Anterior Cervical Hybrid Decompression and Fusion Surgery to Treat Multilevel Cervical Spondylotic Myelopathy

Summary

This paper describes a hybrid surgical technique that combines anterior cervical discectomy and fusion with anterior cervical corpectomy and fusion to treat patients with multilevel cervical spondylotic myelopathy.

Abstract

Cervical spondylotic myelopathy (CSM) is a common disease resulting from intervertebral disc herniation, ossification of the posterior longitudinal ligament, and other pathological changes that cause spinal cord compression. CSM progresses insidiously with mild upper-limb numbness, which patients tend to ignore. As the condition worsens, the patients may experience a limp, limited fine motor activity, and eventually, a loss of daily activity. Conservative treatments, such as physical therapy and medication, are frequently ineffective for CSM. Once surgery is deemed to be required, decompression surgery is the best option. So far, both anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) have been commonly used to treat CSM. In addition, a type of hybrid procedure that combines ACDF with ACCF has been used to treat some CSM cases and achieved satisfying results. Thus, this study aims to introduce this hybrid surgical technique and advocate for it based on its patient success.

Introduction

Cervical spondylotic myelopathy (CSM) is a common cause of cervical nerve dysfunction. It is characterized by acquired stenosis of the cervical spinal canal, osteoarthritic degeneration, or spinal column ligamentous aberrations¹. Due to the pathological characteristics of the disease, conservative treatments are ineffective in removing the increasing compression, and prompt surgical intervention is required. In clinical practice, anterior cervical discectomy and fusion (ACDF) surgery is usually the first option for single-level CSM². Despite the variety of procedures available, the best procedure for multilevel cervical ....

Protocol

The protocol was approved and followed the guidelines of the Ethics Committee of the Third Hospital of Hebei Medical University. Informed consent was obtained from patients for including them and the data generated as a part of this study.

1. Preoperative preparation

1. Apply the following inclusion criteria.
   1. Ensure that the radiological examination shows three or more diseased levels.
   2. Ensure that the symptoms are caused by pathological changes of the cervical vertebrae with the exclusion of other systemic diseases.
   3. Look for hypertonia, hyperreflexia, positive pathological signs, o....

Results

The CT and MRI scans revealed disc herniation in the cervical segments C3-C7 and ossification in C6-C7 (Figure 1). Although C3-C4 had pathological changes, spinal cord compression was not observed. As a result, C4-C7 was chosen as the surgical segment. The postoperative VAS score decreased from 5 before the operation to 3 at 3 months and 1 at 20 months. The JOA score increased from 7 before the operation to 8 at 3 months and 12 at 20 months. The neck pain only occurred if the patient bowed t.......

Discussion

Multilevel cervical spondylotic myelopathy is a disease that affects multiple intervertebral discs. This increases the severity of the disorder, makes it more challenging to obtain a good prognosis, and makes determining the responsible segment more difficult than for single-level CSM. Clinically, the mJOA score is commonly used to grade CSM. An mJOA score ≤ 11 is generally regarded as severe, 12-14 is moderate, and 15-17 is mild; moderate and severe CSM require prompt surgical treatment, while patients graded as m.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Adhesive	Biatain	3420	12.5 x 12.5 cm
Bipolar electrocoagulation tweezers	Juan'en Medical Devices Co.Ltd	BZN-Q-B-S	1.2 x 190 mm
Bone wax	ETHICON	W810T	2.5 g
High frequency active electrodes	ZhongBangTianCheng	GD-BZ	GD-BZ-J1
interbody fusion cage	WEGO	900200013	5 x 16 x 13 mm
Laminectomy rongeur	Qingniu	2051.03	220 x 1.5 x 130°
Laminectomy rongeur	Qingniu	2054.03	220 x 3.0 x 130°
Pituitary rongeur	Qingniu	2028.01	220 x 3.0 mm
Pituitary rongeur	Qingniu	2028.02	220 x 3.0 mm
self-tapping screw	WEGO	700054012	4.0 x 12 mm
spreader	WEGO	818-021	-
Surgical drainage catheter set	BAINUS MEDICAL	SY-Fr16-C	100-400 mL
Surgical film	3L	SP4530	45 x 30 cm
titanium plate	WEGO	700000057	57.5 mm
Titanium cage	WEGO	9051028	10 x 28 mm