[A comparative study of anterior decompression approach by using cervical retractor systems and traditional surgical approach to treat cervical spondylosis].
OBJECTIVE
To compare and evaluate the whole effect of anterior decompression approach to treat cervical spondylotic myelopathy by using cervical retractor systems and the traditional surgical approach.


METHODS
From April 2001 to August 2004, group A included 30 males and 23 females aging from 31 to 69 years, and the involved time was from 7 months to 15 years. Involved segments included 22 one-segments, 24 two-segments and 7 three-segments. In all 53 cases, anterior windowing decompression and fusion with autograft and titanium plate internal fixation by using traditional circular saw were performed. Group B included 48 males and 20 females aging from 33 to 74 years, and the involved time was from 5 months to 18 years. Involved segments included 23 one-segments, 34 two-segments and 11 three-segments. In all 68 cases, anterior undermined far-reaching decompression and fusion with autograft and titanium plate internal fixation by using removing disc merely in the single-level or separately in the multilevels employing self-retractor and Caspar cervical retractor systems via interspinal approach were performed. X-rays and MRI showed cervical disc degeneration, herniation and spinal cord compression. The surgery time, loss of blood, vertebral body fusion time, difference in height of involved segments pre- or postoperatively and complications were counted up and compared between the two groups. Improvement rate of spinal function pre- or postoperatively were valued by using JOA score.


RESULTS
A total of 92 cases including 42 of group A and 50 of group B were followed up for 3 to 5 years, mean 3.5 years. In group A, surgery time, loss of blood, time of vertebral body fusion, difference in height of involved segments pre- or postoperatively, and improvement ratio of spinal function were (76.80 +/- 28.41) min, (564.00 +/- 181.96) mL, (12.10 +/- 3.58) weeks, (1.30 +/- 0.67) mm and 0.49% +/- 0.14%, respectively. In group B, they were (57.90 +/- 15.01) min, (317.50 +/- 136.92) mL, (9.75 +/- 1.36) weeks, (3.00 +/- 0.56) mm and 0.71% +/- 0.17%, respectively. The differences between the two groups were significant in all measured values (P < 0.05). Complications occurred in 7 cases of group A including 1 spinal cord injury, 1 plate displacement, 1 bonegraft displacement and 4 disfunctions of iliac region. No complication happened in group B.


CONCLUSIONS
Anterior decompression approach using cervical retractor systems is significantly superior to the traditional approach as to the whole effect to treat cervical spondylotic myelopathy, and further perfects the traditional anterior decompression approach. The modified approach is scientific, safe and easily spread.
Department of Orthopedics, Affiliated First Hospital of Harbin Medical University, Harbin Heilongjiang, 150001, P.R. China. chenglinyang@163.com
Chenglin
C
Yang
Zhenggang
Z
Bi
Shaohui
S
Yuan
Chunjiang
C
Fu
Yang
Y
Cao
Ming
M
Shao
D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000379:methods; D013128:Spinal Osteophytosis / Q000601:surgery*; D055009:Spondylosis / Q000601:surgery*; D014025:Titanium; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D014025:Titanium