Multiple Segmental Posterior Cervical Degenerative Disease Clinical Research

Part1Plate-only open-door laminoplasty with fusion in treatment of multilevel degenerative cervical diseaseObjective:To evaluate safety and efficacy of improved plate-only fixation open door laminoplasty with supraspinal ligament preserved. Methods:Thirty-five patients with multilevel cervical degenerative disease were enrolled for selective open-door laminoplasty with miniplate fixation; autologous bone debris was put on the hinge side to promote fusion, with no bone struts on the open side. The JOA score, X-ray,3-dimensional CT and MRI were used for the pre-and postoperative evaluation.Results:The mean follow-up period was22months (12-34months), and all patients had achieved osseous fusion within6months after the operation. The JOA improvement was60.7%; a23%incidence of axial neck pain and a3.2°loss of ROM were observed in the patients who underwent open-door laminoplasty. No instrumentation failure or clinical deterioration was observed in our study.Conclusion:The research showed that open-door laminoplasty with miniplate fixation is a safe, simple surgery for multilevel cervical disease that has significant clinical efficacy. This approach can maintain the cervical range of motion, reduce the incidence of postoperative axial neck pain, decrease surgical time and cost, and avoid complications related to fusion. Part2Clinical evaluation of improved open-door laminoplasty with miniplate fixation and fusion versus laminectomy in cervical degenerative disease, a retrospective cohort studyObjective:to evaluate clinical efficacy of an improved open-door laminoplasty with pre-bend miniplate fixation and fusion as well as early post-operative exercise.Methods:Among41patients diagnosed as multilevel OPLL or cervical spondylotic myelopathy,23patients were enrolled for conventional posterior laminectomy and fusion, and18patients were enrolled for selective open-door laminoplasty with miniplate fixation, with bone debris on hinge side to promote fusion. The JOA score, X-ray (including forced flexion and extension),3-dimenstional CT and MRI were used for the pre-and post-operative evaluation.Results:The mean follow-up period was26months for the laminoplasty group and30months for the laminectomy group. All patients in laminoplasty group gained osseous fusion6months after operation. No significant difference in JOA score improvement, surgical time, and complications related to instrumentation was observed between two groups. In contrast, the incidence of axial neck pain and loss of ROM in the open-door laminoplasty group was significantly lower than that in the conventional laminectomy group.Conclusions:Compared with conventional laminectomy, open-door laminoplasty with miniplate fixation is a safe, simple and lowly invasive surgery for multilevel cervical disease with profound clinical efficacy. Moreover, the improved open-door laminoplasty can maintain the cervical motion rage, reduce the incidence of post-operative axial neck pain and avoid the complications related to fusion. Part3Risk factor analysis of axial syndromes after laminectomy or laminoplasy.Objective:To identify the risk factor of axial syndromes after laminectomy or laminoplasty by evaluate the clinical efficacy and safety of the cervical surgeries.Methods:Patients presented with multilevel ossification of posterior longitude ligament or cervical myelopathy between2005.6to2011.6were enrolled into the research,86patients received laminectomy and fusion, while45patients received plate-only instrumented laminoplasty. The parameter include age, gender, axial syndromes before surgery, operated level, operation time, blood loss in surgery, drainage volume, discharge days, JOA score and X-ray before and after surgery, as well as the severity and duration of axial syndromes after surgery were collected.Results:The mean follow-up period was6-36months. Age, gender, operation time, blood loss in surgery, drainage volume, discharge days, JOA score improvement and Ishihara index had no significant correlation with the incidence of axial syndromes. And laminectomy had a high correlation with the axial syndromes, as well as axial syndromes before operation and if C2or C7was involved in the surgery. Conclusion:The research showed that laminectomy, C2or C7involved, and axial syndromes before surgery could induce a higher risk of axial syndromes.