Experiences of Treating Cervical Spondylosis by Anterior Cervical Discectomy and Fusion_West China Medical Journal

Authors：

 WANGYan-bo , JIAXu-feng , LEIFei , LIUShuang ,  FENGDa-xiong

Department of Spinal Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

FENGDa-xiong, Email: fdxlz2002@163.com

Keywords：

Anterior cervical discectomy and fusion; Cervical spondylosis; Surgery; Experience

DOI：

10.7507/1002-0179.20150247

Video：

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Objective To explore the surgical indication and summarize the experiences of anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylosis. Methods Seventy-five cases of cervical spondylosis were treated with ACDF from January 2010 to October 2013, including 34 cases of cervical spondylotic radiculopathy and 41 cases of cervical spondylotic myelopathy. The pre/post-operative Japanese Orthopedic Association (JOA) score and imaging data were observed. Results Thirty-six patients were followed up for 6 to 25 months, with an average of 16 months. The mean JOA score before surgery was 10.67±2.66, and 3 months later, the score was 13.47±2.06. Six months later the score was 14.11±1.56, and after 12 months the score was 14.97±1.78. No spinal cord injury or esophagus, trachea injury occurred, and there was no superior laryngeal nerve and recurrent laryngeal nerve injury during the operation. Eight cases of postoperative dysphagia obviously decreased within 3-5 days, 6 cases decreased within 5-7 days, and 10 cases decreased within 3 weeks. And all 36 patients recovered within one month. There was no titanium mesh subsidence, displacement or titanium plate failure after operation. Conclusion ACDF is suitable for the decompression of spinal cord or nerve root which is compressed by the degenerated intervertebral disc, especially without rigid kyphosis, ossification of the posterior longitudinal ligament extending across multiple segments, and the compression located at the level of intervertebral disc. The appropriate approach can achieve a stable efficacy, less interference on the stability of the spine, and the incision heals fast. It is a kind of classic anterior cervical operation for it can reduce the complication effectively.

Citation： WANGYan-bo, JIAXu-feng, LEIFei, LIUShuang, FENGDa-xiong. Experiences of Treating Cervical Spondylosis by Anterior Cervical Discectomy and Fusion. West China Medical Journal, 2015, 30(5): 855-858. doi: 10.7507/1002-0179.20150247 Copy

1.	Fernández-Fairen M, Sala P, Dufoo M Jr, et al. Anterior cervical fusion with tantalum implant:a prospective randomized controlled study[J]. Spine (Phila Pa 1976), 2008, 33(5):465-472.
2.	Matsumoto M, Okada E, Ichihara D, et al. Anterior cervical decompression and fusion accelerates adiacent segment degeneration:comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study[J]. Spine (Phila Pa 1976), 2010, 35(1):36-43.
3.	Parkinson JF, Sekhon LH. Cervical arthroplasty complicated by delayed spontaneous fusion. Case report[J]. J Neurosurg Spine, 2005, 2(3):377-380.
4.	Yonenobu K, Hosono N, Iwasaki M, et al. Neurologic complications of surgery for cervical compression myelopathy[J]. Spine (Phila Pa 1976), 1991, 16(11):1277-1282.
5.	王红, 邓丽丽, 李海波, 等. 糖尿病骨折患者围手术期的处理[J]. 中华外科杂志, 2003, 41(11):40-44.
6.	Yonenobu K, Abumi K, Nagata K, et al. Interobserver and intraobserver reliability of the Japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy[J]. Spine (Phila Pa 1976), 2001, 26(17):1890-1894; discussion 1895.
7.	Heary RF, Benzel EC, Vaicys C. Single and Multiple-Single Interbody Fusion Techniques[M]//Benzel EC. Spine surgery:techniques, complication avoidance, and Management. 2nd ed. USA:Elsevier, 2005:351-362.
8.	John C. Anterior cervical diskectomy and fusion[M]//Wang JC. Advanced reconstruction:spine. USA:American Academy of Orthopaedic Surgeons, 2011:1-13.
9.	袁文, 王新伟, 贾连顺. 颈椎病手术治疗的相关问题探讨[J]. 中国脊柱脊髓杂志, 2006, 16(5):325-329.
10.	Lee MJ, Bazaz R, Furey CG, et al. Risk factors for dysphagia after anterior cervical spine surgery:a two-year prospective cohort study[J]. Spine J, 2007, 7(2):141-147.
11.	Chau AM, Mobbs RJ. Bone graft substitutes in anterior cervical discectomy and fusion[J]. Eur Spine J, 2009, 18(4):449-464.
12.	Wada E, Suzuki S, Kanazawa A, et al. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy:a long-term follow-up study over 10 years[J]. Spine (Phila Pa 1976), 2001, 26(13):1443-1447; discussion 1448.
13.	Anderson DG, Albert TJ. Bone grafting, implants, and plating options for anterior cervical fusions[J]. Orthop Clin North Am, 2002, 33(2):317-328.
14.	Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications[J]. Spine (Phila Pa 1976), 2007, 32(21):2310-2317.
15.	唐向盛, 谭明生, 移平, 等. 多节段脊髓型颈椎病前路手术疗效分析[J]. 中国骨伤, 2013, 26(6):460-463.
16.	Netterville JL, Koriwchak MJ, Winkle M, et al. Vocal fold paralysis following the anterior approach to the cervical spine[J]. Ann Otol Rhino Laryngol, 1996, 105(2):85-91.
17.	Hacker RJ, Cauthen JC, Gilbert TJ, et al. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage[J]. Spine (Phila Pa 1976), 2000, 25(20):2646-2654; discussion 2655.
18.	Wang JC, Mcdonough PW, Kanim LE, et al. Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion[J]. Spine (Phila Pa 1976), 2001, 26(6):643-646; discussion 646-647.
19.	祁敏, 梁磊, 陈华江, 等. ACDF术式中采用Zero-p颈椎椎间融合器置入治疗颈椎病的学习曲线[J]. 中国矫形外科杂志, 2013, 21(3):213-216.
20.	Baskin DS, Ryan P, Sonntag V, et al. A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate[J]. Spine (Phila Pa 1976), 2003, 28(12):1219-1224.

