Analysis Of The Clinical Effect Of Anterior And Posterior Combined Operation For Severe Multistage Cervical Spondylotic Myelopathy

ObjectiveTo explore the clinical effect of Anterior and Posterior combined operation for severe multistage cervical spondylotic myelopathy.MethodsRetrospective analysis in February 2013-September 2015,after Anterior and Posterior combined operation and obtain complete follow-up data of 50 cases of severe multiple segmental spondylotic myelopathy,according to preoperative angle of trailing edge of cervical vertebral body,Angle of CSA,is divided into normal group of 18 cases,curvature straighten group of 17 cases,kyphotic deformity of 15 cases.All of the patients with developmental stenosis,including 43 cases with huge disc herniation ahead,34 patients with posterior giant osteophyte of vertebral body or longitudinal ligament ossification,rear yellow ligament hypertrophy 22 cases,cause serious compression of spinal cord from anterior and posterior.Clinical evaluation: Japanese Orthopaedic Association Scores(JOA)Scores were used to evaluate postoperative efficacy and calculate neurological improvement rate.NDI was used to evaluate the quality of life after surgery.Operation time,amount of bleeding and hospital stay;Postoperative complications.Imaging evaluation: the recovery of the intervertebral height of the operation segment;preoperative and final follow-up of c2-c7 cobb angle;Cervical mobility ROM.ResultsThe number of patients in the three groups,age,sex ratio,duration of disease,duration of follow-up,disease structure,compression section,surgical method,preoperative JOA score,the difference were not statistically significant.Postoperative clinical efficacy evaluation: there was no statistically significant difference between the three groups of operation time,bleeding amount and length of hospital stay.At lastpostoperative follow-up,the normal group,the curvature straighten group,the kyphotic deformity group average JOA period were 58.65 ±6.7%,63.15 ±3.4%and 70.15 ± 10.13%,comparing with preoperative neurological function improved significantly,and the kyphotic deformity group is better than the other two groups;There was no statistically significant difference between the three groups of NDI at the last postoperative follow-up.The total complication rate was 12%(6/50),and there were no serious complications such as death,among which 11.1%(2/18)of the normal group,11.7%(2/17)of the curvature straighten group,and 13.3%(2/15)of kyphotic deformity group.Imaging evaluation: in the three groups,the intervertebral height of the postoperative segmental surgery was better than that of the preoperative period,and the height recovery of thecurvature straighten group and kyphotic deformity group was better than that in the normal group,and the difference was statistically significant.The average c2-c7 cobb Angle was decreased before the operation in the normal group,,but the difference was not statistically significant,and the average c2-c7 cobb Angle of the curvature straighten group and the kyphotic deformity group was larger than that before surgery,the difference was statistically significant.In the three groups,cervical ROM was decreased in different degrees before surgery,but the final follow-up was more than 85%.At the end of the follow-up,all the patients had good fusion in the operation section,and no breakage occurred.ConclusionFor patients with severe multistage cervical spondylotic myelopathy,postoperative neural functional recovery after anterior and posterior combined operation is good.The operation is safe and reliable,decompress thoroughly,can restore cervical physiological curvature and stability,and can better keep the cervical activity;for patients with multi-segmental cervical spondylotic myelopathy with a straight or kyphotic deformity,the postoperative outcomes were better,and the postoperative complications were not increased.