脊椎ジャーナル

Study of Functional Outcome of Anterior Cervical Decompression and Fusion Using Tricortical Iliac Bone Graft for Degenerative Cervical Spondylotic Myelopathy with Modified Japanese Orthopedic Association Score

Abstract

Ayush Sharma, Mayur Dhake, Vijay Singh1, Natraj B, Rajat Mahajan, Prashant Kamble, Pritish Khardikar, Tarun Chabra, Akshay Jadhav and Darshan Devani

Objective: To determine functional outcome of anterior cervical decompression and fusion using tricortical iliac bone graft (ACDF) for degenerative cervical spondylotic myelopathy with modified Japanese orthopedic association score (MJOA).
Materials and Methods: 60 diagnosed cases of one and two levels cervical myelopathy were prospectively analyzed preoperatively and at 3 months, 6 months, 1 year using MJOA.
Results: 46 patients underwent Single level ACDF with C5-C6 the commonest level to be affected. The correlation between Duration of Symptoms to Preoperative and postoperative MJOA was statistically significant. We noted statistically significant improvement in symptoms of axial neck pain, radicular arm pain, clumsy hand, and gait disturbances post operatively at one year. Statically significant difference was noted while comparison MJOA of Preoperative to 6 months and 1 year, and 3 months to 6 months and 1 year. Statistically significant difference in blood loss and anesthesia time for one level fusion compared with two level fusions was also noted. The fusion rate for single level ACDF was 95.65% compared to 71.42% for two levels.
Conclusion: Functional outcomes in operated patients at 1-year follow up are better if ACDF surgery is done early. Symptoms of axial neck pain; radicular arm pain, clumsy hand and gait disturbances show significant improvement at one year follow up. While bladder and bowel involvement showed the least recovery. Significant improvement in function occurs postoperatively between 3 and 6 months, and then it plateaus from 6 months to 1 year. Fusion rates for single level ACDF are better than two levels ACDF.