Department of Orthopedics, Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
Eur Spine J. 2010 May;19(5):713-9. doi: 10.1007/s00586-010-1319-8. Epub 2010 Feb 21.
Anterior decompression and fusion is an established procedure in surgical treatment for multilevel cervical spondylotic myelopathy (MCSM). However, contiguous corpectomies and fusion (CCF) often induce postoperative complications such as nonunion, graft subsidence, and loss of lordotic alignment. As an alternative, noncontiguous corpectomies or one-level corpectomy plus adjacent-level discectomy with retention of an intervening body has been developed recently. In this study, we prospectively compared noncontiguous anterior decompression and fusion (NADF) and CCF for MCSM in terms of surgical invasiveness, clinical and radiographic outcomes, and complications. From January 2005 to June 2007, 105 patients with MCSM were randomized to NADF group (n = 55) and CCF group (n = 50), and followed up for average 31.5 months (range 24-48 months). Average operative time and blood loss decreased significantly in the NADF group as compared with those in the CCF group (p < 0.05 and <0.001, respectively). For VAS, within 3 months postoperatively, there was no significant difference between the two groups. But at 6 months after surgery and final follow-up, VAS improved significantly in NADF group than that in CCF group (p < 0.05). No significant difference of JOA score was observed between the two groups at every collection time. In NADF group, all 55 cases obtained fusion at 1 year after operation (average 5.1 months). In CCF group, 48 cases achieved fusion 1 year postoperatively, but the other 2 cases were performed posterior stabilization and achieved fusion 6 months later. The differences of cervical lordosis between two groups were insignificant at the same follow-up time. But the loss of lordosis and height of fusion segments in 6 months postoperatively and final follow-up were significantly more in CFF group than in NADF group (p < 0.001). Complications were similar in both groups. But in CCF group three cases needed reoperation, one case with extradural hematoma was immediately re-operated after anterior decompression and two cases mentioned above were performed posterior stabilization at 1 year postoperatively. In conclusion, in the patients with MCSM, without developmental stenosis and continuous or combined ossification of posterior longitudinal ligaments, NADF and CCF showed an identical effect of decompression. In terms of surgical time, blood loss, VAS, fusion rate and cervical alignment, NADF was superior compared with CCF.
前路减压融合术是治疗多节段脊髓型颈椎病（MCSM）的一种既定手术方法。然而，连续椎体切除术和融合术（CCF）常导致术后并发症，如不愈合、移植物下沉和前凸丢失。作为一种替代方法，最近开发了非连续椎体切除术或单节段椎体切除术加相邻节段椎间盘切除术，保留中间节段。在这项研究中，我们前瞻性地比较了非连续前路减压融合术（NADF）和 CCF 在 MCSM 患者中的手术侵袭性、临床和影像学结果以及并发症。从 2005 年 1 月至 2007 年 6 月，105 例 MCSM 患者被随机分为 NADF 组（n = 55）和 CCF 组（n = 50），平均随访 31.5 个月（24-48 个月）。与 CCF 组相比，NADF 组的手术时间和出血量明显减少（p < 0.05 和 <0.001）。术后 3 个月内，两组 VAS 评分无显著差异。但术后 6 个月和末次随访时，NADF 组 VAS 评分明显优于 CCF 组（p < 0.05）。两组在各采集时间 JOA 评分无显著差异。NADF 组术后 1 年（平均 5.1 个月）所有 55 例均获得融合。CCF 组术后 1 年有 48 例获得融合，但另外 2 例进行后路稳定治疗，6 个月后获得融合。两组在同一随访时间的颈椎前凸无显著差异。但 CCF 组术后 6 个月和末次随访时的前凸丢失和融合节段高度丢失明显多于 NADF 组（p < 0.001）。两组并发症相似。但在 CCF 组中，有 3 例需要再次手术，1 例硬膜外血肿在前路减压后立即再次手术，上述 2 例在术后 1 年进行后路稳定治疗。综上所述，对于多节段脊髓型颈椎病患者，在无发育性狭窄和连续或联合后纵韧带骨化的情况下，NADF 和 CCF 具有相同的减压效果。在手术时间、出血量、VAS、融合率和颈椎排列方面，NADF 优于 CCF。
