Clinical Analysis of Treatment of Cervical Spondylosis Using Anterior(Modified Trans-Unco-Discal) Approach

Shin, Won Han; Baek, Seung Ho; Kim, Bum Tae; Choi, Soon Kwan; Byun, Bark Jang

Abstract

A retrospective study of operative results was carried out in a series of 79 patients who operated upon for cervical spondylosis using anterior(modified Trans-Unco-Discal) approach over the past 10 years at the Department of Neurosurgery, Soonchunhyang University Hospital. The operative findings were analysed and also the correlation between preoperative clinicoradiological factors and postoperative clinical results were statistically assessed. The major results were as follows: 1) Of 79 patients, there were 53 in radiculopathy, 18 in radiculomyelopathy and 8 in myelopathy. Mean age was 49 years and the incidence was the highest in sixth decade. Male to female ratio was 2.3:1. 2) In 132 levels operation was performed and C 5, 6 was the most commonly involved level. Incidence of one level operated was 47% and one of above 2 levels operated was in 53%. Of 129 interbody grafts there were 79 levels using BOP and 50 levels using ilium. 3) Operative results; (1) Clinical results were graded excellent in 63%, good in 30%, fair in 6%, and poor in 1%. (2) Clinical results in radiculopathy was statistically significant better than one in myelopathy and radiculomyelopathy(p<0.05). As to number of osteophytes, clinical results in below 3 osteophytes was statistically significant better than above 4 osteophytes(p<0.05). (3) As to age, duration of symptoms, disc space narrowing, developmental canal stenosis, number of operated levels and material of bone graft, clinical results were non statistically significant. (4) Improvement rates in myelopathy and radiculomyelopathy(n=26) were 50% in Nurick's grade and 85% Kadoya's grade. (5) In 23 patients who could be performed follow-up at recently, improvement rate was 88% in Japanese Orthopeadic Association's scale. (6) The rates of complications were 16% and the most complication was related to bone graft. There was no significant correlation between the complications and clinical results in all cases.