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

Study DesignRandomized controlled trial (RCT).ObjectivesTo compare the clinical performance of anterior cervical X-shape-corpectomy and fusion (ACXF) and anterior cervical corpectomy and fusion (ACCF) in treating cervical spondylotic myelopathy (CSM).MethodsIn this single-center, prospective RCT, patients with CSM were enrolled between January 2023 and June 2024 and randomly assigned to undergo either ACXF or ACCF. Blinded coordinators collected clinical and imaging data at baseline, 3 months, 6 months, and 1 year postoperatively. The primary outcome was the composite success rate at 1 year postoperatively. Secondary outcomes included perioperative outcomes, patient-reported outcome measures (PROMs), and radiological outcomes.ResultsEighty-six patients were randomized equally to the ACXF or ACCF group, among whom 82 (95.3%) were eligible for the primary analysis. At 1 year postoperatively, the composite success rate was significantly higher in the ACXF group than in the ACCF group (57.5% vs 21.4%, <i>P</i> < 0.001), with lower incidences of general medical adverse events (15.0% vs 41.5%, <i>P</i> = 0.008), dysphagia (10.0% vs 27.5%, <i>P</i> = 0.045), and implant subsidence (25.0% vs 75.6%, <i>P</i> < 0.001). ACXF also resulted in lower drainage volume (<i>P</i> < 0.001) and shorter drainage duration (<i>P</i> < 0.001). Both groups showed improvements in PROMs and sagittal alignment, with no between-group differences. Fusion rates remained comparable between the ACXF and ACCF group throughout follow-up, while ΔFSU height and subsidence rate in the ACXF group was significantly lower than that in the ACCF group.ConclusionACXF achieved a higher composite success rate than conventional ACCF. It may represent a valuable surgical alternative for appropriately selected patients with CSM.