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Cervical corpectomy with preserved posterior vertebral wall for cervical spondylotic myelopathy: a randomized control
Zhang Ying1, Wang Xinwei, Zhang Jing
1Department of Orthopedics Changzheng Hospital, Second Military Medical University of China, Shanghai, PR China.
Study Design:
Cervical corpectomy with preserved posterior vertebral wall (CPW) had been performed by the senior author (Y.W.) since 1999. A prospective study had been conducted to evaluate the efficacy of CPW since 2001.
Objective:
To validate the clinical outcome of CPW against conventional corpectomy (CC).
Summary Of Background Data:
Anterior surgical managements of cervical spondylotic myelopathy (CSM) include discectomy and corpectomy. Both have significant disadvantages, including low fusion rates and residual symptoms. A procedure incorporating multilevel discectomy, corpectomy with preserved posterior vertebral wall, autograft and plating was described. By keeping the posterior vertebral wall (PW), infringement of the vein plexus and spinal canal was avoided and more fusion site was available.
Methods:
From March 2001 to March 2004, 178 cases of CSM were randomized to undergo CPW (n = 89) or CC (n = 89). Arthrodesis was done with autogenous iliac bone graft or titanium cage supplemented with anterior self-lock plates in both groups. Operation time, blood loss, days of hospitalization, the numbers and types of complications, and preoperative and postoperative JOA scores were recorded. Fusion rate, segmental lordosis, and disc height were assessed by roentgenography. Three-dimensional reconstructions of CT scan were used to confirm fusion evidence.
Results:
Average operation time and blood loss decreased significantly in the CPW group (98.06 +/- 19.42 minutes, and 131.69 +/- 62.41 mL) as compared with those in the CC group (108.45 +/- 22.35 minutes, and 181.57 +/- 82.10 mL) (P < 0.05). There were 2 cases of epidural bleeding and 1 case of CSF leak in the CC group. Other complications were minor. JOA improvement scores were similar in both groups. Roentgenograms showed that the fusion rate was 100% at 6 months postoperatively in both groups. CT scans showed that PW fused with grafts and bone dust in cages. Improvement in segmental lordosis and disc height was similar in both groups.
Conclusion:
CPW is a feasible procedure for anterior decompression and fusion, with safety, complete decompression, and high fusion rate, as long as indicative patients are selected.