) ACDF. (Japanese Orthopaedic Association,JOA) ACCF (175.4±12.1ml VS 201.3±80.4ml) ACDF JOA VAS (P=0.000),ACCF :A : X(2015)

Transcription

1 Chinese Journal of Spine and Spinal Cord,2015,Vol.25,No , 2, 2, 3, 3 (1 ; ; ) : (anterior cervical discectomy and fusion,acdf) (anterior cervical corpectomy and fusion,accf) : ~ (Polyetheretherketone cage,peek cage) 54,ACCF 23,ACDF 31 (Japanese Orthopaedic Association,JOA) (visual analogue score,vas) 3d, :,ACDF ACCF (175.4±12.1ml VS 201.3±80.4ml) ACDF JOA VAS (13.06± ±1.43) (15.45± ±1.28) (P=0.000),ACCF JOA VAS ACDF, (P<0.05); (P> 0.05) 3d (P<0.05), ACDF ACCF (P<0.05) 100% :,ACDF, ; ; doi: /j.issn x :R681.5 :A : X(2015) Comparison of two anterior techniques in the surgical management of adjacent two -level cervical spondylotic myelopathy/li Cheng, WANG Bing, WANG Yiyu, et al//chinese Journal of Spine and Spinal Cord, 2015, 25(5): Abstract Objectives: To compare the outcome between double segments anterior cervical discectomy and fusion(acdf) and anterior cervical corpectomy and fusion(accf) on the adjacent two segments in cervical spondylotic myelopathy. Methods: From September 2010 to July 2013, the application of two segments discectomy polyetheretherketone cages (PEEK cage) and bone grafting fusion and single segment corpectomy decompression and titanium mesh and bone graft for the treatment of 54 cases with adjacent two segments spondylotic myelopathy was analyzed retrospectively. Comparison of baseline data, length of hospital stay, operation time, amount of bleeding, Japanese Orthopaedic Association(JOA) scores and visual analogue scale(vas) between two groups was performed. Analysis of two groups of cervical curvature, fusion segmental height and fusion rate of change at each follow-up time was conducted. Results: The fusion rate for two groups was 100%. The difference of age, gender, lesion segment, sagittal alignment, bone material, length of hospital stay and the operation time was not statistically significant, the amount of bleeding in group ACDF was significantly less than that in ACCF group(observation group, control group, ml VS ml). JOA and VAS score of two groups before surgery and at the final follow-up showed statistical significance (P=0.000), but there was no significant difference between two groups. Two groups had cervical curvature and height of : (1990-),, : :(0431) lichengguke@163.com : kinglooc@163.com

2 Chinese Journal of Spine and Spinal Cord,2015,Vol.25,No.5 the fused segment at 3 days after operation significantly increased compared with preoperation and final follow-up, that in ACDF group improved significantly than that in ACCF group(p<0.05). Conclusions: For adjacent double segments cervical spondylotic myelopathy, ACDF has less blood loss, well improves the cervical curvature and maintains the height of the fused segment. Key words Cervical spondylotic myelopathy; Discectomy; Corpectomy; Discectomy and fusion Author s address The Spine Surgery of the Second Affiliated Hospital of Jilin University, Changchun, , China (cervical spondyloticmyelopathy,csm) [1] 12%~30%, 1.2, 1.2.1,,, [2], (anterior cervical discectomy and fusion,acdf) 4cm, 1.2.2, (anterior cervi-, C X cal corpectomy and fusion,accf),,, [3] ACCF, (ACDF): ACDF [4],,, ~ Table 1 General clinical data of patients (Polyetheretherketone cage,peek cage) (Total) 31 23, (Sex) [5] :1 X CT MRI CSM ;2 C3/4~C6/7; 3 3 :1 ;2C7 ;3 ;4 12 ACDF ACDF, 31, 19, 12 1 Clinical parameters (Male) (Female) ( )(Age) 59.0± ±6.7 (Surgical segment) C3~C5 5 4 C4~C6 9 8 C5~C (Sagittal sequence) (Lordosis) 8 6 (Straight) ;5 ;6 (Kyphosis) 6 5 [6] : (Bone graft material), ACCF ACCF, Autologous bone decompression 23, 13, 10 ; + Autologous bone decom- 4 5 pression+allogeneic bone ( ) Follow-up period(months) 24.7± ±6.0

