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OBJECTIVE@#To compare the clinical effects and complications of two hybrid decompression techniques in treating multilevel (>=3) cervical spondylotic myelopathy(MCSM).@*METHODS@#The clinical data of 124 patients with multilevel (>=3) cervical spondylotic myelopathy treated by surgery and follow-up from January 2008 to December 2016 were retrospectively analyzed. According to the different operative methods, the patients were divided into group A and group B. Anterior cervical discectomy and fusion (ACDF) combined with anterior cervical corpectomy and fusion with preserved posterior vertebral wall (PWCF) were performed in group A; ACDF combined with anterior cervical corpectomy and fusion(ACCF) were performed in group B. There were 44 males and 16 females in group A with an average age of (60.43±7.52) years old, 46 males and 18 females in group B with an average age of (61.61±6.39) years old. No significant differences were found in gender, age between two groups. The operative time, intraoperative blood loss, hospital stay, rate of complications, postoperative Japanese Orthopaedic Association (JOA) score and improvement of cervical curvature were compared between two groups.@*RESULTS@#All the operations were successful. The follow-up time was 13 to 28(23.0±12.1) months in group A and 12 to 30(24.0±11.5) months in group B. The operative time, intraoperative blood loss, hospital stay in group B were higher than those in group A(0.05). The physiological curvature of cervical vertebra was improved significantly after operation, and there was no significant difference between two groups(>0.05).@*CONCLUSIONS@#Both surgical methods can obtain satisfactory clinical efficacy for multilevel(>=3) cervical spondylotic myelopathy, but compare with group B (ACDF combined with ACCF), group A (ACDF combined with PWCF) has shorter operation time, less trauma, less bleeding, and lower incidence of complications. ACDF combined with PWCF can be preferentially selected for the patients who corresponding to the indications.
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Aged , Female , Humans , Male , Middle Aged , Cervical Vertebrae , Diskectomy , Retrospective Studies , Spinal Cord Diseases , Spinal Fusion , Spondylosis , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical outcomes of anterior corpectomy combined with anterior intervertebral decompression and fusion for multilevel cervical spondylotic myelopathy.</p><p><b>METHODS</b>The clinical data of 28 patients with multilevel cervical spondylotic myelopathy who underwent surgery from October 2012 to June 2014 were retrospectively analyzed. There were 18 males and 10 females, aged from 45 to 77 years old with an average of (60.11±9.37) years. Three levels were involved in 27 cases, while four levels were involved in 1 case. The preoperative JOA score was 8.89±1.87; the fusion segments angles was (4.87±4.56)°; and the cervical curvature was (11.68±1.25)°. Anterior hybrid decompression and fusion were performed in 28 patients. The fusion segments angles and the cervical curvature were assessed by X-rays at 1, 12 months after operation, respectively. JOA score was used to evaluate the clinical effect.</p><p><b>RESULTS</b>The operative time was 163 min on average (ranged from 120 to 205 min), and intraoperative bleeding was 198 ml on average(ranged from 100 to 300 ml). Hoarseness occurred in 1 case and got recovery at 3 weeks after operation and choke cough occurred in 1 case, and got improvement at 1 week after operation. All the patients were regularly followed for 12-24 months with an average of(18.46±3.20) months. Graft bone obtained fusion at 12 months after operation and the position of internal fixation was good. The fusion segments angles, the cervical curvature and JOA scores were significantly improved at 1, 12 months after operation(<0.05). The improvement rate of JOA score was(46.46±20.26)% at 12 months after operation, 12 cases got excellent results, 14 good and 2 fair.</p><p><b>CONCLUSIONS</b>Anterior corpectomy combined with anterior intervertebral decompression and fusion is safe and effective and can get satisfactory effects for multilevel cervical spondylotic myelopathy.</p>
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Objective To compare the clinical effects of modified single open-door laminoplasty combined with segmental lateral screw fixation with conventional single open-door combined with continuous screw fixation in the treatment of multilevel cervical spondylotic myelopathy (MCSM).Methods Retrospective analysis was used to analyze the fifty-five cases of MCSM who underwent posterior operation in Lianyungang Hospital Affiliated to Xuzhou Medical University from March 2009 to January 2017.Among them,26 cases in the modified group were treated by modified single open-door laminoplasty combined with segmental lateral screw fixation;29 cases in the traditional group were treated by conventional single open-door combined with continuous screw fixation.JOA score collected before the operation and at the last time of the follow-up,the cervical spine mobility,cervical curvature,cervical axial symptom,C5 nerve root palsy and the incidence rate of screw fracture in both groups were compared.Operation time and the intraoperative blood loss were recorded.Results 55 cases were all followed up.The cervical spine mobility at the last time of the follow-up in the modified group was significantly higher than that of the traditional group ((39.63°±5.98°) vs.(36.14°±6.05°),P=0.036).The cervical curvature in the modified group was higher than that of the traditional group ((19.83°±5.61°) vs.(16.02°±7.05°),P=0.030).The operation time and intraoperative blood loss in the modified group were significantly lower than those of the traditional group ((116.3±13.2) min vs.(128.7±14.3) min,(186.7±39.8) ml vs.(228.7±42.5) ml,P=0.002,0.000).In the modified group,the proportion of patients with postoperative cervical axial symptom was 15.38%,the rate of C5 nerve root palsy cases was 8.69%,compared with 48.27% and 34.48%,respectively in the control group,the difference between the two groups was statistically significant (P=0.011,0.022).In the traditional group,2 cases of screw fracture were found at the last follow-up,while there was no such case in the modified group.Conclusion The modified cervical single open-door laminoplasty combined with segmental lateral screw fixation can obtain good effect of nerve decompression,maintain cervical mobility and cervical curvature,reduce the occurrence of postoperative cervical axial symptom,C5 never root palsy,screw fracture and other complications,is a safe and effective surgical method.
