Anterior cervical discectomy and fusion versus corpectomy and fusion in treating two-level adjacent cervical spondylotic myelopathy: a minimum 5-year follow-up study.

OBJECTIVE

A retrospective study was performed to compare the clinical and radiological outcomes of two-level anterior cervical discectomy and fusion (ACDF) with those of single-level anterior cervical corpectomy and fusion (ACCF) in treating two adjacent level cervical spondylotic myelopathy (CSM) with at least 5-year follow-up.

METHODS

A total of 46 consecutive patients who underwent surgery for the treatment of two-level CSM in our institution were evaluated from February 2002 to December 2007. In this series, 22 patients underwent two-level ACDF (group ACDF) and 24 received single-level ACCF (group ACCF). The operation duration, blood loss, perioperative complication, fusion rate, neural function (mJOA score) and the segmental lordosis of the surgical level were compared between the two groups.

RESULTS

The mean follow-up time was 84.5 ± 13 months in group ACDF and 86 ± 11 months in group ACCF (P = 0.723). The rates of perioperative complications were 18.2 % in group ACDF and 20.8 % in group ACCF, respectively (P > 0.05). Although there was no significant difference in neural function (mJOA score) between the two groups at the final follow-up (P > 0.05), the blood loss and the operation duration were significantly less in group ACDF than those in group ACCF (P < 0.05). The fusion rates at the 12th week after surgery were 86.4 % (19/22) in group ACDF and 87.5 % (21/24) in group ACCF (P > 0.05). According to the radiographs measurement, the segmental lordosis at the surgical segment was significantly greater in group ACDF than that in group ACCF (P < 0.05).

CONCLUSION

There were high fusion rates and excellent clinical outcomes in both ACDF and ACCF for treating two adjacent level CSM. However, there were less blood loss, less operation duration and better cervical lordosis in group ACDF than those in group ACCF.