Anterior surgical treatment of 4-level cervical spondylotic myelopathy

Abstract

Objective To investigate the clinical results, neurological scores, radiographic changes and complications for patients with 4-level cervical spondylotic myelopathy(4-level CSM) who underwent anterior decompression and fusion surgery. Methods All the medical records of anterior cervical surgery in our hospital between September 2006 and March 2014 were collected. Among them, thirty-two consecutive patients with 4-level CSM underwent the anterior decompression and fusion procedures were retrospectively investigated. Neurological function was measured at different times using Japanese Orthopedic Association(JOA) scores. The visual analogue score(VAS) was recorded for neck-shoulder pain evaluation. X-rays were conducted before and after surgery for cervical lordosis and fusion rate. Complications such as iliac pain, dysphonia, C5 palsy, cerebral fluid leakage, axial neck pain and temporary dysphagia were recorded and analyzed as well. Results All the operations were performed uneventfully. The mean operative time was 136±18min and mean blood loss was 67±16ml. The overall follow-up period of the patients ranged from 1-8 years(average 3.6±1.7years). The VAS score significantly decreased from 7.3±1.2 preoperatively to 3.6±0.8 at 12 months postoperatively. The JOA score was 9.2±1.6 preoperatively, and 9.6±2.2, 12.5±3.3, 13.2±3.2, 13.7±3.4 at 1 week, 3 months, 6 months and 12 months postoperatively. Autologous iliac bone grafts were used in 4 patients, whose fusion rate was 100% at 6 months postoperatively. Titanium meshes were used in 28 patients, whose fusion rate was 85.7% at 6 months postoperatively and 100% at 12 months postoperatively. No hardware-related complications such as screw pull-out or plate bending occurred during the short-or long-term follow-up. Complications included iliac pain(3 cases), dysphonia(1 case), C5 palsy(1 case), cerebral fluid leakage(2 cases), axial neck pain(5 cases) and temporary dysphagia(1 case). Conclusion Anterior approach for 4-level CSM is a challenging surgical technique. The choice of corpectomy levels should depend on the characteristics of cord compression. C4 and C6 discontinuous corpectomy with titanium mesh graft fusion and plate fixation is recommended procedure. This technique will be safe and effective if proper decompression and steady fixation are guaranteed. Key words: Cervical vertebrae; Spinal cord compression; Spinal fusion; Postoperative complications