Unit of Spinal Neurosurgery and Neurotrauma, Division of Neurosurgery, Maimonides Medical Center, Brooklyn, NY, USA -
Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA -
J Neurosurg Sci. 2021 Aug;65(4):402-407. doi: 10.23736/S0390-5616.18.04563-0. Epub 2018 Oct 2.
Cervical spondylotic myelopathy (CSM) most commonly occurs at the C3-7 levels and is successfully treated by multilevel anterior cervical discectomy and fusion (ACDF) or cervical laminectomy and fusion (CLF), but no procedure has clearly demonstrated superiority. Most prior investigations comparing approaches are limited by marked heterogeneity in the composition of the study groups. This investigation compares ACDF versus CLF surgery specifically at C3-7 in terms of long-term neurological outcome and the fate of the adjacent levels.
Over a twelve-year period, surgeries to treat CSM at C3-7 by ACDF or CLF were retrospectively reviewed. Demographic/clinical data were recorded, pre/postoperative modified Japanese orthopedic association scores (mJOA) were calculated, and any complications were noted.
Of 781 cervical surgery patients, 15 underwent C3-7 ACDF and 49 CLF. There were no differences in patient characteristics or pre/postoperative mJOA scores. Mean follow-up was 52 and 44 months for the anterior and posterior groups, respectively. A complication occurred in 3/15 (21%) of the anterior and 14/49 (28%) of the posterior group. No infections occurred in ACDF patients, but there were three in CLF patients. Pseudoarthrosis occurred in two ACDF patients, neither associated with symptoms. Four in the CLF group had asymptomatic pseudoarthrosis; two others needed reoperation for kyphosis at the inferior level.
Long-term neurological improvement occurs following C3-7 ACDF and CLF to a similar degree. While not statistically significant, fewer complications, were seen following ACDF. The absence of symptomatic adjacent segment degeneration (ASD) following ACDF in this series raises a question for further study whether the statistical likelihood of ASD changes once the C3-7 levels are already fused.
颈椎脊髓病（CSM）最常发生在 C3-7 水平，通过多节段前路颈椎间盘切除术和融合术（ACDF）或颈椎板切除术和融合术（CLF）可成功治疗，但没有哪种手术方法明显具有优势。大多数比较手术方法的先前研究受到研究组组成明显异质性的限制。本研究比较了 C3-7 处 ACDF 与 CLF 手术在长期神经预后和相邻节段命运方面的效果。
回顾性分析了 12 年间采用 ACDF 或 CLF 治疗 C3-7 颈椎脊髓病的手术。记录了人口统计学/临床数据，计算了术前/术后改良日本矫形协会评分（mJOA），并注意到任何并发症。
在 781 例颈椎手术患者中，有 15 例行 C3-7 ACDF，49 例行 CLF。患者特征或术前/术后 mJOA 评分无差异。前路组和后路组的平均随访时间分别为 52 个月和 44 个月。前路组有 3/15（21%）例发生并发症，后路组有 14/49（28%）例发生并发症。ACDF 患者无感染，但 CLF 患者有 3 例。2 例 ACDF 患者发生假关节，均无症状。CLF 组有 4 例患者无症状性假关节；另有 2 例因下节段后凸畸形需要再次手术。
C3-7 ACDF 和 CLF 均可获得类似程度的长期神经改善。虽然没有统计学意义，但 ACDF 组并发症较少。在本系列中，ACDF 后没有出现症状性相邻节段退变（ASD），这引发了一个进一步研究的问题，即一旦 C3-7 水平已经融合，ASD 的统计学可能性是否会发生变化。
