Surgical treatment of cervical spondilotic myelopathy: two-level anterior discectomy-fusion versus one level anterior corpectomy-fusion

Introduction: The optimal surgical strategy of two level cervical degenerative disc disease with myeloradiculopathy remains controversial. The aim of this retrospective study is to compare two fusion techniques with reference to radiological and clinical outcomes in patients. Materials and Methods: 58 patients who underwent ACDF(two contigous levels) or ACCF(single level including 2 disc spaces) for treatment of myeloradiculopathy due to disc herniation and uncovertebral joint osteophytes were included. The perioperative parameters(hospitalization, blood loss, operation times, complications), clinical parameters(Visual Analog Scale(VAS) scores of neck and arm pain), and radiologic parameters(cervical lordosis, fusion rate) were compared between two groups. Intergroup comparisons were made by using the t test and p values of less than 0.05 were considered statistically significant. Results: There were 31 patients(12 male, 19 female) with mean age of 46.5 years in the ACDF group while there were 27 patients(12 male,15 female) with a mean age of 48.8 years in the ACCF group. Mesh cages filled with allograft and semi-dinamik plates were used for all patients in both groups. Mean follow-up period was 48.4 for ACCF and 51.2 for ACDF(range;24 to 84) months. There was no difference between groups in term of hospitalization period. Blood loss and operation time was lower in ACDF group but sitatistically insignificant. Complications in ACDF group were dura laceration in one patient and hoarseness in 3 patients. Complications in the ACCF group were dura laceration in one patient and incomplete transient C5 palsy. Postoperative neck and arm VAS scores were similar in both groups(2.5 versus 2.8). Solid fusion was observed in all patients. Cervical lordosis improved meanly from 18.3 degrees to 24.4 degrees in ACDF group and meanly from 17.4 degrees to 18.9 degrees in ASKF gorup.(p<0.05) Conclusion: Surgical management of 2 level cervical degenaratve disc disease with myeloradiculopathy by ACDF or ACCF showed no significant differences in terms of cilinical symptom improvement and fusion rates. Although statistically insignificant, blood loss and operation times were lower in ACDF group. In addition, ACCF provided less improvement in cervical lordosis.