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Objective:To compare the therapeutic characteristics of anterior hybrid decompression and posterior cervical posterior laminectomy in the treatment of multilevel cervical spondylotic myelopathy.Methods:Thirty six cases of multilevel cervical spondylotic myelopathy patients treated by anterior hybrid decompression and thirty three cases of multilevel cervical spondylotic myelopathy patients treated by posterior cervical posterior laminectomy were involved.The general information,bleeding amount,operative time,cervical curvature D value,JOA score and incidence of postoperative complications of the two groups before and after surgery were compared.Results:There was no significant difference in the general information among the two groups(P＞0.05),including age (anterior group:56.23± 7.64 years old,posterior group:55.76± 8.18 years old),sex (anterior group:22 males/14 females,posterior group:20 males/13 females),cervical curvature D value (anterior group:7.41± 3.14,posterior group:8.19± 2.74),JOA score (anterior group:9.08± 1.09 scores,posterior group:8.82± 1.26 scores),disease course (anterior group:17.24± 7.36 months,posterior group:15.75± 5.78 months) and affected segment (anterior group:3.11 ± 0.26 segments,posterior group:3.24± 0.39 segments).The the amount of bleeding in the anterior group (anterior approach:221.79± 178.02 ml,posterior group:483.07± 434.25 ml) was lower than that of the posterior group(P＜0.05).The operative time (anterior group:196.54± 51.88 mins,posterior group:175.12± 54.93 mins) was longer,but there was no significant difference (P＞0.05).The cervical curvature D value and JOA score of posterior group were increased with the extension of surgery time.However,the cervical curvature D value of posterior group was decreased,but JOA score was increased.The incidence of bone unfinished,hoarseness and cerebrospinal fluid leakage were found in the anterior group,and axial pain and C5 nerve root paralysis were found in the posterior group.But there was no significant difference in the incidence of complications between the two groups (anterior group 14.89％,posterior group:12.12％)(P＞0.05).Conclusions:Anterior hybrid decompression and posterior cervical posterior laminectomy had their own advantages in the treatment of multilevel cervical spondylotic myelopathy.,The appropriate treatment should be taken according to the condition of patients.
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Objective To explore the application value of single-door laminoplasty via Y type nano-bone plate in treating multilevel cervical spondylotic myelopathy (MCSM) and analyze the short-term efficacy.Methods From January 2013 to December 2016,79 cases of MCSM were treated with single-door laminoplasty via Y type nano-bone plate to evaluate the improvement of post-operative neurological function by the Japanese Orthopaedic Association (JOA) evaluation system.We also measured cervical curvature of cervical X-ray and C5 sagittal diameter of the spinal canal before operation and 6 months after operation to understand the maintenance and enlargement of the spinal canal.The improvement degree of spinal cord compression was evaluated by preoperative and postoperative cervical MRI.Osseous healing on the open door side and the door shaft side was observed with the aid of three-dimensional spiral CT.Results Follow-up ranged from 6 to 36 months,with an average of (20.4±7.9)months.Preoperative JOA score was (8.6 ± 1.3) points and JOA score 6 months after operation was (14.3 ± 1.5)points (P ＜ 0.05).JOA improvement rate was (68.6 ± 15.8)％;postoperative follow-up X-ray and threedimensional spiral CT showed that the spinal canal had satisfying enlargement,the door shaft side all had osseous healing,the open door side osseous healing was not obvious,and there was no lamina collapse or reclosing.Sagittal diameter of theC spinal canal was (8.9±l.1)mm before operation and (15.1±l.1)mm 6 months after operation (P＜0.05).The spinal canal enlargement rate was (70.8±22.3)％,cervical curvature was (14.8± 7.0)°preoperatively and (15.1±6.7)°postoperatively with no significant difference (P＞0.05).Conclusion EOLP via Y type nano-bone plate is safe and efficacious in treating MCSM.It not only provides a good immediate fixation,but also provides the possibility for the open door side lateral osseous fusion.