Clinical Curative Effect Of Two Methods In Treating Adjacent Two-level Cervical Spondylotic Myelopathy And The Analysis Of Adjacent Segment Degeneration

Objective To compare the the efficacy of adjacent two-level cervical spondyloticmyelopathy and long-term postoperative the differences of adjacent segmentdegeneration by the treatment of anterior cervical corpectomy and fusion(ACCF) andanterior cervical discectomy and fusion(ACDF).Method To review and analysis the patients who receive the treatment ofadjacent two-level cervical spondylotic myelopathy using two different methods inshaanxi province people’s hospital from January2009to December2012.32cases ofpatients were included in the standard and complete follow-up data.(group B), male8cases,7patients were female. To compare the two groups of patients aspect of theneurologic JOA score, axial symptoms(AS) after surgery, fusional segment height,cervical curvature, fusional segment curvature, the rate of fusion and adjacent segmentdegeneration and so on,and then to evaluate the clinical effects of two different surgicaltreatment for adjacent two-level cervical spondylotic myelopathy and the differences ofadjacent segment degeneration long-term postoperative.Results Compared with per-operation, the JOA score of1week,3months and thelast follow-up All have statistical significance in two groups(P<0.05),but there was nostatistically significant in all periods between two groups(P>0.05). The incidence of ASat final follow-up was35.3%(6/17) and20.0%(3/15) for group A and B respectively,with no significant difference (P>0.05).There were no significant differences in fusionalsegment height, cervical curvature and fusional segment curvature between two groups (P>0.05)after operation1week and there were no significant difference in cervicalcurvature and fusional segment curvature between two groups3months and the lastfollow-up after operation, but fusional segment height of B was higher than group A(P<0.05). All the patients obtained bone fusion at final follow-up after operation betweentwo groups. The last follow-up were found that there were no significant differences inadjacent segment degree of osteophytes, protrusions encroach spinal cord and sagittalfunctional diameter of two groups(P>0.05), but the difference was statistically significantcompared with remote segment (P<0.05). The superior and inferior adjacent segmentvertebral canal sagittal diameter decreased significantly and compared with thepreoperative difference have statistical significance(P<0.05) at the last follow-up.Eachgroup has one patient who appear neurological symptoms with spinal cord compressioncaused by serious adjacent segment degeneration and the clinical symptoms improvedsuccessfully after secondary surgery with responsibility intervertebral disc.Conclusion The different treatments of Anterior Cervical Corpectomy andFusion(ACCF) and Anterior Cervical Discectomy and Fusion(ACDF) for adjacenttwo-level cervical spondylotic myelopathy can achieve good therapeutic effect; ACCFand ACDF surgery methods in maintaining cervical curvature and fusional segmentcurvature have no obvious differences, but fusional segment height in group ACCF wassignificantly lower than group ACDF.Two methods of surgery can cause different degreeof adjacent segment degenerative diseases, possible cause is superimposed effect theresult of interaction of adjacent segment change in stresses and kinemation as a result ofthe fusion.