关键词: 减压术, 多节段颈椎病, 骨折内固定术

Abstract:

Objective To discuss the clinical outcome of anterior cervical discectomy and fusion （ACDF）with internal fixation in treating multi-level cervical spondylotic myelopathy. Methods Thirty-seven cases suffer from multi-level cervical spondylotic myelopathy were treated with anterior cervical decompression and fusion with internal fixation by titanium plate in our hospital from Jan. 2012 to Jan. 2015. The clinical outcomes were evaluated by the parameters including improvement of Japanese Orthopaedic Association （JOA） score and neck disability index values （NDI）before operation, one months after operation and at the last follow up, measured cervical Cobb Angle （CA） and Segmental Angle （SA） on X-ray film. Record operation time, intraoperative blood loss, and the incidence of complications. Bony fusion was verified by X-ray at the final follow-up. Results The patients were followed up for 11 to 30 months. VAS scores were decreased from 6.76±2.02 preoperatively to 3.24±1.53 postoperation and 3.0 ± 0.9 at the final follow-up. JOA scores were increased from 9.71 ± 1.66 preoperatively to 13.26 ± 2.14 postoperation and 15.97 ± 16.79 at the final follow-up. NDI scores were decreased from 30.68 ± 8.46 preoperatively to 6.68 ± 3.85 postoperation and 4.14 ± 1.27 at the final follow up. SA were increased from 8.65°±11.03° preoperatively to 18.65°±8.68° postoperation and 18.26°±8.59° at the final follow up. CA were increased from 12.35° ± 12.86° preoperatively to 21.45° ± 9.92° postoperation and 21.43° ± 9.97° at the final follow up. There were significant improvement for all postoperatively and at the final follow up compared with those preoperatively. There were no significant difference between postoperation and at final follow up for all. Height were increased from 70.44 ± 1.64 mm preoperatively to 76.05±7.98 mm postoperation and 76.05±7.98 mm at the final follow up. There was significant improvement for postoperatively compared with that preoperatively. There were no significant difference between that at final follow up and preoperatively. Bony fusion rate was 94.6%, and one case complicated with nerve root injury, one case had a secondary surgery because of cervical haematoma, three had dysphagia after surgery but was improved after treatment, four cases had adjacent segment degeneration. No complications of internal fixation was found. Conclusion  The clinical outcomes of anterior cervical decompression and fusion with internal fixation in treating MCSM is affirmative, and it makes spinal canal decompression and neurologic symptoms ease and fusion rate increase.

Key words: multi-level cervical spondylotic myelopathy , decompression, fracture fixation