1. Fernández-Fairen M, Sala P, Dufoo M Jr, et al. Anterior cervical fusion with tantalum implant:a prospective randomized controlled study[J]. Spine (Phila Pa 1976), 2008, 33(5):465-472.
2. Matsumoto M, Okada E, Ichihara D, et al. Anterior cervical decompression and fusion accelerates adiacent segment degeneration:comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study[J]. Spine (Phila Pa 1976), 2010, 35(1):36-43.
3. Parkinson JF, Sekhon LH. Cervical arthroplasty complicated by delayed spontaneous fusion. Case report[J]. J Neurosurg Spine, 2005, 2(3):377-380.
4. Yonenobu K, Hosono N, Iwasaki M, et al. Neurologic complications of surgery for cervical compression myelopathy[J]. Spine (Phila Pa 1976), 1991, 16(11):1277-1282.
5. 王红, 邓丽丽, 李海波, 等. 糖尿病骨折患者围手术期的处理[J]. 中华外科杂志, 2003, 41(11):40-44.
6. Yonenobu K, Abumi K, Nagata K, et al. Interobserver and intraobserver reliability of the Japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy[J]. Spine (Phila Pa 1976), 2001, 26(17):1890-1894; discussion 1895.
7. Heary RF, Benzel EC, Vaicys C. Single and Multiple-Single Interbody Fusion Techniques[M]//Benzel EC. Spine surgery:techniques, complication avoidance, and Management. 2nd ed. USA:Elsevier, 2005:351-362.
8. John C. Anterior cervical diskectomy and fusion[M]//Wang JC. Advanced reconstruction:spine. USA:American Academy of Orthopaedic Surgeons, 2011:1-13.
9. 袁文, 王新伟, 贾连顺. 颈椎病手术治疗的相关问题探讨[J]. 中国脊柱脊髓杂志, 2006, 16(5):325-329.
10. Lee MJ, Bazaz R, Furey CG, et al. Risk factors for dysphagia after anterior cervical spine surgery:a two-year prospective cohort study[J]. Spine J, 2007, 7(2):141-147.
11. Chau AM, Mobbs RJ. Bone graft substitutes in anterior cervical discectomy and fusion[J]. Eur Spine J, 2009, 18(4):449-464.
12. Wada E, Suzuki S, Kanazawa A, et al. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy:a long-term follow-up study over 10 years[J]. Spine (Phila Pa 1976), 2001, 26(13):1443-1447; discussion 1448.
13. Anderson DG, Albert TJ. Bone grafting, implants, and plating options for anterior cervical fusions[J]. Orthop Clin North Am, 2002, 33(2):317-328.
14. Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications[J]. Spine (Phila Pa 1976), 2007, 32(21):2310-2317.
15. 唐向盛, 谭明生, 移平, 等. 多节段脊髓型颈椎病前路手术疗效分析[J]. 中国骨伤, 2013, 26(6):460-463.
16. Netterville JL, Koriwchak MJ, Winkle M, et al. Vocal fold paralysis following the anterior approach to the cervical spine[J]. Ann Otol Rhino Laryngol, 1996, 105(2):85-91.
17. Hacker RJ, Cauthen JC, Gilbert TJ, et al. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage[J]. Spine (Phila Pa 1976), 2000, 25(20):2646-2654; discussion 2655.
18. Wang JC, Mcdonough PW, Kanim LE, et al. Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion[J]. Spine (Phila Pa 1976), 2001, 26(6):643-646; discussion 646-647.
19. 祁敏, 梁磊, 陈华江, 等. ACDF术式中采用Zero-p颈椎椎间融合器置入治疗颈椎病的学习曲线[J]. 中国矫形外科杂志, 2013, 21(3):213-216.
20. Baskin DS, Ryan P, Sonntag V, et al. A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate[J]. Spine (Phila Pa 1976), 2003, 28(12):1219-1224.

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