The Effect Of Different Lamina Door Opening Angles On Postoperative Axial Pain Of Patients Undergoing Cervical Single-door Micro Titanium Plate Laminoplasty

Objective: To investigate the impact of different lamina door opening angles of cervical single-door microplate angioplasty on the degree of postoperative cervical axial pain.It is expected to make a certain reference for the selection of intraoperative door opening angle and alleviation of postoperative neck pain in patients.Methods: We selected 89 patients with multi-segment cervical spondylotic myelopathy treated with posterior cervical single-door micro titanium plate laminoplasty in our hospital from June 2018 to June 2020,including 56 males and 33 females;The age range of all individuals is 36 to 69 years.The average age of the patients is 56±6 years.The operational level ranged from C3-C7 in all patients.All patients have complete and detailed imaging data.The laminae open angles were measured on the CT one week after the operation.The mean value was taken for statistical analysis.The patients were divided into 3 groups,group A(open angles?<30°;22 patients)、group B(open angles 30°~45°;41 patients)and group C(open angles>45°;26 patients).To compare the statistics of age,course of disease,operation time,blood loss,C2-C7 Cobb angle,cervical spine range of motion,and degree of pain in axial symptoms of each group.To measure the recovery of nervous function at the last follow-up by using the JOA score,and calculate the recovery rate.Results: There were no statistically obvious differences in the general data(disease course,surgical bleeding,age,operation time),preoperative JOA scores,and VAS scores of the three groups of patients(P>0.05);There was no significant difference in VAS scores between A(Group A: 2.80±1.89)and B(Group B: 2.73±1.98)groups at 1 month after surgery(P>0.05),and the scores of group C(Group C: 4.02 ± 2.04)were significantly higher than the other two groups(P<0.05);The VAS scores were compared at 6 months after the operation,and the VAS scores of groups A and B(Group A:2.16±1.28;Group B:1.94±1.18)were significantly lower than those of group C(Group C:2.88±1.23)(P<0.05).The C2-C7 Cobb angle and cervical range of motion between the three groups had no obvious difference(P>0.05),but they all decreased significantly compared with the pre-operation(P<0.05).A total of 3 cases(3.3%)had C5 nerve root palsy after operation,including 1 case in group A(4.5%),1 case in group B(2.4%),and 1 cases in group C(3.8%).The morbility of C5 nerve root palsy among the groups was not distinctly different(P>0.05).There was no significant difference in the JOA rehabilitation rate of the 3 groups(P>0.05),but the nerval function of the 3 groups was obviously rehabilitated(P<0.05).Conclusions:Posterior cervical single-door spinal canalplasty can achieve good spinal cord decompression and improvement of nerve function,but it will cause significant loss of cervical spine mobility and curvature.However,the postoperative pain degree of axial symptoms will become more serious as the opening angle is larger.