Comparison of anterior and posterior decompression in the treatment of spinal cord injury without fracture and dislocation / 中国综合临床

ABSTRACT

Objective To investigate the clinical effect of anterior and posterior decompression internal fixation in the treatment of spinal cord injury without fracture and dislocation(CSCIWFD).Methods The clinical data of sixty-five patients with CSCIWFD in Worker's Hospital and Handan Central Hospital from December 2013 to May 2015 was analyzed.According to the surgical methods,the patients were divided into two groups,31 cases in the anterior group,accepted the anterior cervical decompression and internal fixation,34 cases in the posterior group,treated with posterior cervical open-door laminoplasty fixation.The operation time, intraoperative blood loss,neurological function recovery and complications of each group were recorded.Results The operative time in the anterior group was(63.2 ± 15.1)min and in the posterior group was(113.8 ±21.5)min,there was significant difference between the two groups(P<0.05).The intraoperative blood loss in the anterior group was lower than that in the posterior group((116.3 ± 18.9)ml vs.(236.3 ± 41.0)ml,t=55.837,P<0.05).In the anterior group,the JOA score was(6.9±1.6)points before operation,(9.6±1.9) points at 2 weeks after operation,(11.7±2.6)points at 3 months after operation and(13.5±3.1)points at the last follow-up,there were significant differences between the preoperative level and postoperative level(F between groups=33.759,P<0.05;F grouP=5.213,P<0.05;F interaction=6.769,P<0.05).In the posterior group,the JOA score was(6.7 ± 1.5)points before operation,(8.7 ± 1.8)points at 2 weeks after operation, (10.9±2.5)points at 3 months after operation and(13.1±3.4)points at the last follow-up,the differences were all statistically significant(P<0.05).Based on the JOA scores,there was significant difference between the two groups at 2 weeks after operation(P<0.05).The anterior group had 1 case of recurrent laryngeal nerve injury and 1 case of cerebrospinal fluid leakage,while the posterior group had 1 case of wound infection,1 case of liquefaction necrosis and 1 case of epidural hematoma.There was no significant difference in the complication rate between the two groups(X2= 0.000,P= 1.000).Conclusion The anterior decompression has the advantages of less operative trauma,shorter operation time,less intraoperative blood loss and quick recovery of nerve function.The selection of surgical method should be based on the compression section of the spinal cord.