Comparison of clinical efficacy between retention and removal of the vertebral bony endplate in anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy

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BackgroundAnterior cervical discectomy and fusion (ACDF) have a history of more than 60 years to treat cervical spondylotic myelopathy. This study is based on the original classic surgical procedure to remove the bony endplate to expand the range of vertical decompression to analyze and compare the clinical efficacy of two different ACDF in treating cervical spondylotic myelopathy. MethodsThe inpatients in hospital were randomly divided into two groups A and B. Patients in Group A received ACDF surgery with bony endplates preserved, and patients in group B received ACDF surgery with bony endplates removed. All patients were followed-up for three years, and then compared the clinical efficacy from the following aspects, blood loss statistics during and after the operation, Japanese Orthopedic Association's scoring (JOA) standard for cervical spondylotic myelopathy, Cervical curvature index, cervical flexion and extension range, intervertebral bone graft fusion time and fusion rate. Results1. The operative time and intraoperative (postoperative) blood loss in group A were significantly better than that in group B, with statistical significance (P < 0.05)0.2. There was no significant difference in postoperative neurological function recovery, cervical curvature index, cervical flexion and extension activity, and Intervertebral fusion time between two groups (P > 0.05), while group A was superior to group B in terms of bone graft fusion rate (P < 0.05). 3. Four patients (6.7%) in group B suffered from dyspnea due to neck hematoma caused by drainage tube blockage, but all of them were cured immediately and no death occurred. ConclusionsDuring the 3-year follow-up period after the operation, six patients in group B have subsidence and loosening of the internal fixator due to bone subsidence around the implant. Although immediate surgical treatment is not required, renovation surgery is inevitable in the long term.