Two-level anterior cervical discectomy versus one-level corpectomy in cervical spondylotic myelopathy.

摘要

STUDY DESIGN: A retrospective investigation of clinical and radiologic outcomes after surgical treatment for 2-level cervical spondylotic myelopathy (CSM). OBJECTIVE: The study was undertaken to compare the outcomes of 2 different anterior approach types for 2-level CSM. Specifically, 2-level anterior cervical discectomy and fusion (ACDF) was compared with 1-level anterior cervical corpectomy and fusion (ACCF). SUMMARY OF BACKGROUND DATA: The optimal surgical approach for 2-level CSM has not been defined, and thus, the relative merits of 2-level ACDF and 1-level ACCF remain controversial. However, few comparative studies have been conducted on these 2 surgical approaches. METHODS: The authors reviewed the case histories of 31 patients that underwent surgical treatment for 2-level CSM from 2002 to 2006. Cases of myelopathy because of cervical ossification of posterior longitudinal ligament were excluded. Thirty-one patients (16 men and 15 women) of mean age 54.45 +/- 11.6 years (28 approximately 77) were included. The average follow-up period was 26.23 +/- 15.0 months (12 approximately 63). The authors compared perioperative parameters (hospital stays, bleeding amounts, operation times, complications), clinical parameters (Japanese Orthopedic Association scores, Visual Analog Scale scores for neck and arm pain), and radiologic parameters (total cervical range of motion, segmental range of motion, segmental height, cervical lordosis, fusion rate). RESULTS: Of these above parameters, operation time (P = 0.001) and bleeding amount (P = 0.001) were significantly greater in the ACCF group, whereas segmental height (P = 0.018) and postoperative cervical lordosis (P = 0.009) were significantly lower in the ACCF group. However, other parameters were not significantly different in the 2 groups. CONCLUSION: Surgical managements of 2-level CSM using ACDF or ACCF were found to be similar in terms of clinical outcomes. However, 2-level ACDF was found to be superior to 1-level ACCF in terms of operation times, bleeding amounts, and radiologic results.