Anterior Cervical X-Shape-Corpectomy and Fusion Versus Anterior Cervical Corpectomy and Fusion for Cervical Spondylotic Myelopathy: A Prospective Randomized Controlled Trial.

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Résumé de l'étude

86 patients with one or two-level cervical spondylotic myelopathy were included and were randomized to undergo anterior cervical X-shape-corpectomy and fusion (ACXF) or anterior cervical corpectomy and fusion (ACCF). The primary outcome of interest was the composite success rate at 1 year, defined by the absence of adverse events, reoperation, or implant failure, clinically meaningful improvement in Japanese Orthopaedic Association (JOA) score and successful fusion without significant implant subsidence. Secondary outcomes included perioperative outcomes, patient-reported outcome measures (JOA, Neck Disability Index, neck and arm pain), radiological outcomes, fusion rates, and implant subsidence. Outcomes were assessed preoperatively and at 3 months, 6 months, and 1 year postoperatively. Overall, the results of the study revealed that ACXF achieved a significantly higher composite success rate, fewer medical adverse events, lower implant subsidence and improved perioperative recovery compared with ACCF, while both procedures produced comparable improvements in symptoms and cervical alignment. These findings suggest that ACXF is a safe and effective alternative to conventional ACCF for appropriately selected patients with cervical spondylotic myelopathy.