3 Chinese Journal of Spine and Spinal Cord,2015,Vol.25,No PEEK,,, (P>0.05,, 1) 2.2 (ACCF):,, ;, (P=0.763,P>0.05) (P=0.072, P>0.05) ;ACDF, ACCF (P=0.000,P<0.05),,, ( 2) ACDF ACCF JOA,, VAS 3 JOA, ; 24~48h (P>0.05), (P< ; ), (P> 1.3 (t=6.191,p<0.001), (Japanese Orthopaedic Association,JOA) 2.4 ACDF ACCF 3d (visual analogue score,vas) 3d, (P<0.05); X (P>0.05), 3d ACDF C2~C7 Cobb, C7 C2 (P<0.05) ACDF ACCF 3d Cobb,,, (P<0.05); 3d (P>0.05, 4) [7] : X 3 ; 60 ;, 1.4 SPSS 22.0 (SPSS Inc., Chicago, IL,USA) ± Robinson, [9 10] Fessleret [11],92% T 2 Table 2 Group differences in perioperative parameters P< , 24.7±6.2 (ACDF ) 25.5±6.0 (ACCF 2.3 JOA VAS ) 0.05) VAS ACDF ACCF (P<0.05), (P>0.05), ACCF,, 1958 Smith Clinical parameters (d) Length of stay(days) (ml) Bleeding volume (min) The operative time(min) :1 ACCF P<0.05 Note: 1Compared with group ACCF, P< ± ± ± ± ± ±11.2 [8]

4 Chinese Journal of Spine and Spinal Cord,2015,Vol.25,No.5 Time Preoperative 3d 3d postoperation 3 Table 3 JOA VAS Group differences in JOA and VAS JOA VAS JOA VAS 13.06± ± ± ± ± ± ± ± :1 P<0.05 Note: 1Compared with preoperative of same group, P<0.05 Table 4 4 Comparison of cervical curvature and height of the main stage of the fusion group Preoperation ( ) Cervical curvature 3d Three days after operation Final follow-up Preoperation (mm) The fusion stage height 3d Three days after operation Final follow-up 5.4± ± ± ± ± ± ± ± ± ± ± ±2.2 :1 P<0.05,2 ACCF P<0.05 Note: 1Compared with preoperative of same group, P<0.05; 2Compared with ACCF group, P<0.05 ACCF,,ACDF ACCF (ACDF ACCF) ACDF, ACCF, ACDF ACCF [12],,, ACDF, ACDF ACCF JOA!, 13.06± ±0.77,,, 15.45± ±0.81, ACDF ACCF ACCF, Oh [13] 14 ACDF, 17 ACCF VAS, ACCF, ACDF ACCF, Jiang [14] Meta 9 ACDF ACCF, (P=0.072,P>0.05) 6,3, ACDF ACCF ACDF, Nirala [15] 201,ACCF 87.1% ACDF 81.1%, ACDF ACDF, ACCF,,

5 Chinese Journal of Spine and Spinal Cord,2015,Vol.25,No.5 437, ACCFACDF,4 ACCF,, 2011, 15(4): ACDF 6 3 ACDF PEEK,, [J]., 2013, 26(6): ACDF 5.,, PEEK,ACCF, [J]., 2010 (25): %,,, 2014, 18(17): ,,,. [J]. 2.,,,. [J]., 2015, 18(1): ,,,. [J]., 2009, 15(3): ,,,.. 6.,,,. Meta [J]., 7.,,,. [J]., 2013, Oh [12],ACDF 28(7): ,ACDF ACCF 8.,,,., [J]., 2011, 24(2): Park [15] 52 ACCF ACDF [J]., 2014, 23(3): , 6, 10.,., [J]., 2010 (1): 8-10., 3d 11. Fessler RG, Steck JC, Giovanini MA. Anterior cervical corpectomy for cervical spondylotic myelopathy[j]. Neurosurgery, (P=0.023,P<0.05), 1998, 43(2): (P=0.30,P>0.05) 3d 12.,,,. [J]., 2009 (29): (P<0.01) ACDF 13. Oh MC, Zhang HY, Park JY, et al. Two-level anterior 3d,cervical discectomy versus one-level corpectomy in cervical,acdf ACCF spondylotic myelopathy[j]. Spine, 2009, 34(7): , (P<0.05) 14. Jiang SD, Jiang LS, Dai LY. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical spondylosis: a systematic review[j]. Arch, PEEK Orthop Trauma Surg, 2012, 132(2): , 15. Nirala AP, Husain M, Vatsal DK. A retrospective study of ACDF ACCF multiple interbody grafting and long segment strut grafting following multilevel anterior cervical decompression [J]. Br J Neurosurg, 2004, 18(3): , 16. Park DK, Lin EL, Phillips FM. Index and adjacent level,acdf, kinematics after cervical disc replacement and anterior, fusion: in vivo quantitative radiographic analysis [J]. Spine, ACCF,PEEK 2011, 36(9): ( : : ) ( / ), ( )