Comparison of 3 Reconstructive Techniques in the Surgical Management of Multilevel Cervical Spondylotic Myelopathy

Spine 2012 ; 37 : E1450 – E1458

A retrospective comparative study was performed in patients with 3-level cervical spondylotic myelopathy (CSM).

Objective. To compare the clinical outcomes, radiological parameters, and complication incidence of 3 reconstructive techniques after the anterior decompression of multilevel CSM.

Summary of Background Data. There has been growing interest in combination of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) for the treatment of multilevel CSM in recent years. However, the clinical efficacy and radiological outcomes of the hybrid decompression and fusion (HDF) have rarely been investigated.

Methods. A total of 180 consecutive patients with 3-level CSM undergoing the anterior decompression and fusion procedures from January 2003 to July 2010 were retrospectively investigated. According to various reconstructive techniques, the patients were divided into 3 groups: HDF, ACDF, and ACCF groups. The clinical effects and improvements of cervical and segmental lordosis in each group were assessed. In addition, the fusion rate, postoperative complications, and radiographical adjacent-level changes regarding each group were also evaluated.

Results. No statistical differences in clinical effects, restoration of cervical lordosis, and incidences of postoperative complications were found between the HDF and ACDF groups ( P > 0.05). The ACCF group has achieved clinical effects similar to the ACDF or HDF group ( P > 0.05), but it had more bleeding, lower fusion rate, and higher incidences of postoperative complications compared with the ACDF or HDF group ( P < 0.05). The improvements of the cervical and segmental lordosis in the ACCF group were significantly less than the ACDF or HDF group ( P < 0.05). There was no significant difference in radiographical adjacent-level changes among the 3 groups ( P > 0.05).

Conclusion. The HDF can be considered an effective and safe alternative procedure compared with ACDF in the treatment of the multilevel CSM, and ACCF should be the last option.