Clinical Comparison Of The Effects On Cervical Spondylotic Myelopathy Between The Single,Double Open-door Laminoplasty

Objective: It is to analyze and compare the clinical effects on CervicalSpondylotic Myelopathy(≥3and≤4segments,≥5segments not in this comparison)between the single open-door and double open-door laminoplasty,including operationtime,intraoperative blood loss,postoperative spinal sagittal diameterchanges,postoperative complications,and the improvement of neurological function.Methods: We selected40cases patients with Cervical SpondyloticMyelopathy(≥3and≤4segments) from March2006to March2011in the FirstAffiliated Hospital of Dalian Medical University.It was a clinical retrospective study.20patients was treated with Single-open door laminoplasty(including10patients with3segments as A group,10cases of4segments as B group), and20patients was treatedwith cervical posterior double-door laminoplasty (including10patients with3segmentsas C group,10cases of4segments as D group), In the study,we observed andcalculated the operation time,blood loss,the improvement rate of JOA(JapaneseOrthopedics Association),postoperative complications and compared them at last.Weused two independent samples T-test and X2test to do statistical analysis for theclinical data of segments3and segment4in the different operation.Results:1.The operation time in group A was (110±13) minutes, in the group Bwas (140±20) minutes. There were significant differences between them(p<0.01).Operation time of C group was (120±11) minutes, in group D was (160±26) minutes, There were significant differences significant difference between the twogroups (p<0.01).2.Group A with (150±55.2) ml was less than the group C with (260±15.5) ml,group B with (200±60.2) ml was less than the group D with (330±27.5) ml.Therewere significant differences between group A and group C, group B and group D (p<0.01).3.The number of blood transfusion were:0cases in group A,2cases in group B,1cases in group C,and2cases in group D.X2test showed group A and group C, group Band group D had no statistical difference (p>0.05).A, C groups had no cerebrospinalfluid leakage or hematoma occurred. But group B had1cases of cerebrospinal fluidleakage, group D had1cases of cerebrospinal fluid leakage,1cases of hematoma.They were not statistically significant (p>0.05).4.Preoperative sagittal diameter of spinal canalin group A was (5.25±0.97) mm,group C was (5.31±1.13) mm, there was no statistical difference; postoperative sagittaldiameter in group A was (9.12±1.37) mm, in group C was(8.53±1.24) mm, lthere wassignificant difference (p<0.05).Preoperative sagittal diameter of spinal canal in group Bwas (5.34±1.17) mm, group D was (5.36±1.23) mm,there was no statistical difference;postoperative sagittal diameter of spinal canal in group B was (9.85±1.49) mm, ingroup D was (8.80±1.32) mm, postoperative sagittal of spinal canal in the two groupswas statistically significant (p<0.05).5.All3segments CSM patients (A, C) in2years after operation were found nokyphosis deformity,"goose", and "completely" closed phenomenon.Group B had2cases with "completely"closed"phenomenon,1cases of gooseneck" deformities,1caseswith kyphosis deformity, group D found no long-term complications, but there was nostatistical difference between the two comparison(p>0.05).8cases in group A had axialsymptoms, the incidence was40%; there was3cases in group C with axial symptoms,the incidence was30%. Using X2test, no statistically significant difference was foundbetween the two groups (P>0.05). There were5cases in group B patients with axialsymptoms, the incidence was50%;3cases in group D with axial symptoms, theincidence was30%, the difference between the two groups was statistically significantdifferences (P<0.05).6.In group A, preoperative JOA score was8.3±0.5,2years after operation, JOAscore was14.5±1.3, the improvement rate was (70.1±1.13)%. In group C,preoperative JOA score was8.4±0.7,2years after operation, JOA score was14.4±1.5,improvement rate was (69.8.±2.54)%. There was statistically significant differencesbetween preoperative and postoperative JOA score in group A or group C(p<0.01), butthe preoperative and postoperative JOA score and the improve rate had no statisticalsignificance between A and C (p>0.05).In group B, preoperative JOA score was7.6±0.4,2years after operation, JOA score was13±1.2, improvement rate was (57.4± 1.24)%. In group D, preoperative JOA score was7.7±0.6,2years after operation, JOAscore was14.6±1.5, improvement rate was (68.8±2.54)%.There was statisticallysignificant differences between preoperative and postoperative JOA score in group B orgroup D(p<0.01), meanwhile the preoperative and postoperative JOA score and theimprove rate also had statistical significance between B and D (p>0.05).Conclusion: Both the methods have good effect on improvement of neurologicalfunction for CSM patients of3segments,but the treatment of double-door group isbetter than the single door group for CSM patients with4segments. Doctors shouldchoose operation plan flexibly according to the actual situation.