Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

Abstract

Purpose We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM). Methods A total of 40 patients who underwent ACDF or ACCF for multilevel CSM were divided into two groups. Group A (n = 25) underwent ACDF and group B (n = 15) ACCF. Clinical outcomes (JOA and VAS scores), perioperative parameters (length of hospital stay, blood loss, operation time), radiological parameters (fusion rate, segmental height, cervical lordosis), and complications were compared. Results Both group A and group B demonstrated significant increases in JOA scores and significant decreases in VAS. Patients who underwent ACDF experienced significantly shorter hospital stays (p = 0.031), less blood loss (p = 0.001), and shorter operation times (p = 0.024). Both groups showed significant increases in postoperative cervical lordosis and achieved satisfactory fusion rates (88.0 and 93.3 %, respectively). There were no significant differences in the incidence of complications among the groups. Conclusions Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM.However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.

Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up

“…In the past few years, cervical motion preserved through implantation of artificial disc prosthesis has been proved to be an effective and safe alternative option in 1 and 2 level pathologies [10,17,23,39]. However, anterior cervical discectomy and fusion (ACDF) remains the gold standard in the surgical treatment of the patients with multilevel CSM, resulting in well established results and less complications [19,28,36]. The use of stand-alone cage technology in cervical spondylosis was first introduced by Bagby [1].…”

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

“…Studies reported on differences between anterior and posterior approaches (n = 9); 15,18,19,22,30,42,44,48,59 laminoplasty and laminectomy and fusion (n = 4); 10,19,70,72 anterior decompression and Bryan disc (n = 1); 11 and anterior cervical discectomy and fusion (ACDF) and corpectomy (n = 2). 47,63 In addition, 11 studies compared laminoplasty techniques or considered technical differences such as laminoplasty with and without foraminotomy or muscle preservation. 28,29,34,38,39,43,57,58,60,66,71 …”

Anterior corpectomy and fusion for two adjacent levels of cervical stenosis

“…Cervical corpectomy represents an alternative technique, which creates a better access to osteophytes behind the vertebral body. Both techniques seem to have similar clinical outcomes and fusion rates when treating two adjacent levels [1]. The number of complications such as cage subsidence, dysphagia, and hoarness of nerve root palsy, increases in double level corpectomies [3].…”

“…Multilevel anterior cervical discectomy and fusion represents a current technique in the treatment of spondylotic myelopathy and myeloradiculopathy, if the stenosis remains limited to the level of the disc and the lateral recess [1]. A partial or complete corpectomy and fusion may be preferable in situations where access to the posterior aspect of the vertebral body is needed.…”