Efficacy of open-door laminoplasty with titanium plate fixation with different fixed segments in the treatment of multilevel cervical myelopathy in the elderly patients / 中国综合临床

ABSTRACT

Objective To investigate the clinical effect of titanium plate fixation for posterior one-door-open laminoplasty in the treatment of elderly patients with multi segmental cervical spondylotic myelopathy,to analyze the advantages and disadvantages of open cervical spine fixation under fixed mode.Methods Thirty-eight cases with multi segmental cervical spondylotic myelopathy treated in China Meitan General Hospital with titanium plate fixation and posterior cervical laminoplasty from January 2011 to January 2014 were selected as the research object,a retrospective analysis was made on the clinical data of the patients.Group A with 20 cases was fixed with open-door segment C3~C6;18 cases in group B were treated with open door fixation of segmental C3~C7.X-ray,CT,MR were examined in preoperative time,JOA score was performed at 7d and 6 months after surgery.Door opening angle of CT cross section,the anteroposterior diameter(APD)of the spinal canal and shaft fusion were measured.MR spinal cord signal changes and the degree of compression,cervical spine activity, postoperative pain,the initial pain degree,VAS score and remission time differences were evaluated and analyzed.Results The incision healed in group A and B after the operation,the incidence rate of axial symptoms was 30%(6/20)in group A and 38.9%(7/18)in group B,the difference was statistically significant(P= 0.043); postoperative JOA scores were(12.2 ± 2.3)% points and(12.8 ± 1.7)points respectively in group A and B,the improvement rate of nerve function were(49.31 ± 14.5)% and(47.93 ±18.6)%,respectively in group A and B,the change rate of cervical spine were(-2.37±1.88)% and(-2.65 ±1.23)%,respectively in group A and B,the difference was not statistically significant(P>0.05).Initial VAS scores were(3.2±1.3)points and(4.1±1.7)points respectively in group A and B,the pain time were(55.2±28.5)d and(24.9± 19.2)d respectively,and complete remission time were(93.2± 47.3)d and(152.5 ± 59.3)d respectively,the differences between the two groups were statistically significant(P=0.028,P=0.031) .There were no change in opening angle,the anteroposterior diameter of spinal canal and spinal canal expansion rate at 7 days after surgery,but the door had bony fusion,without lamina closure phenomenon,and the seveity of spinal cord compression was improved at 6 months after surgery, compared with the preoperative time.Conclusion To obtain the ideal clinical treatment effect on titanium plate fixation of open-door laminoplasty in the treatment of multilevel cervical myelopathy in the elderly patients,the characteristics of the patient's own disease and selective fixation section should be taken into consideration.