Clinical Observation Of Two Kinds Of Surgical Treatment Of Cervical Spondylotic Myelopathy

ObjectiveThis study aimed to obtain guidelines for choosing between anterior subtotal corpectomy and fusion and posterior open-door laminoplasty by analysing the surgical outcomes, influencing factors, postoperative complications,Indications and advantages/disadvantages.And also to provide clinical references for treating Cervical spondylotic myelopathy.MethodsA cohort of 110 patients with Cervical spondylotic myelopathy who underwent surgery treatment in TCM Hospital of Sichuan Province or No.2 People’s Hospital of Cheng du. Ultimately, and 60 patients completed follow-up and were included.Group A comprised 30 patients who underwent anterior subtotal corpectomy and fusion and Group B comprised 30 patients who underwent posterior open-door laminoplasty. The general information of patients such as gender, age, duration was no significant difference in two groups (P>0.05).All the 60 patients participated regular follow-up and examed DR. We evaluated difference between the improvement rate of JOA score, VAS pain score and D values in group A and group B based on follow-up to discuss weather the outcome of surgery affected by the different surgical segments, cervical curvature, age, MRI signal changes in preoperative and postoperative 1,3,6,12 months follow-up and analysised the advantages and disadvantages of the two surgery.Results1.In preoperative,the two groups were not significantly different (P> 0.05) on gender, age, duration, JOA scores,VAS scores, D values and were comparable (P> 0.05)2.1n postoperative 1,3,6,12 months,there was no significant difference between groups in JOA scores,last JOA score improvement rate and VAS scores (P>0.05)3.In postoperative,the difference was statistically significant between two groups in cervical curvature (P<0.05). The difference was statistically significant between preoperative and postoperative in cervical curvature in group A (P< 0.05).There was no significant difference between preoperative and postoperative in cervical curvature in group B (P> 0.05)4.In preoperative,there was no significant difference between groups of multiple segments patients in JOA scores,VAS scores and were comparable (P>0.05). The difference was statistically significant between groups of multiple segments patients in JOA scores and in last JOA score improvement rate after surgery 6,12 months (P <0.05).The difference was statistically significant between groups of multiple segments patients in VAS scores after surgery 6,12 months (P<0.05)5.The difference was statistically significant between two groups in operation time and blood loss (P<0.05)6.All patients were grouped according to age-stepped compared last JOA improvement rates were significantly different, and were statistically significant (P< 0.05).All patients were grouped according to preoperative SI compared last JOA improvement rates were significantly different, and were statistically significant (P< 0.05).There was no significant difference between surgical segment(<3)and surgical segment (≤3) in last JOA score improvement rate (P>0.05).Conclusion1.Both anterior and posterior surgery had the good effect for Cervical spondylotic myelopathy in neurological improvement and neck and shoulder pain.2.For patients with multiple segments(lesion segments≥3), posterior surgery was better than anterior surgery in improving neurological function,and anterior surgery better than posterior surgery in relieving neck and shoulder pain3.Anterior surgery was better than posterior surgery in restoration of cervical lordosis.4.Anterior surgery was better than posterior surgery in operability5.Postoperative neurological recovery was closely related to the same age and preoperative MRI signal intensity.Postoperative neurological recovery was negatively correlated with age, the greater the age, the worse the effect recovery.If there was preoperative high signal intensity in MRI, the postoperative recovery would be poor.6.The age,preoperative MRI high signal intensity and postoperative complications were related factors affecting surgical treatment.In summary,the choice of surgical approach was mainly affected by segmental lesions and cervical curvature.For lesion segment when three or less, both two procedures had a good effect. For more than three lesion segment multi-segment cervical myelopathy without cervical curvature decrease or absence of anti-bow, should be the preferred posterior surgery.If the cervical curvature was disappeared or even anti-bow,should be the preferred anterior surgery.The choice of surgical approach also needed to consider the age, operative time, blood loss, postoperative complications as well as preoperative high signal intensity of MRI.