The Outcomes of Anterior Spinal Fusion for Cervical Compressive Myelopathy—A Retrospective Review

摘要

Background This study examined the prognostic factors that affect the surgical outcome of anterior spinal fusion in patients with cervical compressive myelopathy (CCM). Methods A retrospective review of the result of surgical treatment in 49 cases of CCM using anterior spinal fusion surgical techniques. The study period was from June 1990 to June 2008, with a mean follow-up of 6.57 years. Seven patients died during the follow-up period because of other medical diseases. The Japanese Orthopaedic Association score for cervical myelopathy and recovery rate were used to assess the functional results of the remaining 42 cases. Results A mean Japanese Orthopaedic Association score improvement from 10.21 to 14.23 points after the operation was observed. The overall recovery rate was 65.38%, with excellent or good results of 80%. After a year of follow-up, we did not find significant improvement or deterioration on the neurological status on further follow-up. Acute complications were not common. One patient underwent re-operation because of slipping of the graft during resuscitation after early post-operative acute myocardial infarction. This patient showed post-operative neurological deterioration. Two patients had subsidence of the graft, three had pseudo-arthrosis, and two had graft resorption. There were also three patients with degenerative changes of the adjacent vertebra. No re-operation was done for patients with these late complications in this review. Conclusion Anterior cervical decompression with bone fusion is a viable surgical option for patients with one level of anterior cervical cord compression, especially for patients with kyphosis or straight canal spine. For patients with two- to three-level involvement, anterior cervical decompression with bone fusion provides good functional result in proper selection of cases. We also identified some prognostic factors (male sex, symptoms less than 1 year, and age less than 70 years) in predicting a favourable outcome of anterior spinal fusion for CCM.