.08)mm.术前颈髓最大受压部位的矢径为1.6～7.2 mm.平均(4.01±1.25)mm.T2加权像出现高信号改变者29例,无变化者15例.手术出血量50～700 ml.平均(242.05±148.22)ml.手术时间90～250min,平均(153.75±34.54)min.44例患者均获得随访,平均(17.18±7.41)个月(6～31个月).JOA评分术前(12.73±2.23)分,末次随访(15.09±1.91)分,术后平均改善率(60.01±26.98)%,优16例,良12例,可15例,差1例.经统计学分析,手术疗效与患者年龄、病程、术前JOA评分、颈髓最大受压部位矢径和T2加权像颈髓信号强度改变密切相关,而与手术出血量、手术时间、颈椎弧度改善值及融合节段椎体高度增加值无关.结论:双节段脊髓型颈椎病可通过前路手术得到良好的治疗效果,颈髓受压程度可作为脊柱外科医师预判手术疗效最为直观可靠的因素.
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