The Study Of Posterior Operative Methods In The Treatment On Senile Multilevel Cervical Spondylotic Myelopathy With Cervical Spinal Stenosis

Backgroud: With China’s economic and social development and progress,people’s living habits changed and the arrival of an aging population, theincidence of multi-segmental cervical spondylotic myelopathy (MCSM) in theelderly population increases every year which has become more common in theclinical age-related diseases. Patients with varying degrees of limb weakness,walking，holders matter unstable symptoms, severe cases, they are difficult totake care of themselves in daily life, the quality of life significantly decreased,and the long oppression of the degenerative tissue on the spinal cord can causespinal cord of irreversible degenerative changes, leading to the symptomsfurther increased and the surgical result is not satisfactory. After diagnosis,timely surgical treatment is very important. Surgery according to the cervicalspinal cord disease pathology and clinical conditions to determine the anteriorcervical or posterior surgery. Which the surgery including spinal cord, nervesconstitute the expansion of resection or the spinal canal to the pressure oftissues, intervertebral disc, osteophytes, and ligaments forming the spinalcord and nerve roots get adequate decompression and cervical fusion graft orfixed line, to obtain the stability of the cervical spine. For multi-segmentalcervical spondylotic myelopathy (MCSM) and cervical spinal canal stenosis,some scholars have advocated simple posterior long-segment single ordouble-door laminoplasty. For elderly multi-segmental cervical spondyloticmyelopathy (3or more) and cervical spinal canal stenosis,there is no relevantreport about the comparison between the posterior single-door laminoplastytechnique and posterior double-door laminoplasty technique.Objective: To investigate the surgical outcomes and the correlation influencing factors of the two posterior operative methods in the treatment onsenile multilevel cervical myelopathy with cervical spinal stenosis.Methods:Thirty-three old patients with multilevel cervical spondyloticmyelopathy and cervical spinal stenosis treated by posterior operative methodswere included in a retrospectively studied during the period of2005.8-2010.8.To divide fifty-three patients into two groups based on the type of operativemethods i.e.Group A(single-door laminoplasty and lateral mass screw fixation25patients) and Group B(bilateral hinge-type laminoplasty and trapezoidalartificial bone fixation28patients).According to Japanese OrthopedicsAssociation17scores method respectively evaluate the preoperative andfollowing up neurological function of all the patients.Result:The follow-up time was7-15months(mean time was10months).There was no statistically significant differences about preoperative JOA scoresbetween tow groups(P﹥0.05),In the follow-up tow groups both have a betterneurological function than befor（eP﹤0.01）. The Group(A) have a little higherrecovery rate than Group (B)but the differences have no significant differences（P﹥0.05）. It is found that in the two groups who have a increased signalintensity in MRIT2before will have a worse recovery rate,and the differencesis significant（P﹤0.01）. The differences in postoperative complications issignificant and group(A)more than group(B)（P﹤0.01）.Conclusion:1.The tow posterior operative methods are effective in thetreatment on senile multilevel cervical spondylotic myelopathy with cervicalspinal stenosis.2.The difference in postoperative complications is significant and thegroup(A)is more than the group(B)（P﹤0.01）. The Group(A) have a littlehigher recovery rate than Group (B)but the differences have no significantdifferences（P﹥0.05）.3.It is found that in the two groups who have a increased signal intensity in MRIT2before will have a worse recovery rate in following up,and thedifferences is significant（P﹤0.01）.