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Two-Level Anterior Cervical Discectomy Versus One-Level Corpectomy in Cervical Spondylotic Myelopathy

Oh, Min Chul MD*; Zhang, Ho Yeol MD†; Park, Jeong Yoon MD†; Kim, Keun Su MD‡

Spine:
doi: 10.1097/BRS.0b013e318199690a
Cervical Spine
Abstract

Study Design. A retrospective investigation of clinical and radiologic outcomes after surgical treatment for 2-level cervical spondylotic myelopathy (CSM).

Objective. The study was undertaken to compare the outcomes of 2 different anterior approach types for 2-level CSM. Specifically, 2-level anterior cervical discectomy and fusion (ACDF) was compared with 1-level anterior cervical corpectomy and fusion (ACCF).

Summary of Background Data. The optimal surgical approach for 2-level CSM has not been defined, and thus, the relative merits of 2-level ACDF and 1-level ACCF remain controversial. However, few comparative studies have been conducted on these 2 surgical approaches.

Methods. The authors reviewed the case histories of 31 patients that underwent surgical treatment for 2-level CSM from 2002 to 2006. Cases of myelopathy because of cervical ossification of posterior longitudinal ligament were excluded. Thirty-one patients (16 men and 15 women) of mean age 54.45 ± 11.6 years (28 ∼ 77) were included. The average follow-up period was 26.23 ± 15.0 months (12 ∼ 63). The authors compared perioperative parameters (hospital stays, bleeding amounts, operation times, complications), clinical parameters (Japanese Orthopedic Association scores, Visual Analog Scale scores for neck and arm pain), and radiologic parameters (total cervical range of motion, segmental range of motion, segmental height, cervical lordosis, fusion rate).

Results. Of these above parameters, operation time (P = 0.001) and bleeding amount (P = 0.001) were significantly greater in the ACCF group, whereas segmental height (P = 0.018) and postoperative cervical lordosis (P = 0.009) were significantly lower in the ACCF group. However, other parameters were not significantly different in the 2 groups.

Conclusion. Surgical managements of 2-level CSM using ACDF or ACCF were found to be similar in terms of clinical outcomes. However, 2-level ACDF was found to be superior to 1-level ACCF in terms of operation times, bleeding amounts, and radiologic results.

In Brief

The authors reviewed the 31 patients who underwent surgical treatment for 2-level cervical spondylotic myelopathy. The author randomly decided upon anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion. The authors compared perioperative parameters, clinical parameters, and radiological parameters. Anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion were found to be similar in clinical outcomes. However, anterior cervical discectomy and fusion was found to be superior to anterior cervical corpectomy and fusion in operation times, bleeding amounts, and radiologic results.

Author Information

From the *Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; †Department of Neurosurgery, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, Gyeonggi-Do, Korea; and ‡Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea.

Acknowledgment date: October 9, 2008. Acceptance date: October 22, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Jeong Yoon Park, MD, Department of Neurosurgery, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, 1232 Bunji, Baekseok-dong, Goyang Si Ilsandong-gu, Gyeonggi-Do 410-719, Korea; E-mail: spinepjy@nhimc.or.kr

© 2009 Lippincott Williams & Wilkins, Inc.