The Therapeutic Effect Of Multi-segment Clamping Cervical Spondylotic Myelopathy Treated By Minimally Invasive Surgery With Posterior And Anterior

ObjectivesIn this paper,we mainly study the clinical data of 51 patients who were diagnosed as multi-segment clamping cervical spondylotic myelopathy and received surgery called after minimally invasive surgery with posterior and anterior in our hospital from January 2011 to January 2016 and observe the clinical effect of multi-segment clamping cervical spondylotic myelopathy treated by minimally invasive surgery with posterior and anterior,of which we analyze the related factors to improve surgical safety and reduce surgical complications.MethodsThe clinical data of 51 patients who were diagnosed as multi-segment clamping cervical spondylotic myelopathy and received surgery called after minimally invasive surgery with posterior and anterior in our hospital from January 2011 to January 2016 has been collected.All patients were treated by cervical microendoscopic laminoplasty combined with anterior cervical artificial disc replacement.There were 30 men and 21 women,and their mean age was 58 years(range 40 to 78 years).The mean course of disease were 11 months,ranging 4 to 21 months.The recovery of postoperative neurological function was assessed on the basis of the Japanese Orthopaedic Association(JOA)score.The cervical curvature index before and after operation was measured according to the Ishihara cervical curvature index measurement,and the cervical vertebra activity was measured by the cervical lateral position and dynamic position,and the spinal cord and nerve decompression status and recovery was evaluated by MRI.JOA score,cervical curvature index and cervical spine activity degree before and after surgery were statistically analyzed by paired t test,and related factors of postoperative efficacy were statistically analyzed by independent sample t test and anova.ResultsThe mean operation time in this group was(212±16.4)min,ranging 150~275min.The mean intraoperative blood loss was(259±28.5)ml,ranging 150~400ml.All of the 51 patients were followed up for 18 to 48 months,and its mean time was(24 ± 7.2)months.It was(8.33±2.33)to the JOA score before surgery,and the score was(13.82±2.04)at the last follow-up.The improvement rate was(66.29%±17.04%),which was significantly different from that before surgery(P<0.05).The mean cervical vertebrae activity was(41.38°±3.39°)before operation and it was(43.45°±4.15°)at the last follow-up,which was significantly different from the preoperative ones(P<0.05).The preoperative cervical curvature index was(15.70%±1.80%),and it was(15.38%±1.71%)at the last follow-up,which was no significant difference compared with the preoperative ones(P>0.05).At the last follow-up,the neurological improvement rate of patients younger than 60 years old was(71.57%±16.92%),and that of patients older than 60 years old(including 60 years old)was(59.35%±14.85%).The difference between the two groups was statistically significant(P < 0.05).The neurological function improvement rate at the last follow-up was(83.17%±7.76%)for patients with the course of disease less than 6 months,(71.66%±15.52%)for patients with the course of disease at 6 to 12 months,and(53.95%±12.31%)for patients over 12 months,and the difference was statistically significant(P < 0.05).The neurological function improvement rate of patients with preoperative JOA score of 0~6 at the last follow-up was(53.90%±12.64%),the neurological function improvement rate of patients with preoperative JOA score of 7~10 at the last follow-up was(65.07%±15.11%),and the neurological function improvement rate of patients with preoperative JOA score of 11~14 at t was he last follow-up(82.36%±12.64%),and the difference was statistically significant(P < 0.05).Dural rupture occurred in 3 cases during operation,and headache occurred after operation.After a week of rehydration and analgesic treatment,the headache gradually relieved.Two cases had pharyngeal discomfort accompanied by hoarseness 2 days after surgery,and the symptoms were relieved after 2 weeks of treatment with non-steroidal anti-inflammatory analgesics and neurotrophic drugs.At the last follow-up,the position of the micro-titanium plate,screw and artificial intervertebral disc was good,no titanium plate was broken and no screw was peeled off,and there was no displacement or collapse of the artificial intervertebral disc.Conclusions⑴With complete decompression,minimal trauma and maximum retention of the original structure and motor function of the spine,MIS-PA is an effective surgical method for the treatment of multi-segment clamping cervical spondylotic myelopathy.⑵The patient’s course of disease,age and preoperative neurological function have an impact on the surgical effect,the course of disease and age are negatively correlated with the postoperative effect,with the course of disease longer,age increases,the postoperative effect becomes worse;Preoperative neurological function was positively correlated with postoperative efficacy,and the postoperative efficacy would become better with the increase of preoperative neurological function score.