The Value Of Anterior Cervical Decompression And Bone Grafting Adding Internal Fixation For The Treatment Of Cervical Spondylosis

The cervical spine afflicted by degenerative spondylosis is a frequent target for surgical intervention. The etiology and pathogenesis of cervical spondylosis is varied. The natural history of myelopathy is varied with neurological improvement in some patients and deterioration in function in others. The optimal procedure for the treatment of cervical spondylosis remains controversial.The anterior approach to the cervical spine was developed hi the 1950s by Baily and Badgley, Smith and Robinson, and Cloward. Since that time, anterior cervical diskectomy and interbody fusion (ACDF )had been applied to the treatment of cervical stenosis resulting from herniated discs and spondylosis. For spinal cord compression at multiple levels, numerous anterior decompression options exist. Although the rate of neurological improvement remains high for multilevel ACDFs, the incidence of nonunion and other complications increases with the number of levels being fused. Because of the problems of instability, many author have reported the use of an additional anterior plating to decrease theincidence of these known complications. The use of anterior cervical plating in cervical spondylosis surgery has increase recently.Anterior cervical plating offers the advantages of providing immediate internal stability, increasing bone fusion rates and minimizing the need for postoperative external immobilization. The use of anterior cervical plating after anterior cervical decompression and fusion to treat cervical spondylosis is controversial. The purpose of this study was to evaluate the value of anterior cervical decompression and bone grafting adding internal fixation with an anterior cervical self-locking plate in a large group of patients.Materials and MethodsClinical dataFifty-two patients, 42men and 10 women, were treated by anterior cervical decompression and bone grafting adding internal fixation with an anterior cervical self-locking plate. Patients' ages ranged from 36 to 73 years (mean age 54 years). There were 10 patients with radiculopathy and 42 patients with myelopathy. Cervical radiculopathy pain was measured by a Numerical Rating Scales (NRS), the preoperative mean NRSs was 7.9 points. The severity of myelopathy was valuated by the Japanese Orthopaedic Association (JOA) score. The preoperative mean JOA score was 9.4 points. Fifteen had one-level disease, thirty two-level disease, and seven three -level disease. Operative techniqueAll patients were operated by the same senior surgeon. Patients with one-level disease were performed anterior cervical diskectomy and interbody fusion (ACDF). Patients with two-level or three-level disease were performed anterior corpectomy and interbody fusion (ACF). All patients included in the study were stabilized with autogenous iliac crest graft and internal fixation with anterior plate. In the majority of the cases, anterior internal fixation was obtainedusing ZEPHIR plate (Sofamor Danek). Clinical evaluationFollow-up radiography and clinical examinations were performed by the surgeon, and the medical records were reviewed extensively. Fusion was judged by the absence of motion between the spinous processes on flexion-extension lateral radiographs, absence of radiolucent gap between the graft and the endplate, and the presence of continuous, bridging, bony trabecular at the graft-endplate junction. Hardware and bone graft related complications were reviewed as well. Outcome were subjectively grade on the basis of patient symptoms at final follow-up assessment, work status, and subjective rating of the pain level. These were graded by Odom's criteria.ResultsAll patients were followed up for mean 18.8 months .The mean postoperative NRS was 2.5 points in the radiculopathy patients. The mean postoperative JOA score was 14.0 points in myelopathy patients. The postoperative JOA scores did not correlate with the number of fusion levels .All patients had a solid bone fusion at all levels. All screws and plates were positioned correctly without immediate...