TITLE:
Anterior Surgery in Multilevel Stenosis of the Lower Cervical Spine: Technical Indications and Personal Experience. 12 Years Follow-Up
AUTHORS:
Alessandro Landi, Nicola Marotta, Cristina Mancarella, Carlotta Morselli, Roberto Tarantino, Andrea Ruggeri, Roberto Delfini
KEYWORDS:
Corpectomy; Discectomy; Multilevel; Cervical Spine
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.5 No.4,
February
15,
2014
ABSTRACT:
Objective: cervical spondylotic myelopathy is a progressive degenerative
cervical spine disease. During later stages of segmental degeneration, kyphosis
of the cervical spine can occur and further compromise the spinal cord and
nerve roots. Optimal surgical approach remains controversial.
The choice to perform an anterior, posterior or combined approach depends on: sagittal alignment, number of involved
levels, main compression localization, and clinical status. The
anterior approach is recommended when compression involves primarily anterior
horn of spinal cord. Methods: between January 2001 and December 2005, 121
patients (42 F, 79 M,
mean age 62 years) were operated for cervical spondylosis (98 myelopathy, 23
radiculopathy). Anterior surgical approach was performed in 81 patients. 63
patients were operated performing multilevel discectomy and fusion (ACDF) and
18 patients performing corpectomy and fusion and anterior plating (ACCF). Preoperative
documentation collected consisted of cervical X-ray (static-dynamic), cervical spine TC, cervical
MRI. Clinical documentation permitted us to obtained clinical status of each
patient based on JOA, NDI and VAS. A Clinical and radiological follow-up was
performed at 1 month, 3 months, 1 year, 6 years, 12 years. Results: the fusion
rate was calculated based on the static and dynamic X-ray (flexion and extension position), only a
little percentage of patients underwent CT scan. There were no significant
differences between ACDF and ACCF in clinical outcome at 6 years evaluated by
VAS and NDI. The rate of fusion at 6 years for 2 levels ACCF (92%) was higher
than that for 2 levels ACDF
(86%) but is not statistically significative. Conclusion: classifying degenerative
disease and biomechanics feature, preoperatively in necessary to guide the
surgeon to choose the best
anterior approach for cervical spondylosis.