Comparison Of Short-term Efficacy Of ACHDF And PCEOLP In The Treatment Of Multilevel Cervical Spondylotic Myelopathy Based On Propensity Score Matching Method

Objective:to compare the short-term clinical efficacy of anterior hybrid decompression and fusion and posterior single door laminoplasty with mini titanium plate in the treatment of multilevel cervical spondylotic myelopathy.Methods: the medical records of 89 patients with multilevel cervical spondylotic myelopathy who were hospitalized and operated in the first orthopedic ward of Yulin Red Cross Hospital from June 2016 to February 2020 were collected.According to the operation methods,they were divided into two groups: anterior group(52 cases)and posterior group(37cases).The Japanese Orthopaedic Association(JOA)score,neck disability index(NDI),C2～7Cobb angle,C2～7 cervical sagittal axial distance(C2～7)were compared before and 1 year after operation,C2～7sva),T1 slope(t1s),thoracic inlet angle(TIA),intraoperative blood loss,operation time and complications were analyzed..Results:(1)JOA scores of the two groups were significantly increased and NDI was significantly decreased 1 year after operation(P < 0.001);there was no significant difference in JOA scores and NDI between the two groups before operation(P > 0.05),and there was no significant difference in JOA scores and NDI between the two groups 1 year after operation(P > 0.05).(2)There was no significant difference in C2～7cobb angle,C2～7sva,t1 s and TIA between anterior group and posterior group.C2～7cobb angle increased and C2～7sva decreased1 year after operation in anterior approach group(P < 0.05),while t1 s,TIA and preoperative had no significant difference(P > 0.05).C2～7cobb angle decreased and C2～7sva increased 1year after operation in posterior approach group(P < 0.05),while t1 s,TIA and preoperative had no significant difference(P > 0.05).There were significant differences in C2～7cobb angle and C2～7sva between anterior group and posterior group(P<0.05),but there were no significant differences in t1 s and TIA(P>0.05).(3)The operation time and intraoperative blood loss of the anterior group were less than those of the posterior group(P<0.05).(4)There were 1 case of cerebrospinal fluid leakage,2 cases of swallowing discomfort,1 case of C5 nerve palsy and 1 case of axial symptoms in the anterior group;there were 2 cases of C5 nerve palsy and 2 cases of axial symptoms in the posterior group;there was no significant difference in the total incidence of complications between the two groups(P > 0.05).Conclusion:(1)Both anterior cervical hybrid decompression and fusion and posterior cervical open-door laminoplasty and mini titanium plate internal fixation in the treatment of multilevel cervical spondylotic myelopathy can obtain satisfactory neurological improvement.There is no significant difference in JOA score and NDI improvement between the two methods.(2)The operation time and blood loss of anterior hybrid decompression and fusion were less than those of posterior single door laminoplasty.(3)Anterior decompression can restore the physiological curvature of cervical vertebra,and posterior open-door laminoplasty and mini titanium plate internal fixation can partially lose the physiological curvature of cervical vertebra.(4)There was no significant difference in the incidence of short-term complications between anterior hybrid decompression and fusion and posterior single door laminoplasty and mini titanium plate fixation.