Objective: To evaluate the clinical effects of anterior segmental decompression and autograft fusion in treating multi-level cervical spondylotic myelopathy (CSM).
Methods: Between January 2007 and May 2009, 23 patients with multi-level CSM were treated with anterior segmental decompression, autograft fusion, and internal fixation. There were 16 males and 7 females with an average age of 58 years (range, 49-70 years). Consecutive 3 segments of C3, 4, C4, 5, and C5, 6 involved in 15 cases and C4, 5, C5, 6, and C6, 7 in 8 cases. All patients suffered sensory dysfunction in limbs and trunk, hyperactivity of tendon reflexes of both lower extremities, walking with limp, and weakening of hand grip. Cervical MRI showed degeneration and protrusion of intervertebral disc and compression of cervical cord. The disease duration was 6 to 28 months (12.5 months on average). Japanese Orthopaedic Association (JOA) score system was adopted for therapeutic efficacy evaluation. JOA scores were recorded preoperatively, 1 week, 3 months, and 12 months postoperatively.
Results: Dura tear occurred in 1 case and was treated by filling with gelatin sponge during operation; no cerebrospinal fluid leakage was observed after operation. All the incisions healed by first intention. All cases were followed up 12 to 24 months (15.1 months on average), and no vertebral artery injury or recurrent laryngeal nerve injury occurred. The nervous symptoms in all cases were improved significantly within 1 week after operation. Lower limb muscle strength increased, upper limb abnormal sensation disappeared, and limb moved more agile. A 2-mm collapses of titanium mesh into upper terminal plate were found in 1 case and did not aggravated during follow-up. The other internal fixator was in appropriate situation, and the fusion rate was 100%. The JOA score increased from 9.1 +/- 0.3 preoperatively to 14.3 +/- 0.4 at 12 months postoperatively with an improvement rate of 65.8% +/- 0.2%, showing significant difference (P < 0.01). According to Odom evaluation scale, the results were excellent in 10 cases, good in 8 cases, fair in 4 cases, and poor in 1 case.
Conclusion: Anterior segmental decompression and autograft fusion is a recommendable technique for multi-level CSM, which can make full decompression, conserve the stability of cervical cord, and has high fusion rate.