Comparasion Between The Iliac Bone Autograft And The Titanium Surgical Mesh In Anterior Cervical Decompression And Fusion On The Treatment Of Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy,most dcotors agree,is a kind of spinal dysfunctional disease associated with spinal cord compression and/or spinal cord barriers to blood supply,because of cervical disc degeneration,vertebral height loss,secondary segmental instability,then lead to vertebral body and interbertebral joints heperplasia.The onset of the disease is insidious with course of different lengths and diversified clinical manifestations.Early diagnosis and treatment significantly affect prognosis.Cervical spondylotic myelopathy may cause phyical disablity with its progressive aggravating tendency.Therefore,at present a morjority of doctors believe that cervical spondylotic myelopathy once identified,most patients should do surgery as early as possible,except of a small number of cases treated conservatively.Most clinical reports indicate that after decompression and reconstruction of stability with surgical treatment,spinal cord function was recovered well.Cervical anterior decompression and fusion has been one of main operations of cervical diseases for its thorough decompression of spinal cord and litte impact on physiological cervical function.Recent years,a variety of interface fixations were used besides traditional iliac bone autograft.This article retrospectively concluded two surgical methods with anterior cervical decompression and fusion from January 2004 to March 2008 at our hospital.We evaluated 65 consecutive patients who underwent surgery for treatment of cervical spondylotic myelopathy respectively with TSM and iliac bone autograft,and made a comprasion from operative situation,radiographical data and neurological function improvement. We chose 65 consevative patients up to grade through selection criteria,including into the standard and exclusion criteria.In this series,26 patients underwent TSM and 39 patients underwent iliac bone autograft.Medical records were reviewed to assess outcome,and we did follow up after surgery with mean time 14.1 months(12 months to 18 months).Operative situation was measured by operative time and blood loss,complications after surgery included cervical,iliac and internal fixation complications,radiographs were obtained at 1 weeks,3 months,6 months and 1 year.,which including fusion curvature,height and fusion rate.Nervous functional improvement was measured by the rate of JOA scores changing.Final results showed that①Group A had a significant lower operative time and blood loss(P＜0.01),respectively with 80.0±13.0min,65.4±10.1ml compared with Group B with 94.8±9.6 min,78.3±12.3ml.②there was 1 patient with plate shifting slightly in group B and there were 3 patients with screw loosing plus 1 patient with plate shifting slightly in group A.Two groups had no obvious cervical complication,and complication rate in iliac bone area was 10.3%in group A.but there was no significance in two groups(P＞0.05).③Segmental fusion Cobb in both group had significant improvement after 1 week of surgery compared with preoperation (P＞0.05).However,group B had lower lordosis loss after 3 months of surgery compared with 1 week after sugery,and this change was significantly(P＜0.01).Group B had 0.08o±0.84o,0.04o±0.68o loss respectively,Group A had 0.81o±0.64o,0.51o±0.67o.④There was no significant difference of segmental fusion HAB in two groups(P＞0.05).However,group B had lower height loss in HPB both after 3 months to 1 week and after 1 year to 3 months,the data were respectively 0.21±0.34mm,0.12±0.26mm in group B,and 1.46±0.49mm,0.72±0.38mm in group A,there was significant difference in two groups(P＜0.01).⑤JOA scores in both groups were obviously improved and there was no significant difference in two groups after different period of surgery(P＞0.05).These results above identified that group B had advantages in maintaining the segmental fusion curvature and height after surgery compared with group A.and cervical HPB loss may increase the tension of vertevral anterior post,which may have complications like screw loosen easier to effect fusion rate.Group A had longer operative time and more blood loss for iliac bone autograft,which also may lead to long pain.Therefore,although TSM and the iliac bone autogrft are both important and efctive methods for CSM in the treatment of anterior decompression,TSM is an ideal surgical method for CSM with the same clinical effects,except of minor surgical trauma,better maintaining segmental fusion HPB and lordosis.