| Objective: To explain the adaptive symptom for each surgery and to analyse various predictions of surgical outcome and the curative effect between the anterior apporach and the posterior apporach by comparing the results of 90 cases of cervical spondylotic myelopathy after surgery.Methods: Totally 90 cases of cervical spondylotic myelopathy patients, clinical datas were collected who had treated in the Second Affiliated Hospital of Dalian Medical University and followed-up more than one years during 2002-2007.Functional improvement was evaluated using the Japanese Orthopaedic Association (JOA) Score and Hirabayashi methord compairing postoperation and preoperation.Result:(1)The 90 cases of cervical spondylotic myelopathy patients, mean follow-up time was 3 years and 4 months(1-5years), including 62 male cases and 28 female cases,whose age ranged from 39 to 76 years(mean,58 years). The duration of preoperative symptoms was 27 days to 9 years(mean,24.6 months).There were 14 cases (16%)with single segment involved ,44 cases (49%)with two segments ,10 cases(11%) with three segments,22(24%) cases with four segments.Four kinds of surgerise were formed:10 cases were treated with anterior cervical decompression and cervical interbody fusion cage,58 cases were treated with anterior cervical decompression and fixation with titnium plate and titnium mesh, 10 cases treated with extensive open-door laminoplasty, 12 cases treated with posterior and internl fixation.(2)JOA score and recover rate at last following time:The anterior apporach mean preoperative JOA score was 8.33±3.24 and postoperative JOA score was 10.59±4.25 , whose recover rate was 69.2±6.9% . The posterior apporach mean preoperative JOA score was 8.52±3.48 and postoperative JOA score was 9.68±5.47,whose recover rate was 71.2±6.1%. The patients, JOA score had no distinct difference between the anterior apporach and the posterior apporach during the same time.(3) At last following time,there were 52(76.5%) patients in anterior apporach and 16(72.7%)patients in posterior apporach whose sympotms had alleviation and 16(23.5%) patients in anterior apporach and 6(27.3%)patients in posterior apporach whose sympotms had no alleviation.(4) The duration of preoperation symptoms , JOA score and the patients'age was correlated significantly with the rcover rate.Conclusion:(1)The patients with cervical spondylotic myelopathy should receive operation at early time.(2)Adaptive symptoms for each surgery were selected correctly so that the curative effect was similar between the anterior apporach and the posterior apporach.(3) Anterior apporach sugery is the first choice according to the basic of sugery.Posterior laminoplaty is more suitable for multilevel cervical spondylotic myelopathy and patients with development cervical stenosis or ossification of cervical posterior longitudinal ligament. |
