Effect Of Anterior Approach With Two Cervical Intervertebral Disc Resection In The Treatment Of Cervical Spondylotic Myelopathy

[Objective] Patients with single segmental or adjacent 2-level segmental cervical spondylotic myelopathy were given anterior approach operation, with Caspar distraction device and curet or with trepan to remove the intervertebral disc. Whether there are differences in the operative complications and postoperative clinical curative effect were compared.[Method] 72 patients with single segmental or adjacent 2-level segmental cervical spondylotic myelopathy from September 2011 to December 2013 were included in this study. And their clinical data were reviewed and analyzed. According to the different numbers of cervical spondylosis segments, the anterior cervical discectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) were used, and all the operations were conducted by the same leading doctors. Caspar distraction device and curet were used to remove the intervertebral disc in 35 cases of the experimental group during surgery while trepan was used in 37 cases of the control group. Mean postoperative follow-up was 13 months. Follow-up, telephone visit, mail visit, etc. were used to count the surgical complications, such as postoperative amelioration of nerve function, preoperative and postoperative VAS score, and the changes of cervical vertebra curve. By statistical analysis on the above indexes, statistical significance was observed.[Result] 72 patients have received effective postoperative review. For patients followed up for more than 1 year, all the bone graft sites were well fused. Based on the statistics, the incidence of complications was 8.75% in 35 cases of the experimental group, and 2.78% in 37 cases of the control group. No statistical difference was found through comparison (P>0.05). Preoperative cervical vertebra curves were increased by (3.51±0.28) mm and (2.36±0.34) mm respectively in two groups at the first review, with statistically significant (P<0.05). While 1 year after operation, the cervical vertebra curves were increased by (1.82±0.31) mm and (1.76±0.39) mm respectively, and the difference was not statistical (P>0.05). Postoperative amelioration rates of nerve function were (47.82±11.70)% and (53.94±10.25)% at 3 months after the surgery, while (50.10±5.39)% and (63.23±5.72)% at 1 year after the surgery. And no statistical difference was found in pairwise comparison (P>0.05). VAS scores were decreased by (2.66±0.31)points and (2.00±0.24)on the 3 days after the surgery, while by (3.14±0.35) and (2.77±0.26) at 1 month after the surgery compared with the baseline. No statistical difference was found in through comparison (P>0.05).[Conclusion] During the surgical treatment for single segment or adjacent segmental myelopathic cervical spondylosis, no statistical differences were found through comparing the complications and long-term clinical curative effect of the two excision modes. They were found both feasible and effective way of operation. Anterior approach operation to treat single segment or adjacent segmental myelopathic cervical spondylosis had significant curative effect and fewer complications. The patients’ preoperative nerve function was recovered obviously, and the physiological radian of cervical vertebra could be better restored and maintained.