[Microsurgery and intervertebral fusion with anterior plating for cervical spondylitic radiculopathy].

OBJECTIVE

To introduce and evaluate the efficacy of microsurgical decompression and titanium cage implants fusion with anterior plating in cervical spondylitic radiculopathy.

METHODS

From September 2000 to September 2002, 54 consecutive patients were treated with anterior microsurgical decompression followed by intervertebral fusion using a titanium cage packed with autogenous cancellous bone graft and an anterior cervical plating. There were 31 males and 23 females, with an average age of 45.2 years (38-65 years). The disease course was 5-19 months. The locations were C3,4 in 3 cases, C4,5 in 25, C5,6 in 21 and C6.7 in 5 cases. The bony endplates were preserved to prevent cage subsidence. Thirty-nine cases suffered from monosegmental fusion and 15 cases did bisegmental fusion. The Cobb angle was 0.80+/-0.31 degrees before operation.

RESULTS

All wounds healed by first intention and no complications of vertebral artery injury, vertebral nerve injury and leakage of cerebrospinal fluid occurred. Dysphagia occurred within 2 weeks in 2 cases, hoarseness occurred and recovered without treatment in 1 case, and pain in upper limbs aggravated and was relieved after 1 month of conservative treatment in 1 case. Fifty-four patients were followed 12-36 months (16.4 months on average). The X-ray films showed no breakage of screws and robs and olisthy of implants. Fusion was achieved in 53 patients and the fusion rate was 98.2%. The Cobb angles were 5.50+/-0.22 degrees after operation and 5.20+/-0.17 degrees at final follow-up, showing significant differences when compared with before operation (P<0.01). According to Odom's criteria, the results were excellent in 24 cases, good in 22 cases and fair in 8 cases, the excellent and good rate was 85.2%.

CONCLUSION

Anterior cervical microsurgical decompression is a safely and effectively treatment option in patients with cervical spondylitic radiculopathy caused by protrusion of intervertebral disc (1-2 discs) and by degenerative osteophyte. Titanium cage interbody fusion with concomitant use of anterior plating provides immediate biomechanical stability, successfully restores and maintains posterior interbody height and cervical lordosis to ensure satisfactory long-time outcomes.