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| XIE Shaohua,YU Miao,LIU Xiaoguang.Department of orthopedics, Peking University Third Hospital, Beijing, 100191, China[J].Chinese Journal of Spine and Spinal Cord,2018,(11):961-968. |
| Department of orthopedics, Peking University Third Hospital, Beijing, 100191, China |
| Received:April 28, 2018 Revised:October 22, 2018 |
| English Keywords:Anterior cervical discectomy and fusion Cervical spondylosis Outcome |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the early clinical and radiological outcomes of skip-level ACDF in the treatment of noncontiguous levels of cervical spondylosis. Methods: The clinical data of 18 patients including 14 males and 4 males with a mean age of 52.2±10.1 years(ranged from 37 to 67) who underwent skip-level ACDF (group A) and 20 patients including 16 males and 4 males with a mean age of 51.6±9.5 years (ranged from 40 to 68) who underwent contiguous ACDF (group B) in our hospital from March 2010 to December 2015 were retrospectively studied. The operation time, intraoperative blood loss, postoperative complications, JOA scores, C2-7 SVA and T1 slope obtained from Sagittal reconstruction CT images were evaluated. The C2-7 range of motion(ROM) was determined by using dynamic X-ray which was obtained in standing position before surgery and at routine postoperative intervals. The adjacent segment disc degeneration was verified according to Miyazaki classification. Results: All 38 patients received postoperative follow-up with a median time of 12 months (ranged from 6 months to 36 months), with no remarkable difference between the two groups. The average operation time(71.7±9.2min) and intraoperative blood loss(17.8±7.3ml) of group A were significantly lower than those (111.5±36.1min and 47.0±19.1ml) of group B(P＜0.05). Both of the two groups had significant improvement after operation in JOA scores(P＜0.05). But there was no significant difference in JOA score between the two groups. The mean C2-7 ROM of group A decreased from 50.0°±7.1° to 38.0°±6.1° after 3 months and back to 44.3°±5.7° at final follow-up(P＜0.05). The mean C2-7 ROM of group B decreased from 51.8°±10.6° to 38.0°±9.4° after 3 months and then increased to 43.9°±10.5° at final follow-up(P＜0.05) with no significant difference between the two groups. The postoperative mean C2-7 SVA of group A remarkably increased from 24.2±2.0mm to 26.8±2.0mm after 3 months and showed no significant difference at final follow-up(24.5±2.2mm). The postoperative mean C2-7 SVA of group B significantly increased from 23.8±1.4mm to 26.5±1.8mm after 3 months and 24.3±1.5mm at final follow-up(P＜0.05). No significant difference of postoperative mean C2-7 SVA between the two groups was found. The mean T1 slope of group A increased from 28.1°±3.2° to 31.4°±3.0° after 3 months and 30.0°±3.1° at final follow-up(P＜0.05). The mean T1 slope of group B increased from 28.3°±2.1° to 31.6°±2.3° after 3 months and 30.3°±2.1° at final follow-up(P＜0.05) with no significant difference when compared with group A. The rate of adjacent segment disc degeneration was 16.7%(6/36) in group A and 20.0%(8/40) in group B respectively without clinical symptom. The rate of skip-level segment disc degeneration was 14.3%(3/21) in group A. No significant difference of the fusion rate existed between the two groups. Conclusions: Skip-level ACDF presents good early clinical and radiological outcomes, with no significant difference comparing to contiguous ACDF. |
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