Abstract
Background
This study examined the prognostic factors that affect the surgical outcome of anterior spinal fusion in patients with cervical compressive myelopathy (CCM).
Methods
A retrospective review of the result of surgical treatment in 49 cases of CCM using anterior spinal fusion surgical techniques. The study period was from June 1990 to June 2008, with a mean followup of 6.57 years. Seven patients died during the followup period because of other medical diseases. The Japanese Orthopaedic Association score for cervical myelopathy and recovery rate were used to assess the functional results of the remaining 42 cases.
Results
A mean Japanese Orthopaedic Association score improvement from 10.21 to 14.23 points after the operation was observed. The overall recovery rate was 65.38%, with excellent or good results of 80%. After a year of followup, we did not find significant improvement or deterioration on the neurological status on further followup. Acute complications were not common. One patient underwent reoperation because of slipping of the graft during resuscitation after early postoperative acute myocardial infarction. This patient showed postoperative neurological deterioration. Two patients had subsidence of the graft, three had pseudoarthrosis, and two had graft resorption. There were also three patients with degenerative changes of the adjacent vertebra. No reoperation was done for patients with these late complications in this review.
Conclusion
Anterior cervical decompression with bone fusion is a viable surgical option for patients with one level of anterior cervical cord compression, especially for patients with kyphosis or straight canal spine. For patients with two- to three-level involvement, anterior cervical decompression with bone fusion provides good functional result in proper selection of cases. We also identified some prognostic factors (male sex, symptoms less than 1 year, and age less than 70 years) in predicting a favourable outcome of anterior spinal fusion for CCM.