Abstract:Objective To compare the clinical efficacy and imaging results of anterior decompression with fusion (ADF) and of posterior open-door laminoplasty (LAMP) in the treatment of type Ⅱ multilevel cervical spondylotic myelopathy (MCSM)according to spinal cord line (SC line)and to provide a reference for the selection of surgical procedures.Methods 65 patients with type Ⅱ MCSM who underwent surgical treatment in our hospital from January 2014 to June 2018wereretrospectively analyzed.The research objects were divided into ADF group and LAMP group.There were 30 cases in the ADF group,including 21 males and 9 femaleswith an average of (62.5±10.7) (range:37~79 year).The LAMP group involves 35 cases,including 22 males and 13 femaleswith an average of (61.1±10.7)(range:34~81 year).According to whether there was residual compression of the anterior spinal cord during the follow-up after LAMP operation,the patients were divided into the subgroup LAMP(+) andLAMP(-) subgroup.There were12 cases of residual anterior compressionin LAMP(+)groupand 23 cases of without residual anterior compressionin LAMP(-) group.The the Japanese Orthopaedic Association Scores(JOA),improvement rate and pain visual analogue scale(VAS),cervical curvature and range of motion before and after operation were studied.Results The JOA improvement rate at the last follow-up in the ADF group and the LAMP group were (64.0±8.1)% and (48.7±14.7)% respectively.The VAS score was (1.1±0.4) and (1.4±0.6)points respectively.There were statistically significant differences in the VAS scores and the JOA of the two groups (P<0.05).At the last followup,the average cervical curvature in the ADF group increased from (12.9±7.7)° to (15.7±6.8)°,and the LAMP group decreased from (17.1±6.1)° to (14.1±5.4).There were statistical differences (P<0.05).The range of motion (ROM) of the cervical spine before operation in the ADF group was (24.5±6.3)°,and the last follow-up was (19.2±5.5)°.The preoperative cervical ROM of the LAMP group was (23.9±6.6)°,and the last follow-up was (18.9±5.4)°,and the ROM of the cervical spine in both groups was significantly lower than that before operation (P<0.05).The improvement rates of JOA at the last follow-up of LAMP(+) and LAMP(-) subgroups were (32.7±9.2)% and (57.0±9.4)% respectively.The VAS scores were (1.8±0.5) points and (1.3±0.5) points,respectively.The changes in the angle of curvature were (4.0±1.0)° and (2.3±1.5)°,respectively.There were statistically significant differences in the JOA improvement rate,VAS score and changes in the angle of curvature between the two subgroups (P<0.05).The postoperative complication rate was 16.7% in the ADF group and 25.7% in the LAMP group,and the difference was not statistically significant (χ2=0.782,P=0.376).Conclusion The recoveryis better for patients with type Ⅱ MCSMunderwentanterior surgery. The contact with or exceed the SC line in the front of the spinal cord before surgery,and loss of postoperative cervical spine curvature are risk factors for residual compression of the anterior spinal cord after LAMP surgery.Residual compression in front of the spinal cord after LAMP surgery impedes recovery of neurological function.
梁冬牧,韩来春,郝晨,刘瑞祯,关海山 *. 脊髓线标准下Ⅱ型多节段脊髓型颈椎病手术选择及疗效研究[J]. 实用骨科杂志, 2021, 27(4): 294-305.
Liang Dongmu,Han Laichun,Hao Chen,et al. Surgery Plan and Curative Effect of Type Ⅱ Multilevel Cervical Spondylotic Myelopathy According to Spinal Cord Line. sygkzz, 2021, 27(4): 294-305.
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