| ObjectiveTo compare the outcomes of.Anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy combined with abnormal curvature MethodRetroprectively studied multi-level cervical spondylotic myelopathy patients who were treated surgically in our institute from January 2010 to June 2014.There were two parts of study methods in our study.Firstly,54 patients with multilevel cervical spondylotic myelopathy combined with cervical kyphosis underwent surgical treatment.Among them,29 patients underwent ACDF,and 25 patients underwent LF.For all cases in both two groups,the operation time,intraoperative blood loss,fusion segments,JOA(Japanese Orthopaedic Association)score,Neck Disability Index(NDI),Visual Analog Scale(VAS),change of cervical curvature,range of motion(ROM)and complications were recorded and compared statistically;secondly,128 patients with cervical spondylotic myelopathy with straight cervical curve underwent surgical treatment.Among them,36 patients underwent ACDF(A group),48 patients underwent LF(B group),and 44 patients underwent laminoplaty(C group).In three groups,the operation time,intraoperative blood loss,fusion segments,JOA(Japanese Orthopaedic Association)score,Neck Disability Index(NDI),Visual Analog Scale(VAS),change of cervical curvature,range of motion(ROM)and complications were recorded and compared statistically.Results1.In our first part of study which focused on patients with multilevel cervical spondylotic myelopathy combined cervical kyphosis underwent surgical treatment.Mean operative time has no significant difference as that was 162.7±21.31 minutes in the anterior approach group and 176.3±29.82 minutes in the posterior group(P>0.05).Mean intraoperative blood loss revealed significant difference in both group as that was 135.6±27.84 ml in the anterior approach group and 255.2±32.27 ml in the posterior approach group(P < 0.05).Mean fusion levels revealed significant difference as that was 4.1±0.26 in the anterior approach group and 5.3±0.44 in theposterior approach group(P < 0.05).The mean preoperative JOA score and postoperative score showed no significant difference in both group(preoperative JOA score were8.29±2.73 in the anterior approach group and 8.94±2.08 in the posterior approach group(P>0.05);postoperative JOA score were13.59±2.49 in the anterior approach group and 14.02±1.73 in the posterior approach group at final follow-up(P>0.05)).The mean improvement rate showed no significant difference in both group(mean improvement rate was 55.69±16.3% in the anterior approach group and 58.27±15.7% in the posterior approach group(P>0.05)).The mean preoperative NDI score and mean postoperative NDI score showed no significant difference in both group(mean preoperative NDI score were33.79 ± 11.01 in the anterior approach group and 34.36±8.71 in the posterior approach group(P>0.05);mean postoperative NDI score were16.91±7.46 in the anterior approach group and 15.58±8.13 in the posterior approach group at final follow-up(P>0.05)).The mean preoperative VAS score and mean postoperative VAS score showed no significant difference in both group(mean preoperative VAS score were2.87±1.51 in the anterior approach group and2.46±1.46 in the posterior approach group(P>0.05);mean postoperative VAS score were1.24±1.21 in the anterior approach group and1.19±1.32 in the posterior approach group(P>0.05)).The mean preoperative Cobb angle of the operative site showed no significant difference in both group(mean preoperative Cobb angle of the operative site were-24.31±4.39°in the anterior approach group and-22.71±3.71°in the posterior approach group(P>0.05)).At final follow-up,the postoperative Cobb angle of the operative site revealed significant difference in both group(the postoperative Cobb angle of the operative site were13.65 ± 3.18 ° in the anterior approach group and 6.16±4.18°in the posterior approach group(P<0.01)).The mean preoperative ROM showed no significant difference in both group(mean preoperative ROM were 28.96 ± 6.71°and 30.42 ± 5.39°in the anterior approach group and posterior approach group(P > 0.05)).The Mean postoperative ROM revealed significant difference in both group(mean postoperative ROM were 11.74±6.51°in the anterior approach group and 8.24±5.93°in the posterior approach group,(P<0.05)).There were 16 patients with complications in the anterior approach group and 7 patients with complications in the posterior approach group.(P<0.05).2.In our second pat study which focused on patients with cervical spondylotic myelopathy combined straight cervical curve underwent surgical treatment.Mean operative time was 154.4±17.33 mininutes in A group,162.3±20.17 minutes in the B groupand 145.6±19.67 minutes in the C group(intragroup paired t test,P > 0.05).Mean intraoperative blood loss was 163.4±22.33 ml in A group,242.2±27.73 ml in B group and 203.7±25.13 ml in A group(intragroup paired t test,P<0.01).Mean fusion levels are4.1±0.28 in A group and 5 in B group(t test,P<0.01).The mean preoperative JOA score were 88.77±2.43 in A group,8.32±3.13 in B group and 9.14±2.47 in C group(intragroup paired t test,P > 0.05).Mean postoperative JOA score were13.16±2.06 in A group 13.92±2.77 in B group and 13.61±3.08 in C group at final follow-up(intragroup paired t test,P > 0.05).Mean improvement rate was54.79±14.5% in A group,60.67±18.2% in B group and 53.14±17.4%in C group(intragroup paired chi-square test,P > 0.05).Mean preoperative NDI score were35.29±8.42 in A group,33.49±10.21 in B group and32.83±7.32 in C group(intragroup paired t test,P > 0.05).Mean postoperative NDI score were14.14±9.07 in the A group,15.69±7.23 in B group and17.29±8.84 in C grop,at final follow-up(intragroup paired t test,P>0.05).Mean VAS score were2.43±1.32 in A group,2.49±1.57 in B group and 2.24±1.23 in C group,before operation(intragroup paired t test,P > 0.05),They are improved to 1.31±1.63,1.45±2.27and2.05±2.16,respectively(intragroup paired t test,P > 0.05).Mean Cobb angle of the operative site were3.2±1.69°in A group,2.1±2.73°in the B group and 3.7±2.11°in C group,before operation(intragroup paired t test,P>0.05).At final follow-up,the Cobb angle of the operative site were17.55±4.28°in A group,11.23±5.43°in B group and2.4±2.69°in C group(intragroup paired t test,P<0.01).Mean preoperative ROM were25.36±7.47°in A group,26.43±8.25° in B group and 24.84±6.24°in C group respectively(intragroup paired t test,P > 0.05).Mean postoperative ROM were13.31±5.78°in A group,10.04±6.91°in B group and 17.18±4.32° in C group,respectively,so that there are statistic differences between A group and C group 、B group and C group(P<0.05),and showed no statistic difference between A group and B group(P>0.05).There were 30 patients with complications in A group and 17 patients with complications in B group,19 patients with complications in Cgroup.there are statistic difference between A group and B group 、A group and C group(intragroup paired t test,P<0.05),there is no statistic difference between B group and C group(P>0.05).Conclusion1.For multilevel cervical spondylotic myelopathy combined with cervical kyphosis,ACDF can restore the better lordosis,fuse less levels but have more complications compared with LF.Patients treated with LF can get as good life quality as with ACDF and have less complications although fuse more levels compared with ACDF.2.For multilevel cervical spondylotic myelopathy with straight cervical curve,ACDF can restore the lordosis better,fuse less levels but have more complications compared with other two operation options.Patients treated with LF can get as good life quality as with ACDF and have less complications even fuse a little more levels than ACDF.Patients treated with laminoplasty can get as good recovery of nerve function quality as with ACDF and LF,but have more axial pain cases and have the risk of developing kyphosis.3.Based on our study,for multilevel cervical spondylotic myelopathy combined with soft cervical kyphosis or with straight cervical curve,Laminectomy and fusion maybe one of the best options for management. |
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