Liu Jiaming, Chen Xuanyin, Liu Zhili, Long Xinhua, Huang Shanhu, Shu Yong
Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China.
Arch Orthop Trauma Surg. 2015 Feb;135(2):149-153. doi: 10.1007/s00402-014-2123-4. Epub 2014 Nov 26.
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.
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.
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).
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.
进行一项回顾性研究，比较双节段颈椎前路椎间盘切除融合术（ACDF）与单节段颈椎椎体次全切除融合术（ACCF）治疗相邻两节段脊髓型颈椎病（CSM）且至少随访5年的临床和影像学结果。
对2002年2月至2007年12月期间在我院接受手术治疗双节段CSM的46例连续患者进行评估。在该系列中，22例患者接受双节段ACDF（ACDF组），24例接受单节段ACCF（ACCF组）。比较两组的手术时间、出血量、围手术期并发症、融合率、神经功能（改良日本骨科学会评分）以及手术节段的节段性前凸。
ACDF组平均随访时间为84.5±13个月，ACCF组为86±11个月（P = 0.723）。ACDF组围手术期并发症发生率为18.2%，ACCF组为20.8%，差异无统计学意义（P>0.05）。虽然两组末次随访时神经功能（改良日本骨科学会评分）差异无统计学意义（P>0.05），但ACDF组的出血量和手术时间明显少于ACCF组（P<0.05）。术后12周ACDF组融合率为86.4%（19/22），ACCF组为87.5%（21/24），差异无统计学意义（P>0.05）。根据影像学测量，ACDF组手术节段的节段性前凸明显大于ACCF组（P<0.05）。
ACDF和ACCF治疗相邻两节段CSM均有较高的融合率和良好的临床效果。然而，ACDF组较ACCF组出血量更少、手术时间更短且颈椎前凸更好。
