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BACKGROUND:Laminoplasty and laminectomy are the most commonly used treatment methods for multilevel cervical spondylotic myelopathy, which is more common in elderly patients. C5 nerve root palsy is the common postoprative complication after posterior cervical repair. OBJECTIVE:To compare the incidence of C5 nerve root palsy after laminoplasty with mini-titanium plate fixation and laminectomy with internal fixation in repair of multilevel cervical spondylotic myelopathy. METHODS:Total y 134 patients with multilevel cervical spondylotic myelopathy from August 2010 to December 2014 were enrol ed, and then divided into laminoplasty group (n=45) and laminectomy group (n=89) owing to different ways of repair. Patients in the laminoplasty group were treated with laminoplasty with mini-titanium plate fixation, and patients in the laminectomy group were treated with laminectomy with internal fixation. C5 nerve root palsy condition after repair was recorded and evaluated. The cervical lordosis angle (Cobb angle) and cervical curvature index were compared. The Japanese Orthopaedic Association score was used for neurological assessment. RESULTS AND CONCLUSION:Al patients in both groups were fol owed up for more than 6 months. There were no significant differences in cervical lordotic angle and cervical curvature index at the first week before and after the treatment between these two groups (P>0.05). The Japanese Orthopaedic Association scores of patients after 6 months of treatment were significantly improved compared with that before treatment in these two groups (P<0.05). There were 2 cases of C5 nerve root palsy after the treatment of laminoplasty, the occurrence rate was 4%(2/45);there were 10 cases of C5 nerve root palsy after the treatment of laminectomy, the occurrence rate was 11%(10/89);there was significant difference between these two groups (P<0.05). These results suggest that compared with laminectomy fixation, the incidence of C5 nerve root palsy was lower after the laminoplasty with mini-trianium plate fixation, which can be widely used in decompression repair treatment of multilevel cervical spondylotic myelopathy.
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Objective To investigate procedure and therapeutic effect of resection and reconstruction for axis tumors through the sub mandible approach. Methods Between December 2004 to June 2010,17 patients with axis neoplasm underwent tumor resection and antero-posterior reconstruction through the combined the sub mandible-inner sternocleidomastoid muscle (SMIS) approach and posterior approach. Tumor lesions involved C2 in 11 cases, C2-3 in 4, C2-4 in 2. Eight cases involved vertebral body, and 9 involved both vertebral body and element. Fourteen primary lesions including 4 giant cell tumors, 4 plasmocytomas, 2 chordomas, 2 eosinophilic granulomas, 1 hemangiopericytomas and 1 lymphoma, and 3 metastatic lesions were involved in this study. Three types of reconstruction in upper cervical spine including titanium mesh plus vertically placed titanium plate, titanium mesh plus obliquely placed titanium plate and trimmed titanium mesh alone, were adopted after anterior tumor resection, and then posterior tumor resection and reconstruction were performed. Results All patients experienced pain relief and neurological improvement after surgery. Except for one incidence of screw pull-out which was corrected by a revision surgery, solid fusion was achieved in all patients. A follow-up period of 6 months to 6 years was available for this study. One patient died of cerebral infarction 9 months postoperative. Two patients with chordoma relapsed 13 months and18 months postoperative, respectively, of whom one died of high plegia and respiratory failure, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases 12 months and 18 months postoperative, respectively. Conclusion Through the SMIS apporach, a satisfactory exposure can be obtained for axis tumor resection and reconstruction. Anterior reconstruction of upper cervical spine after tumor resection can be achieved with internal fixation system of cervical spine, which can improve intraopera-tive safety. The combined anterior reconstruction and posterior occipito-cervcial fixation can provide immediate stability, and benefit maintaining stability of upper cervical spine.