Comparative Study Of Theclinical Outcomes Of Posterior Cervical Single Open-door Laminoplasty And ACDF For Multilevel Cervical Spondylotic Myelopathy

Object:To compare the clinical effect and cervical sagittal alignment of anterior cervical discectomy and fusion with posterior single open-door laminoplasty in the surgical treatment of multi-level cervical spondylotic myelopath(MCSM).Methods:A retrospective analysis was implemented on the 65 patients who underwent surgical treatment for multi-level cervical spondylotic myelopath from February 2013 to July 2018,in the Department of Spinal Surgery,China-Japan Union Hospital,Jilin University.The patients were divided into two groups on the basis of surgical methods:anterior cervical discectomy and fusion(ACDF group,n=30)and posterior single open-door laminoplasty(LAMP group,n=35).The main evaluation indexes of clinical efficacy were intraoperative blood loss,operation time,hospital stay,the VAS and JOA score in pre-operation and6 months after operation and the final follow-up,and occurrence of postoperative complications.The main imaging indicators were C2-7cobbAngle,C2-7 sagittal vertical axis,T1 Slope.Results:In this research,There were no significant differences in operation time and hospital stay between the ACDF group and LAMP group.The intraoperative blood loss of the ACDF group was(61.1±15.0)ml and(177.1±66.9)ml in the LAMP group,and the difference between the two groups was significant(P<0.05).Compared with preoperative value,the VAS and JOA score in the ACDF group and LAMP group were significantly improved(P<0.05).At the last follow-up,the VAS score in the ACDF group was(1.1±0.6),and that in the LAMP group was(1.1±0.5),with no significant difference between the two groups(P>,0.05).At the last follow-up,the JOA score of the ACDF group was(14.5±1.9),and that of the LAMP group was(12.7±2.2).The difference between the two groups was significant(P<0.05).At the last follow-up,the C2-7cobb Angle of the two groups changed obviously(P<0.05).The C2-7cobb Angle of the ACDF group increased from preoperative(13.7±7.2)° to(15.1±6.7)°,while the values of LAMP group decreased from preoperative(14.2±5.4)° to(9.9±8.5)°,and the difference between the two groups was significant at the last follow-up(P<0.05).Compared with the preoperative value,there were no significant changes in SVA and T1 S between the two groups,and the difference between the two groups was not significant(P> 0.05).Therewas no significant difference in complication rate between the two groups.Conclusions:The application of ACDF and LAMP can be effective in the treatment of MCSM.With the improved symptoms,ACDF could accomplish the reconstruct of the sagittal sequence of cervical vertebra.Although LAMP surgery is relatively simple,the intraoperative blood loss is relatively large and it is prone to the loss of cervical curvature.Both operations may be combined with related complications and that should be prevented.The treatment of MCSM should be comprehensively evaluated according to the clinical manifestations and imaging examination of the patients,so as to make a safe,reasonable and individualized treatment’s plan and achieve a better prognosis.