[Comparative analysis of two hybrid technique in treating multilevel cervical spondylotic myelopathy via anterior...

To compare the clinical effects and complications of two hybrid decompression techniques in treating multilevel (>=3) cervical spondylotic myelopathy(MCSM).

The clinical data of 124 patients with multilevel (>=3) cervical spondylotic myelopathy treated by surgery and follow-up from January 2008 to December 2016 were retrospectively analyzed. According to the different operative methods, the patients were divided into group A and group B. Anterior cervical discectomy and fusion (ACDF) combined with anterior cervical corpectomy and fusion with preserved posterior vertebral wall (PWCF) were performed in group A; ACDF combined with anterior cervical corpectomy and fusion(ACCF) were performed in group B. There were 44 males and 16 females in group A with an average age of (60.43±7.52) years old, 46 males and 18 females in group B with an average age of (61.61±6.39) years old. No significant differences were found in gender, age between two groups. The operative time, intraoperative blood loss, hospital stay, rate of complications, postoperative Japanese Orthopaedic Association (JOA) score and improvement of cervical curvature were compared between two groups.

All the operations were successful. The follow-up time was 13 to 28(23.0±12.1) months in group A and 12 to 30(24.0±11.5) months in group B. The operative time, intraoperative blood loss, hospital stay in group B were higher than those in group A(P<0.05). A total of 37 patients occurred complications, including 14 cases in group A and 23 cases in group B. The incidence of complications was 23.33%(14/60) in group A and 35.94%(23/64) in group B. The incidence of complications in group B was significantly higher than that in group A(P<0.05). Postoperative JOA scores were significantly improved (P<0.01), there was no significant difference between two groups (P>0.05). The physiological curvature of cervical vertebra was improved significantly after operation, and there was no significant difference between two groups(P>0.05).

Both surgical methods can obtain satisfactory clinical efficacy for multilevel(>=3) cervical spondylotic myelopathy, but compare with group B (ACDF combined with ACCF), group A (ACDF combined with PWCF) has shorter operation time, less trauma, less bleeding, and lower incidence of complications. ACDF combined with PWCF can be preferentially selected for the patients who corresponding to the indications.