OBJECTIVES The optimal surgical strategy for cervical spondylotic myelopathy (CSM) remains controversial; thus, the current study was designed to compare the outcomes of two different anterior approach surgeries for two-level CSM, namely, adjacent two-level anterior cervical discectomy and fusion (ACDF) and one-level anterior cervical corpectomy and fusion (ACCF). PATIENTS AND METHODS A total of 53 patients who underwent adjacent two-level ACDF and 68 patients who underwent one-level ACCF in the Spinal Surgery Department from January 2010 to October 2017 were retrospectively analyzed. Independent sample t tests and chi-square tests were used to compare perioperative parameters (hospital stays, bleeding amounts and operation times), clinical parameters (Neck Disability Index scores and Visual Analog Scale scores for neck and arm pain), and radiologic parameters (difference in segmental height, T1 slope, C2-7 sagittal vertical axis, C2-7 lordosis, segmental angle, and fusion rate). RESULTS The length of hospital stay (p < 0.01), bleeding amount (p < 0.01), operation time (p < 0.001) and difference in segmental height (p < 0.001) were significantly greater in the ACCF group than in the ACDF group, whereas C2-7 lordosis (p < 0.05) and the segmental angle (p < 0.001) were significantly lower in the ACCF group than in the ACDF group. Other parameters were not significantly different between the two groups. CONCLUSION Both ACDF and ACCF provided satisfactory clinical outcomes and fusion rates for CSM. However, adjacent two-level ACDF was associated with shorter hospital stays, less blood loss, shorter operative times, fewer differences in segmental height and greater improvement in segmental lordotic curvature. On most occasions, when either surgical method could be selected, adjacent two-level ACDF as a surgical treatment for CSM may be a worthwhile alternative method to one-level ACCF.

中文翻译：

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相邻两节段前路椎间盘切除融合术与单节段椎体切除融合术治疗脊髓型颈椎病：围手术期参数和矢状面平衡分析

目的 脊髓型颈椎病 (CSM) 的最佳手术策略仍存在争议。因此，本研究旨在比较两节段 CSM 的两种不同前路手术的结果，即相邻两节段颈椎前路椎间盘切除融合术 (ACDF) 和一级颈椎前路椎体切除融合术 (ACCF)。患者与方法 回顾性分析2010年1月至2017年10月在脊柱外科接受相邻两节段ACDF的53例患者和接受单节段ACCF的68例患者。使用独立样本t检验和卡方检验比较围手术期参数（住院时间、出血量和手术时间）、临床参数（颈部残疾指数评分和颈部和手臂疼痛的视觉模拟量表评分），和放射学参数（节段高度、T1 斜率、C2-7 矢状纵轴、C2-7 前凸度、节段角度和融合率的差异）。结果 ACCF组住院时间（p < 0.01）、出血量（p < 0.01）、手术时间（p < 0.001）和节段高度差异（p < 0.001）显着大于ACDF组，而 ACCF 组的 C2-7 前凸 (p < 0.05) 和节段角 (p < 0.001) 显着低于 ACDF 组。其他参数在两组之间没有显着差异。结论 ACDF 和 ACCF 都为 CSM 提供了令人满意的临床结果和融合率。然而，相邻的两节段 ACDF 与较短的住院时间、较少的失血、较短的手术时间、节段高度差异较小，节段性前凸曲率改善较大。在大多数情况下，当可以选择任一手术方法时，相邻的两级 ACDF 作为 CSM 的手术治疗可能是单级 ACCF 的一种有价值的替代方法。