| Objective: The cervical spondylotic myelopathy ( CSM ) is one kinds of the common diseases in clinical orthopedics often in 40~60 years old. It's mainly expression is pyramidal tract symptom. Since Smith and Robinson described the anterior decompressed fusion operation first time at 1958,the operation technique already made use of to treat CSM,and become gold standard of cervical vertebra degenerative disease.But some scholar observed that some patients'fusion segment curvature changed after operation,especially had different degree of kyphosis which affected the recovery of neurological function and affected the cervical anterior approach curative effect.Moreover some patients suffered from neck axial symptom ( AS ) during the period of postoperative rehabilitation or in long-term. The neck axial symptom (AS) contains stiffness, ache and limitation of activity in neck, nape,shoulder and back.This research observed emphasis the cervical curvature change after anterior cervical fusion and the relation to neck axial symptom,and learned the key to reduce the neck axial symptom after operation.Thus we can reduce, even avoid the neck axial symptom to relieve patients'painful. Method: Collect the CSM 70 cases, all cases are judged by the JOA standard. According to the different surgical operation method all CSM patients are divided into two groups.30 cases of the CSM underwent the anterior cervical decompression and bone grafting ( decompression and bone grafting group ), 40 cases of the CSM underwent the anterior cervical decompression and bone grafting addition internal fixation ( decompression and bone grafting addition internal fixation group ). The routine method of preoperative check include: the cervical vertebra X-ray of orthotopic-lateral and a dynamia position, together with CT, MRI check.To analyze each surgical operation groups RIS and complication circumstance by statistics. To statistics the rate of improved JOA score RIS= (postoperative score-Preoperative score) / (17-Preoperative score)×100%. The curative effect is divided into four classes according to the RIS, excellent: The RIS is above 75%, good: The RIS is 74%～50%, general: The RIS is 49%～25%, bad: The RIS is below 25%. All the postoperative cases were followed up at one week, 3 months, 6 months, 12 months and 24 months after opertion, and their recovery information of clinical symptom, physical sign and neurological outcome were observed and recorded. The cervical vertebra X-ray of orthotopic-lateral position was rechecked every time ( parts of cases to recheck the postoperative CT or MRI ), and observe the bone graft fusion condition, the internal fixation device whether or not loosening, moving, breakage and failure, etc. A review of postoperative complications,fusion rate, intervertebral space height and cervical curvature change for the two groups patients were performed. In the end, the neck axial symptoms of two groups after operation were observed.Results: The average preoperative JOA Scores was 9.05±2.39 and add to the postoperative of 13.62±2.45 in decompression and bone grafting group. P value<0.0001<0.05, according to the a=0.05 standards, postoperative curative effect is obvious good. The average preoperative JOA Scores was 8.97±2.64 and add to the postoperative of 13.85±2.37 in decompression and bone grafting addition internal fixation group. P value < 0.0001 < 0.05, according to the a=0.05 standards, postoperative curative effect is obvious good. In decompression and bone grafting group the RIS was 57.35±31.83%, clinical outcome was excellent or good was 80.00%,and the RIS was 61.10±28.35%, clinical outcome was excellent or good was 82.50% in decompression and bone grafting addition internal fixation group.Two groups of the RIS statistics,t=0.54,P value>0.05, according to the a=0.05 standards, the postoperative curative effect in both of groups were good. Compared with preoperativethe intervertebral space height was average decreased 0.8±1.1 mm in decompression and bone grafting group and average increased 1.5±0.7 mm in decompression and bone grafting addition internal fixation group.According to the a=0.05 standards,the difference was obvious ( t=10.99,P<0.01 ). Compared with preoperative cervical curvature in cervical vertebral fusion segment was average decreased 1.33±3.43°in decompression and bone grafting group and average increased 2.51±6.75°in decompression and bone grafting addition internal fixation group.According to the a=0.05 standards, the difference was obvious ( t=2.93,P<0.01 ). The incidence of neck axial symptom was 46.67% in decompression and bone grafting group and 17.50% in decompression and bone grafting addition internal fixation group According to the a=0.05 standards,the difference was obvious (χ~2=5.625,0.01 |
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