Combined use of posterior unilateral open-door laminoplasty and leverage fixation for treatment of multi-segmental cervical spondylotic myelopathy / 军事医学

ABSTRACT

Objective To evaluate the clinical efficiency of posterior unilateral open-door laminoplasty and leverage titanium plate internal fixation in the treatment of cervical spondylotic myelopathy ( CSM ) with multi-segmental spinal stenosis.Methods Between Mar 2011 and May 2015, 25 patients with multi-segmental CSM with multi-segmental spinal stenosis were treated by posterior unilateral open-door laminoplasty and leverage fixation .There were 16 males and 9 females, whose mean age was 60.6 ±9.9 years during the surgery.The change of clinical symptoms and signs was recorded during follow-up,and they all received X-ray and MRI.In all the patients, the preoperative and postoperative neurological function, the cervical curvature,cervical vertebra tube volume and axial symptoms were measured , recorded and analyzed. There was statistically significant difference (P<0.05) in the mean Japanese Orthopaedic Association (JOA) score, and Visual Analogue Scale ( VAS) .Results All the 25 patients were followed up for more than 6 months ( 6-24 months ) .No symptoms of C5 nerve root were found in our series .According to the JOA score and VSA score ,the neurological functions of each patient were significantly improved .The preoperative JOA score was 10.16 ±1.35 and the improvement rate 61.24%. There was statistically significant difference between the preoperative VSA score and the postoperative one (6.68 ±1.12 vs 2.32 ±0.84) ( P<0.05).The preoperative and postoperative meansurement of the spinal vertebrai canal diameter was (9.22 ±2.01) and (15.64 ±2.08) mm, respectively,so there was statistically significant difference (P <0.05), indicating that the cavical spinal canal was increased after operation .Conclusion Leverage titanium plate internal fixation can effectively help maintain the expanded vertebral canal after unilateral open -door laminoplasty ,reduce the incidence of postoperative axial symptoms , and maintain the cervical physical curvature .