The Selection Of Surgical Approach For Cervical Spondylotic Myelopathy

Objective:To investigate the effect of the anterior and posterior approach surgical treatment of Cervical Spondylotic Mye lopathy, exploring the endications,advantages and disadvantagesthe of the anterior and poste-rior approach, providing the clinical basis for the surgery technique-like choice.Methods:Clinical datas of 82 patients with CSM treated in our hospital with operations were collected from January 2004 to December 2008. We choosed different anterior and posterior surgical treatment based on clinical and radiographic factors,evaluated the preoperative and postoperative spinalcord function by using the Japanese Orthopaedic Association(JOA) Score, calculated the rate of improvement and the good rate and analysed therapeutic relations with patient age, course of disease, preoperative JOA score and the different surgical procedure.Results:All patients were followed up for 0.6 to 5 years, an average of 3 years and 6 months. MRI showed lesions involving segments:single segment in 16 cases (19.5%), the two segments of 37 patients (45.1%), three segments in 11 cases (29.7%),4 segment in 19 cases (23.2%).Anterior group,61 patients (74.4%), in which line (1) anterior cervical corpectomy, titanium mesh and bone graft fixation in 35 cases, preoperative score of 8.1±3.9, postoperative one-week score of 14.2±2.7, the rate of improvement (69.4±13.2)%, the good rate was 77.1%; the last follow-up score of 13.9±3.1, the improving rate of (67.7±13.6)%, the good rate of 70.6%; (2) anterior cervical discectomy and decompression and fusion with plate fixation in 26 cases, preoperative score of 8.3±3.2, postoperative one-week score of 13.9±3.1, the improving rate of (68.8±12.9)%,76.9% good rate, the last follow-up score of 13.9±3.1, the rate of improvement (66.8±12.8)%, the good rate was 73.1%.Posterior group of 21 patients (25.6%), in which line (1) unilateral open door expansive laminoplasty of one side in 14 cases, preoperative score of 7.9±3.8, postoperative one-week score of 13.8±3.0, the improving rate of (66.2±12.6)%, the good rate of 85.7%, the last follow-up score of 13.1±3.4 points, the improving rate of (64.4±12.1)%,78.6% good rate. (2) laminectomy laminoplasty with lateral mass plate fixation in 7 cases, preoperative score of 8.2±3.7, postoperative one-week score of 13.7±3.5, the improving rate of (66.2±12.3)%,76.9% good rate; the last follow-up score of 13.2±3.2 points,the rate of improvement(65.5±13.1)%, good rate of 73.1%.There was no significant difference in the improving rate(P>0.05) between the different surgical methods; but the course of disease, patient age, preoperative JOA score had close ties with the curative effect.Conclusions:(1)CSM patients, once diagnosed, should accept surgical treatment early; (2)Anterior and posterior surgery have its own advantages and disadvantages, the choice of suigery should be unsiderde cliniced performance, iconography information and other factors in patients with CSM, which can effectively discharge spinal oppression, raising CSM Patient surgery after JOA score, reduce complications.