Abstract

Introduction: Cervical spondylotic myelopathy (CSM) is the most common cause of cord dysfunction in patients over 55 years of age. Involvement of the C_5-6 is frequent, followed by C_6-7 and C_4-5. The diagnosis of cervical spondylotic myelopathy is primarily based on a thorough clinical and radiological examination. Anterior cervical discectomy and fusion (ACDF) is the standard of care for cervical spondylomyelopathy. Autogenous cancellous bone, taken from the iliac crest was used in cervical fusion. Plating provides rigid fixation, resists setting and development of segmental kyphosis, promotes higher fusion rates, allows for less cumbersome external immobilization and reduces the incidence of graft extrusion. The anterior approach through modified Smith- Robinson technique is less disruptive to the neck musculature and arthrodesis can be adequately performed from C₂-T_2. Methods: Twenty patients with mean age of 58.5 years with clinical and radiological evidence of CSM underwent ACDF with autograft and plating were prospectively studied for a mean duration of 2.8 years. Multilevel (>3) cervical spondylosis with neutral or lordotic, kyphotic sagital alignment, degenerative segmental instability without anterior compressive pathology or kyphosis, anterior pseudoarthrosis without associated kyphosis, congenital cervical stenosis, post-traumatic were excluded from the study. Clinical outcome was assessed using signs and symptoms based on selected items of Odom’s criteria, Japanese Orthopaedic Association (JOA) Score and Nurick’s grading. All patients received pre-operative and post-operative conventional (anterior-posterior, lateral) and functional (flexion/extension) radiographs and MRI.Results: At final follow up, symptoms resolution remained greater than 92% and fusion occurred in 94% of the disc spaces operated on. No graft extrusion / migration or implant complications are yet reported. Post-operatively, MRI signs of myelopathy defined as high signal foci of spinal cord in T2 – weighted images with or without a focal dimensional change in T1 – weighted images disappeared in 90% of the patients. All pre-operative and post-operative differences are significant at the p <0.001 levels. Conclusion: There is integrated improvement of radiologic signs, clinical signs and symptoms and quality of life in patients with cervical spondylotic myelopathy after anterior cervical discectomy and fusion with autograft and plating.