Objective To investigate the short-term clinical efficacy of the treatment in four-level cervical spondylotic myelopathy(CSM) with modified anterior cervical corpectomy and fusion(ACCF) without removing C4 or C5 vertebral body.Methods We enrolled 11 patients with CSM in 4 segments who received modified ACCF(segmental decompression,fusion with bone grafting with titanium cage,and internal fixation with titanium plate) in Liuzhou Municipal Liutie Central Hospital from 2013 to 2014.During the surgery,3 suffering from spinal stenosis in C2/3,C3/4,C4/5 and C5/6 segments were treated with subtotal resection of C3 and C5 vertebral bodies without removing C4 vertebral body,the other 8 suffering from spinal stenosis in C3/4,C4/5,C5/6 and C6/7 segments were treated with subtotal resection of C4 and C6 vertebral bodies without removing C5 vertebral body.The duration of surgery,intraoperative blood loss and postoperative drainage volume were recorded.Neurological function was evaluated before surgery,at 3 ,6 months after surgery and final follow-up time by the modified JOA score,and improvement rate were calculated.The physiological curve of cervical spine was assessed by imaging examination performed before surgery,at 3 months after surgery and the final follow-up.Results The mean duration of surgery,intraoperative blood loss and postoperative drainage volume for the 11 patients was (165±35) min,(735±159) ml,(120±39) ml,respectively.The JOA score was (12.6±2.9) before the surgery,but was improved to(15.4±2.1) at 3 months after surgery,(15.5±2.1) at 6 months after surgery and(16.1±1.9) at the final follow-up (P<0.05),with a mean improvement rate of (59.9±10.3)％,(62.7±8.4)％,and (63.1±7.7)％,respectively. The average cervical physiological curve increased from(9.2±3.1)mm before the surgery to(12.8±4.2) mm at 3 months after surgery and(13.0±3.2) mm at the final follow-up (P<0.05).All cases got bony union without complications such as sink of titanium cage,displacement of plate or screw found at the final follow-up.Conclusion Modified ACCF without removing C4 or C5 vertebral body can achieve good short-term clinical effect.By using this method,an additional screw anchoring force and strengthened stability could be provided by the retention of C4 or C5 vertebral body.Meanwhile,segmental decompression is contribute to the recovery of cervical physiological curve and can increase the bone surface to improve the fusion rate.%目的 探讨保留C4或C5椎体的改良颈前路椎体次全切植骨融合内固定术治疗4节段脊髓型颈椎病(CSM)的短期临床疗效.方法 选取2013—2014年于柳州市柳铁中心医院手术治疗的4节段CSM患者11例为研究对象,3例C2/3、C3/4、C4/5、C5/6椎间盘变性并突出患者,手术方式选择次全切除C3、C5椎体,保留C4椎体;8例C3/4、C4/5、C5/6、C6/7椎间盘变性并突出患者,手术方式选择次全切除C4、C6椎体,保留C5椎体,行分节段减压钛笼植骨融合钛板内固定术.记录手术时间、术中出血量、术后引流量.采用改良的日本骨科协会(JOA)评分标准评估术前、术后3个月、术后6个月及末次随访时神经功能,并计算改善率.分别于术前、术后3个月、末次随访时经影像学检查评估颈椎生理曲度恢复情况.结果 11例患者手术时间(165±35)min,术中出血量(735±159)ml,术后引流量(120±39)ml.术后3、6个月及末次随访JOA评分分别为(15.4±2.1)、(15.5±2.1)、(16.1±1.9)分,均高于术前的JOA评分(12.6±2.9)分(P<0.05);平均改善率分别为(59.9±10.3)％、(62.7±8.4)％、(63.1±7.7)％.术后3个月及末次随访时颈椎生理曲度分别为(12.8±4.2)、(13.0±3.2)mm,均大于术前的(9.2±3.1)mm(P<0.05).末次随访未发现钛笼下沉、钢板螺钉松动移位等并发症,均获得骨性融合.结论 保留C4或C5椎体的改良颈前路椎体次全切植骨融合内固定术治疗4节段CSM可获得满意的短期疗效,保留C4或C5椎体可增加固定钢板螺钉的把持力,分节段减压植骨融合有利于恢复颈椎生理曲度,同时可增加植骨面,从而提高植骨融合率.
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