The Results Of Anterior Cervical Discectomy And Fusion For The Treatment Of Single Or Multi Segmental Cervical Spondylosis Under The Microscope

ObjectiveTo study the The results of anterior cervical discectomy and fusion for the treatmentof single or multi segmental cervical spondylosis under the microscopeMethodA retrospective study of58cervical spondylosis patients（33males and25females，average55.2years old， Spinal cervical spondylosis35, cervicalspondyloticradiculopathy23） who treat by anterior cervical discectomy and fusion under themicroscope. Single segment in32cases, double segments in18cases,three segmentsin8cases, a total of92gap. Operation method: anterior lesion clearance undermicroscope and complete decompression.According to the posteriorlongitudinal ligament lesions were divided into type four:1.posterior longitudinalligament has worn out without hypertrophy;2.posterior longitudinal ligamenthypertrophy without worn out;3.posterior longitudinal ligament have hypertrophyand worn out;4.posterior longitudinal ligament have hypertrophy and calcification.Different decompression operation according to the different types of longitudinalligament. Including simple tick the nucleus pulposus induced pressure,partialresection of the posterior longitudinal ligament or total resection of theposterior longitudinal ligament and resection of the osteophyte, select the appropriatecage interbody fusion and plate fixation. Spinal cord electrophysiological monitoringduring operation. All patients on the3postoperative day,3months, six months,1yearfollow-up examination of cervical vertebra side position piece、dynamic radiographsand evaluate JOA score. Measuring the incision length,record intraoperative hemorrhage. All datas were analyzed by t test using SPSS19.0software, the differencewas statistically significant when P<0.05.ResultAll the cases were followed up, the following time was6～18months, average13.5months. There were no screw loosening, bone block graft detachment and othercomplications.It was found that fusion were reached well. The spinal cordfunction was improved in all patients after operation. JOA score in patients with singlesegmental decompression from preoperative7.35±1.24to14.34±1.12(P<0.05);JOA score in patients with double segmental decompression from preoperative6.95±1.32to13.87±1.13(P<0.05); JOA score in patients with threesegments decompression from preoperative6.78±1.30to13.56±1.05(P<0.05). Theaverage length of a single segment decompression operation incisionwas23.5mm, theaverage intraoperative bleeding was40ml. The average length of a doublesegments decompression operation incisionwas30mm, the average intraoperativebleeding was55ml. The average length of three segments decompression operationincisionwas34.5mm, the average intraoperative bleeding was70ml. All cases ofintraoperative electrophysiological monitoring are used.58cases were detected SEP,the amplitude of SEP were improved in all patients in the intraoperative spinalcord immediately after decompression.52cases detect MEP,6other patients did notdetect MEP, but recovered well.ConclusionAnterior cervical decompression in treatment of single section and multisegmentalcervical spondylosis can achieve satisfactory effect. The operation according to theherniated nucleus pulposus, posterior longitudinal ligament and osteophyte asdecompression operation corresponding. The microscope operation clear field ofvision, improve safety and thorough decompression. Spinal cord monitoring atSEP after decompression is improved, can be used as a prompt radical decompression.