[Treatment of cervical spondylotic myelopathy by decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches].

OBJECTIVES

To evaluate the clinical results of treatment of cervical spondylotic myelopathy by decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches, and to study the methodology to prevent operative complications.

METHODS

28 consecutive cases with cervical spondylotic myelopathy, aged 65.3 (49 ~ 73) were treated by decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches from December 2001 to December 2005. The surgical methods included decompression of spinal canal, spinal fusion, and internal fixation with the combination of anterior and posterior approaches. The patients were followed up for 16 months (6 ~ 52 months). The clinical results and complications were analyzed retrospectively. The clinical effects were evaluated by the Japanese Orthopedic Association (JOA) scoring system and Odom's criteria. The outcome of cervical spinal fusion was evaluated by X-ray plate.

RESULTS

There were no neural injury and wound healing problems in all patients. All postoperative patients ambulated three days after the operation. CSF leak occurring in 3 cases was cured by conservative treatment. The recovery rate by the JOA scoring system was 50% when the patients were discharged. According to the Odom scoring system, 83.3% of the patients had excellent and good effects. No evidence of implant failure was found according to the Brantigan's criteria. Interbody fusion was achieved in 3 approximately 6 months after operation in all followed-up patients. No additional operation was needed for the involved segments, the spinal cord function of the patients had been improved in a certain extent, and the surgical outcomes could be maintained.

CONCLUSION

Decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches is necessary and effective in the treatment of severe and multi-level cervical spondylotic myelopathy, but the operative trauma is relatively serious, surgeons must carefully design the operative plan and pay enough attention to the methods to prevent operative complications, especially for the elderly patients.