• Masato Tomii, Junichi Mizuno, Yasunobu Itoh, and Kazuo Watanabe.
• Department of Neurosurgery, Southern TOHOKU General Hospital, Iwanuma, Miyagi, Japan. Electronic address: masatotomii@ybb.ne.jp.
• Clin Neurol Neurosurg. 2015 Aug 1;135:11-4.

ObjectiveThe purpose of this study was to elucidate the pathological characteristics of C3-C4 cervical spondylotic myelopathy (CSM).MethodsSingle-level anterior cervical discectomy and fusion (ACDF) was performed at C3-C4 in 53 patients (38 men, 15 women). The mean duration of preoperative symptoms was 6.0 months. Fifty-three non C3-C4 ACDF patients of our random sample of ACDF patients were compared to the C3-C4 ACDF patients. Clinical outcomes were assessed according to the Japanese Orthopedic Association score (JOA score), the Neurosurgical Cervical Spine Scale (NCSS), and the Nurick scale. And radiological findings including C2-C7 lordosis, C3-C4 range of intervertebral motion (ROM), C2-C7 ROM, and C3-C4%ROM in the cervical spine were evaluated in both groups.ResultsThe recovery rates of JOA score and the NCSS in C3-C4 ACDF patients were 62.5% and 62.1%, respectively. The radiological study of C3-C4 ACDF patients showed that they had significant cervical lordosis, and cervical motion was dependent on the C3-C4 segment, which accounted for 39.8% of C2-C7 ROM (total motion).ConclusionIn C3-C4 ACDF patients, not only static factors, but dynamic factors (instability) at the C3-C4 level contributed to the major causes of CSM.Copyright © 2015 Elsevier B.V. All rights reserved.

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