Clinical analysis of cervical posterior internal fixation titanium plate and silk suspension internal fixation cervical spondylosis / 中华外科杂志

ABSTRACT

Objective@#To evaluate the clinical effect and imaging evaluation of cervical spine myelopathy treated with Centerpiece.@*Methods@#A retrospective study of 60 patients underwent posterior cervical spine surgery because of cervical myelopathy in Spinal Department of Peking University People′s Hospital from July 2011 to January 2013.According to the different fixation methods, all patients were divided into cervical posterior open-door Centerpiece fixation group (group A) and cervical posterior open-door silk suspension fixation group (group B). There were 40 patients in group A, including 25 males and 15 females, mean age (59.7±11.9) years old, average course of disease before surgery (53.6±61.5) months, average follow-up time (28.5±3.1) months after operation.There were 20 patients in group B, including 15 males and 5 females, mean age (58.3±9.6) years old, average course of disease before surgery (50.4±14.9) months, average follow-up time (28.3±1.9) months after operation.The operation time, intraoperative blood loss, postoperative drainage, preoperative and postoperative Japanese Orthopaedic Association(JOA) score, the neck disability index(NDI) score, visual analog scale (VAS) score, postoperative axial pain, C5 nerve root palsy, postoperative "re-closing" and other related complications were observed.Imaging assessment projects include before and after surgery of cervical curvature, range of motion(ROM), spinal anteroposterior diameter, spinal canal expansion rate, the whole spinal cord backward shift distance and area of the spinal canal and the opening angle.@*Results@#There was no significant difference in general data between the two groups (P>0.05). Group A the average operation time was(117.7±23.4)min, the average amount of operative bleeding was (152.0±122.7) ml, and the postoperative drainage volume was (268.7±222.1) ml.The average operation time of group B was (141.7±23.9) min, the average amount of operative bleeding was (166.7±42.5) ml, and the postoperative drainage volume of group B was (255.3±47.0) ml.There was no significant difference between the two groups in the amount of operative bleeding and postoperative drainage volume (both P>0.05), the operation time between the two groups was statistically significant (P<0.05). At the end of the follow-up, the JOA score, NDI score, and VAS score were significantly improved (P<0.05) in both group A and group B and there was no significant difference between the two groups (P>0.05). C5 nerve root paralysis was not occurred in both two groups after operation.There were 1 case of axial pain in the group A and 7 cases in the group B and there were significant differences between the two groups (P<0.05). The group A was not found "re-closing" during the follow-up and 12 patients of group B found to be "re-closing" phenomenon, there were statistically different between the two groups (P<0.05). Comparison of preoperative and postoperative, there were no significant differences in cervical curvature and ROM in both groups (P>0.05). Butthe spinal canal diameter and the vertebral canal area were statistically different after surgery (P<0.05). There was no statistical difference between the two groups of cervical curvature and ROM (P>0.05). There was no statistical difference between the two groups of spinal canal diameter, spinal canal area and spinal canal diameter enlargement rate(P>0.05). There was no statistical difference between the two groups of the whole spinal cord backward shift distance(P>0.05). There were significant differences between the two groups at the angle of the open door (P<0.05).@*Conclusion@#Centerpiece cervical posterior titanium plate can achieve good clinical efficacy in the treatment of multi segmental spinal cervical spondylosis.