Abstract
We examined the outcomes of anterior cervical decompression and fusion (ACDF) for cervical spondylotic myelo-radiculopathy, including the improvement rate of neurological symptoms and signs, and the time period of stabilization and lordosis, and then compared them among each groups of fixation methods and number of fusions.
We prospectively examined the cases of 330 patients, who underwent a modified trans-unco-discal approach (TUD) with iliac bone graft or cage, and followed their neurological symptoms, neuroradilogical findings and complications. We used the Japanese Orthopaedics Association (JOA) score, radiological stabilization (cervical spine plain dynamic x-ray), C2-7 Cobb angle (CA), and C2-7 sagittal vertical axis (SVA) as examinations of lordosis and inter-vertebral space (IVS) were utilized.
The cases in which the cage was used as a fixation method had a higher rate of recovery of the JOA score and a shorter stabilization time than those in whom the iliac bone graft was used, and those with two or three levels of fusion. The patients who underwent iliac bone grafts as a fixation method had lower C2-7 CA, longer C2-7 SVA, and higher IVS than those in whom the cage was used. Patients who underwent iliac bone grafts experienced significant increases in complications and re-operations than those in the cases which the cage was used.
We confirmed that ACDF had good results as a fundamental treatment for cervical spondylotic myelo-radiculopathy by removal of the compressive lesion for the cervical cord and let to improve alignment of the cervical spine. The comparison of cages and iliac bone grafts as fixation methods demonstarated that the cage, and fewer fusions resulted in better outcomes. However, in the long term, newly adjacent lesions remain a problem.
