| Objective:The choice between posterior cervical single-opening laminoplasty and anterior cervical fusion for the treatment of spinal cervical spondylosis is still differently understood and controversial,and although several methods are now available to evaluate both procedures,postoperative cervical spine mobility is an important factor in evaluating both treatment options.In the present study,we analyzed the differences between the two surgical approaches in terms of the biomechanics of the cervical spine by using oral cone beam CT(CBCT)scans combined with 3D-3D volume fusion alignment techniques to measure the changes in three-dimensional motion of some adjacent segments and the overall cervical spine in patients under physiological load after both procedures,as well as comparing the clinical outcomes by cervical VAS and JOA scores.Methods:In this study,20 participants were included(all participants operated on segments C3-C6),and they were divided into 2 groups: posterior cervical single-opening group(group L),and multi-segment anterior cervical group(group A),with 10 cases in each group.The preoperative VAS score and JOA score for neck pain were perfected in all subjects,while cervical CBCT scans were performed in 7functional positions(neutral,maximal forward flexion-posterior extension,maximal left-right rotation,and maximal left-right deflection);postoperative follow-up was performed for a mean of 6 months to perfect the above steps again.Range of motion(ROM)of each part of the cervical spine as well as overall was measured for each subject preoperatively and postoperatively by using 3D-3D alignment techniques,and changes in ROM were described.Results:The change in ROM of the whole cervical spine in forward flexion-posterior extension motion preoperatively and postoperatively: 35.84 ± 9.56 ° of the whole cervical spine(C1-C7)after single-opening was smaller than 39.17±7.23° in the preoperative group,and decreased by 9% postoperatively compared to the preoperative group;29.31±9° of the whole cervical spine(C1-C7)after anterior cervical approach was smaller than 48.28±4.24° in the preoperative group,and decreased by 39% postoperatively compared to the preoperative group.This was a39% reduction compared to the preoperative group.The greatest change in left-right deflection motion was observed in both groups: the postoperative primary dimensional ROM was significantly smaller in the anterior cervical multi-segment group(17.88±5.02°)than in the preoperative group(33.17±5.51°)at P<0.05,a decrease of 46%,while the postoperative primary dimensional ROM was 19.56±8.65° in the single-opening group and 30.15±12.02° in the preoperative group,a decrease of 35% compared to the preoperative period.In the adjacent segments(C2-C3 and C6-C7),the posterior cervical single-opening laminoplasty showed preoperative and postoperative changes in primary dimensional ROM: the postoperative primary dimensional ROM of the adjacent cervical spine was reduced compared with that of the preoperative period.The greatest reduction in ROM was in the anterior flexion-posterior extension motion,where 5.48±2.48° postoperatively was less than 7.17±2.87° preoperatively,a30% reduction.In contrast,in the anterior cervical multi-segment group,the postoperative activity of the adjacent segments(C2-C3 and C6-C7)was greater than that of the preoperative group.The greatest increase in ROM compensation in the C2-C3 segment was during left-right deflection motion,and 9 ± 3.34 °postoperatively was significantly greater than 6.15±1.93° preoperatively(P=0.01),representing a 46% increase in compensation;the greatest increase in ROM compensation in the C6-C7 segment was during forward flexion-posterior extension motion,and 12±3.34° postoperatively was less than 6.15±1.93° preoperatively(P=0.01),representing a 46% increase in compensation.posterior extension motion,12.79 ± 4.54 ° postoperatively was significantly greater than 6.32 ± 2.91 °preoperatively(P=0.019),with a greater than 50% increase in compensation.This shows that the anterior cervical group had overcompensation in ROM of the adjacent segments.In the postoperative cervical ROM comparison between the two groups,it was found that the postoperative total cervical spine(C1-C7)primary dimensional ROM was greater in the posterior single-opening group than in the anterior cervical multi-segment group,and in forward flexion-posterior extension motion the single-opening group was 35.84±9.56° greater than the anterior cervical group at29.31±9°;while in the adjacent segments(C2-C3 and C6-C7),the single-opening group was significantly smaller than the anterior cervical group,and the difference between the two groups The largest difference was in left-right rotational motion,with ROMs of 1.13 ± 0.57 ° and 1.03 ± 0.36 ° in C2-C3 and C6-C7 in the single-opening group and 3.75±2.79° and 3.95±3.31° in the anterior cervical multi-segment group,respectively,P=0.01.The postoperative total cervical(C1-C7)primary dimensional ROMs were greater in the posterior single-opening group than in the anterior cervical multi-segment group;whereas in the In the adjacent segments(C2-C3 and C6-C7),the single-opening group was significantly smaller than the anterior cervical group.There were no significant differences in the preoperative and postoperative VAS scores and JOA scores between the posterior single-opening group and the anterior cervical multi-segment group.Conclusions:Both posterior cervical unicompartmental laminoplasty and anterior cervical fusion for spinal cord spondylolisthesis can improve spinal nerve function.However,the effects of the two surgical procedures on the three-dimensional mobility of the cervical spine are different,with patients undergoing posterior cervical unilaminoplasty retaining more postoperative than preoperative mobility in the full cervical spine,while patients undergoing anterior cervical surgery have significantly less postoperative mobility.Among the effects on the adjacent segments,there was a significant increase in compensatory mobility of the adjacent segments for anterior cervical surgery,while the mobility of the adjacent segments was slightly reduced in patients undergoing single-opening surgery. |
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