Comparison Of The Curative Effect Of Two Ways To Treat Cervical Spondylotic Myelopathy Accompanied By Cervical Ossification Of Posterior Longitudinal Ligament

Cervical spondylotic myelopathy（CSM）mainly refers to the sensory, motor and reflexdisorders and other symptoms due to spinal cord compression or irritation and (or)spinalcord blood supply disorders. Cervical ossification of the Posterior Longitudinalligament（OPLL） is a pathological phenomenon of heterotopic ossification occurred in thecervical posterior longitudinal ligament, when the pathological changes lead to intervertebralforamen stenosis、vertebral canal stenosis, oppress nerve root and (or) spinalcord，and causethe feeling、motor function and (or) sphincter function of the trunk and limbs disorder，it iscalled cervical OPLL disease. Cervical OPLL disease and CSM are often combined, byX-ray, CT and MRI and other tests for the diagnosis of such patients is not difficult, butsurgical treatment for such patients, including the choice of surgical approach, operationtime and so，there is a dispute.Objective:To compare the clinical efficacy,of short-term (6months), of single stagecombined posterior-anterior approach and a simply posterior approach for the CSMaccompanied by cervical OPLL，and supply clinical reference of surgical treatment for suchpatients.Method: Choose24patients with CSM accompanied by cervical OPLL，who cured inthe orthopaedics of the Second Hospital of Jilin University in March2009to November2011，13cases underwent a single stage combined posterior-anterior approach surgery(group A),and the other11cases, underwent a simply posterior approach surgery (groupB).For postoperative follow-up, we used JOA score、Nurick grading、cervicle curvature、spinal share and cervical X-ray examination to assess the efficacy. Results using SPSS13.0for statistical analysis, P <0.05was statistically significant.Results: Patients in both groups underwent the evaluation of neurological function andradiographic evaluation before、two weeks and six months after the surgery. The statisticalanalysis suggested that two groups of patients in terms of gender, age and duration of disease,preoperative JOA score, preoperative Nurick grading, preoperative cervical curvature and preoperative spinal share was no significant (P=0.628,0.583,0.991,0.827,0.931,0.991and0.924,>0.05), so the two groups were comparable. Two weeks after the surgery，JOA scoreand JOA Score improvement rate between the two groups, P value of0.101and0.116respectively, were less than0.05,difference was not statistically significant; Six months afterthe surgery, JOA score and JOA Score improvement rate between the two groups, P value of0.003and0.002respectively, were greater than0.05, difference was statistically significantbetween the two groups, group A was significantly higher than group B; Two weeks and sixmonths postoperative Nurick grading between the two groups，P value of0.156and0.115,respectively, were greater than0.05, the difference was not statistically significant; Sixmonths postoperative cervical curvature between the two groups, P=0.805>0.05, thedifference was not statistically significant; Six months postoperative spinal share betweenthe two groups, P=0.025<0.05, difference was statistically significant between the twogroups, the spinal share of group A was significantly lower than group B; operative time andblood loss between the two groups, P values were close to0, there was a statisticallysignificant difference between the two groups, group A were significantly higher than groupB in both aspects. Within group comparisons, pairwise comparisons of preoperative、twoweeks and six months postoperative JOA score and Nurick grading,P value of the twogroups were close to0, less than0.05, so the difference were statistically significant;preoperative and six months postoperative，comparisons of cervical curvature and spinalshare in group A and group B, P value were close to0, less than0.05, the difference wasstatistically significant.X-ray examination showed that all cases were to a good fusion aftersix months of the operation, Without internal fixation broken or prolapse.Conclusion:1. Both of the two ways, Single stage combined posterior-anteriorapproach and a simply posterior approach for the patients of CSM accompanied by cervicalOPLL,can be a significant improvement in the patient’s JOA score and Nurick grading, andcould significantly improve the cervical curvature and spinal share;2. Compared with asimply posterior approach, single stage combined posterior-anterior approach showed bettereffect in improving the patient’s JOA score and spinal share, the difference was statisticallysignificant;3. For the patients of CSM accompanied by cervical OPLL,who have appropriate indications, single stage combined posterior-anterior approach is an effective and safetreatment.