Anterior Cervical Discectomy and Fusion to Treat Cervical Spondylosis With Sympathetic Symptoms

Study Design: Retrospective study. Objective: To investigate the clinical effectiveness of polytheretherketone (PEEK) cages-assisted anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis with sympathetic symptoms. Summary of Background Data: The diagnosis and treatment of cervical spondylosis with sympathetic symptoms has remained controversial. To date, few reports have focused on the surgical efficacy of cervical spondylosis with sympathetic symptoms. Methods: Retrospective analysis was undertaken for 39 patients who were diagnosed as cervical spondylosis with sympathetic symptoms and underwent ACDF with PEEK cages. They were followed up for at least 1 year. The mean follow-up was 15.6 months. Radiographs obtained before surgery, after surgery, and at the final follow-up were assessed for quality of fusion. The sympathetic symptoms including vertigo, headache, tinnitus, nausea and vomiting, heart throb, hypomnesia, and gastroenterologic discomfort were scored by 20-point system preoperatively, 2 months postoperatively, and at the final follow-up. The recovery rate and clinical satisfaction rate were also evaluated. Surgical complications were also assessed. Results: Radiographs of the cervical spine at the last follow-up revealed a solid fusion with no signs of a pseudoarthrosis in 36 cases. In 2 patients delayed union and bony fusion were achieved at 9 and 11 months. Pseudoarthrosis was found in 1 case but the patient had no symptoms. The sympathetic symptoms improved in all patients and the score was significantly improved after surgery. There was one patient who had cerebral spinal fluid leakage but he recovered 1 week after surgery. Two patients felt a mild swallowing discomfort, but it disappeared within 1 month after surgery. Subcutaneous hematoma occurred in one patient due to obstructed drainage. It was cleared 2 days after surgery. Conclusions: Cervical spondylosis patients with sympathetic symptoms may be managed successfully with ACDF using PEEK cages. Successful clinical results regarding symptom improvement and general satisfaction with the surgical procedure depend on obtaining successful decompression and radiographic fusion.