Clinical Resulte Of Anterior Compression And Its Related Factors Of Multilevel Cervical Myelopathy

Backgrounds: Now , anterior cervical decompression, fusion and internal fixation(ACDF) is one of the most common use for the treatment of Multi-segmental cervical spondylosis myelopathy, MCSM. With the development of the medicine,people have got more about the pathology and pathophysiology of the MCSM. More and more surgeon pay close attention to the clinical outcomes and it's complications. There are many reports about the ACDF's clinical outcomes and associated factors. In order to investigate the factors associated the outcomes of surgery and the incidence of adjacent segment degeneration,we take a retrospective study of the patients who underwent the ACDF from January 2008 to February 2010 in Fujian Provincial Hospital.Objective: To observe cinical results of Multi-segmental cervical spondylotie myelopathy(MCSM) with anterior decompression and the relationship between the outcomes and influential factors(such as gender, age, disease course, preoperative JOA score)Method: We retrospectively studied 30 patients who underwent anterior decompression and resection of the posterior longitudinal ligament in the treatment of multi-segmental cervical spondylotic myelopathy, include 21 male,9 female, aged from 49 years to 80 years with an average of 60.73 years, whose course of disease ranged from 1 to 36 months(average 9.66 months).The vertebrae involved C3 to C6 (9 cases),C3 to C7 (9 cases),C4 to C7 (12 cases).ALL patients' cervical plain films,magnetic resonance imagings(MRI) and computed tomographies(CT) on preoperation and postoperation(within 13 to 24 months) were observed. The JOA scores of preoperation, 2 weeks and 3 months postoperatively were collected. The treatment results and common influencing factors were analyzed.Results: (1).30 cases were followed up 13 months to 24 months, average 19.00 months. All patients improved their functional status in different degree. No complications such as graft dislocation, titanium meshs, screwes and plates loosing or broken were happened.(2).The JOA score rises markedly after operation and the difference is significant in statistics.(3).The treatment results had relationship to patient's age, duration of symptom, preoperative condition and area of spinal cord at the maximum compression. The patient's age is important factor involved the outcome. But the treatment results had no relationship to the gender.Conclusion: 1.Application of titanium mesh in anterior cervical subtotal corpectomy with locking plate and resection of the posterior longitudinal ligament for MCSM is an effectively surgical treatment, which can effectively decompress spinal cord, can give attention to decompression and avoiding complication resulting from resecting more one vertebral ,multilevel decompression can provide good results. 2. Patient's age, duration of symptom, area of spinal cord is in front and back the path are good prognostic indicator to judge the result after posterior decompression.