Comparisons of three anterior cervical surgeries in treating cervical spondylotic myelopathy

Abstract

BackgroundAnterior cervical discectomy and fusion (ACDF) was one of the preferred treatments for degenerative cervical spondylosis. However, the motion of adjacent segment was significantly increased after operation. So cervical disc arthroplasty have been suggested to keep the motion of adjacent segment. A new implant named dynamic cervical implant (DCI) has been developed to keep the motion of adjacent segment.MethodsWe retrospectively reviewed 91 patients treated for single level cervical spondylotic myelopathy with anterior cervical discectomy and fusion (ACDF), dynamic cervical implant (DCI) and cervical total disc replacement (CTDR) between sep 2009 and Mar 2011 in our hospital. They were divided into three groups by surgical methods: ACDF group (group A, 34 cases), DCI group (group B, 25 cases), CTDR group (group C, 32 cases). Operation time, intraoperative blood loss, preoperative and postoperative JOA score and JOA recovery rate were compared among the three groups. Pre-and postoperative hyperextension and hyperflexion radiograms were observed to measure range of motion (ROM) of C2–7, operative and adjacent levels.ResultsThere was no statistical difference in operative time, intraoperative blood loss, and JOA recovery rate (P > 0.05) among three groups. But the differences of their postoperative JOA scores and preoperative JOA scores were of statistical significance (P < 0.05). Compared the pre-and postoperative ROM of C2–7, operative, upper and lower levels of each group respectively, the difference between preoperative ROM and postoperative ROM of group A were of statistically significant (P < 0.05), while was no statistically significant of group C (P > 0.05). There was no statistically significant difference between preoperative ROM and postoperative ROM of upper and lower levels in group B (P > 0.05), but had statistically significance of C2–7 and operative levels (P < 0.05).ConclusionsThree operations are effective therapies for single level cervical spondylotic myelopathy. But each group has respective advantages and disadvantages.

Cervical Disc Replacement vs Anterior Cervical Discectomy and Fusion

“…[19][20][21][22][23][24][25] Mummaneni et al 23 found that CDA patients showed improved neurologic function, more rapid return to work, and better Neck Disability Index scores in a prospective, randomized, controlled comparison with ACDF. A 7-year follow-up by the same investigators revealed that resolution of neck pain and neurologic status after CDA may be maintained beyond the short term, and that revision surgery after CDA was less frequent.…”

“…Some evidence suggests decreased rates of swallowing pathology after CDA. 25,35 Heterotopic ossification (HO) may occur in up to a third of patients after CDA. 19,27 This has also been shown to be a dynamic process and patients can develop progressive HO more than a year after surgery.…”

Dynamic Cervical Implants in Patients With Disc Degenerative Disease: A Single-Center Cohort From the Greek Population

“…There are a few published reports on DCI in patients with cervical disc herniation, myelopathy, and/or radiculopathy [2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. This study aims to report our experience on patients with DCI for degenerative cervical spondylosis in terms of feasibility and safety (Q1), clinical (Q2) and radiological (Q3) effectiveness, and its associated complications (Q4).…”

Surgical treatment for cervical myelopathy

“…There are several surgical techniques for treating cervical myelopathy, however, a consensus has not been reached as to which is most effective at reducing spinal cord compression. 5,6 One reason for this is a lack of knowledge of in vivo spinal cord mechanics. Many groups have investigated spinal cord mechanics in human cadavers and animal models.…”