Single Level ACCF Combining Single Level Stand-alone ACDF in Treating Cervical Spondylotic Myelopathy

Objective: Single level ACCF combining single level ACDF (AcA) is an ideal way to treat CSM with multiple consecutive cervical intervertebral disc herniation alongside with severe bony narrowing of the spinal canal in between. AcA with the stand-alone technics on the ACDF level and a shorter titanium plate that only covers the ACCF levels (AcAsa) may possess potential advantages than conventional AcA. We performed a retrospective study to evaluate the feasibility, safety and effectiveness of AcAsa procedure. Methods 379 patients with CSM who had conventional AcA or AcAsa were retrospectively reviewed. Related patients factors, disease factors and treatment factors were acquired and subjected into student’s t test, chi-square test and survive analyses. Results Preoperative and postoperative JOA Scores in AcAsa: p<0.001. Preoperative and postoperative VAS Scores in AcAsa: p<0.001. 12months improvement of JOA Score between preoperative VAS Score≥2 and <2 in AcAsa: p=0.002. The amount of intraoperative blood loss between AcAsa and conventional AcA: p=0.011. Incidence of postoperative dysphagia between AcAsa and conventional AcA: p=0.038. Conclusion AcAsa significantly improve patients’ JOA Scores and reduce VAS Scores. Compared with conventional AcA, AcAsa leads to smaller amount of intraoperative blood loss and lower incidence of postoperative dysphagia. The alleviations of neurological symptoms, cervical motions and disc space heights at the ACDF levels are similar between the two types of surgeries. And patients with preoperative VAS less than 2 may benefit more from an AcAsa procedure.