Adjacent two-level anterior cervical discectomy and fusion versus one-level corpectomy and fusion in cervical spondylotic myelopathy: Analysis of perioperative parameters and sagittal balance

Abstract

ObjectivesThe optimal surgical strategy for cervical spondylotic myelopathy (CSM) remains controversial; thus, the current study was designed to compare the outcomes of two different anterior approach surgeries for two-level CSM, namely, adjacent two-level anterior cervical discectomy and fusion (ACDF) and one-level anterior cervical corpectomy and fusion (ACCF). Patients and methodsA total of 53 patients who underwent adjacent two-level ACDF and 68 patients who underwent one-level ACCF in the Spinal Surgery Department from January 2010 to October 2017 were retrospectively analyzed. Independent sample t tests and chi-square tests were used to compare perioperative parameters (hospital stays, bleeding amounts and operation times), clinical parameters (Neck Disability Index scores and Visual Analog Scale scores for neck and arm pain), and radiologic parameters (difference in segmental height, T1 slope, C2-7 sagittal vertical axis, C2-7 lordosis, segmental angle, and fusion rate). ResultsThe length of hospital stay (p < 0.01), bleeding amount (p < 0.01), operation time (p < 0.001) and difference in segmental height (p < 0.001) were significantly greater in the ACCF group than in the ACDF group, whereas C2-7 lordosis (p < 0.05) and the segmental angle (p < 0.001) were significantly lower in the ACCF group than in the ACDF group. Other parameters were not significantly different between the two groups. ConclusionBoth ACDF and ACCF provided satisfactory clinical outcomes and fusion rates for CSM. However, adjacent two-level ACDF was associated with shorter hospital stays, less blood loss, shorter operative times, fewer differences in segmental height and greater improvement in segmental lordotic curvature. On most occasions, when either surgical method could be selected, adjacent two-level ACDF as a surgical treatment for CSM may be a worthwhile alternative method to one-level ACCF.