Comparison Clinical Efficacy Of Different Anterior Cervical Methods In The Treatment Of Two-level Contiguous Cervical Spondylosis

Background: The incidence of cervical disease has an increasing trend in common people at present, which seriously influences the work and life level of the people, and even worse is some patients with severe symptoms lose the ability of work, it also can lead to huge economic damage and social burden to the country. For the patients with severe cervical spondylosis should be timely surgically treated. Many studies have shown that different types of anterior cervical surgery in the treatment of two-level contiguous cervical spondylosis can obtain satisfactory results, but which method is the best has yet to reach a consensus.Objective: To compare the clinical and radiological efficacy and safety of three types of anterior cervical surgery in treating two-level contiguous cervical spondylosis.Methods: We retrospectively collected and analyzed clinical and radiologic data of patients who underwent anterior decompression and fusion in the First Hospital of Lanzhou University from January 2012 to October 2015. 62 patients were divided into three groups according to different surgical methods: iliac bone group received anterior cervical discectomy with autogenous iliac bone graft fusion, titanium mesh group received cervical corpectomy with titanium mesh fusion and cage group received anterior cervical discectomy with cage fusion, all groups with anterior plate fixation. Operation time, intraoperative blood loss, complication rate and Japanese orthopedic association(JOA) scores were evaluated. In addition, fusional segment height, fusional segment curvature, the D value and fusion rate were evaluated radiologically and compared among preoperative, immediate postoperative, 3 months after surgery and final follow-up time points respectively.Results: All patients were followed up and the mean follow-up time was 23 ± 5.24 months(range12 to 35 months). SPSS software was used to analyzed the collected data. Results showed that operation time of the iliac bone group was significantly longer than that in titanium mesh and cage groups(P < 0.05). Intraoperative blood loss of iliac bone group was more than that of iliac bone group and that of cage group was the least(P < 0.05). JOA scores were significantly improved after treatment(P < 0.05), no significant difference was found at different time points(P > 0.05). The fusion rate of iliac bone group was higher the titanium mesh and Cage groups(P < 0.05) at 3 months after treatment, all patients showed complete fusion at the last follow-up. Height of anterior and posterior margin of vertebral body was significantly increased after treatment(P < 0.05) and the increase of HAB had no significant difference among groups. The increase in the height of posterior margin in the Cage group was higher than in the iliac bone group and titanium mesh groups(P < 0.05). Vertebral height loss of the anterior margin was higher in the iliac bone group than in the titanium mesh and Cage groups, but vertebral height loss of the posterior margin was highest in the iliac graft group, followed by titanium mesh group and Cage group at 3 months after treatment(P < 0.05). The increase value of Cobb angle was higher in the titanium mesh group than in the bone graft group and Cage group(P < 0.05). At 3 months after treatment, the altered value of Cobb angle was highest in the iliac bone group, followed by titanium mesh group and Cage group(P < 0.05). No significant difference in the height of anterior and posterior margins of the vertebral body and Cobb angle was detectable between final follow-up and 3 months post-treatment(P > 0.05). D value of the three groups was significantly increased after treatment(P < 0.05), no significant difference was found at different time points(P > 0.05). In all included subjects, eight patients with dysphagia after surgery, two patients with laryngeal nerve injury, two patients with slight graft subsidence and three patients with donor site pain. No patients were found with incision infection, tracheal injury, cage or titanium mesh migrate, rupture or malposition of plate and the loose of screws.Conclusion: These findings indicated that three kinds of fusion method for treating two-level contiguous cervical spondylosis could obviously lessen nervous systems and improve cervical vertebra functions. In the iliac bone group, operation time was long and intraoperative blood loss was more. Postoperative height loss of the posterior margin of the vertebral body was visible. Cervical lordosis could be easily induced. Compared with the iliac bone group, titanium mesh and Cage groups could better maintain the height and curvature of the cervical vertebra, but the Cage group had apparent advantages. So, for the patients with two-level contiguous cervical spondylosis, preoperative related examinations, preoperative assessment and combined with the surgeons’ experience and proficiency should be taken into consideration to choose a reasonable surgical method.