Clinical Analysis Of Expansive Open-door Laminoplasty Using Anchor Method In The Treatment Of Cervical Spondylotic Myelopathy

ObjectTo observe the clinical effects of expansive open-door laminoplasty using anchor methd in the treatment of patients with cervical spondylotic myelopathy. Explore therapeutic effect that taking reasonable lamina opening angle and analyze whether it can change the cervical lordosis after operation.MethodsFrom July2011to July2012, the orthopedics of the First Affiliated Hospital of Zhengzhou University, follow-up analysis of26patients with cervical spondylotic myelopathy that take expansive open-door laminoplasty using anchor method.There are15males and11females, an average age of46.5years old(41-63years), middle disease duration was9months (2months-5years). The average follow-up time of8.5months (6months-13months).All patients take cervical MRI, CT inspection preoperative, and radiography lateral cervical spine,hyperextension flexion and left and right bending to observe each activity, visible multi-segmental cervical spinal cord (≥3) pressure, developmental cervical canal stenosis and cervical ossification of the posterior longitudinal ligament (of OPLL), and exclude cervical spine serious inflection deformity, instability and severe osteoporosis and other factors, in some cases the line limbs EMG clear lesion and spinal cord injury. Routine after cervical spine lateral X-ray and CT scan (some cases postoperative camera the MRI) to observe the cervical lordosis change (measured Cobb angle), lamina open angles, internal fixation location, whether loose or broken bone graft fusion whether to open the door again closed from happening. Use JOA17points system, Nurick grade cervical spinal cord function in patients with two objective scoring system for preoperative and postoperative follow-up assessment of spinal cord function, Evaluation of recovery of neurological function, measure the Cobb angle evaluation preoperative and postoperative cervical lordosis changes observed during the follow-up changes in the lamina opening angle analysis whether happen close once again.ResultsPreoperative JOA score was7.3±2.05,the Nurick grading3.36±1.04level;1month after JOA score was12.2±1.62, Nurick grading1.50±1.21level;3months postoperatively JOA score was12.5±1.56points, Nurick grading1.28±0.86; JOA score was13.4±1.49in the six months after surgery, Nurick grading1.25±1.18level; JOA score improvement rate assessment:excellent in17cases, good in5cases,three cases, poor in1case, overall excellent rate of84.62%. Significantly increased compared with preoperative JOA score of postoperative patients, the difference was statistically significant (F=140.28, P<0.05); significantly reduce postoperative Nurick cervical spondylosis patients compared with the preoperative functional classification of the spinal cord, the difference statistically significance (F=131.50, P<0.05). Linear regression analysis of the two ratings indicators*JOA score improvement rate Nurick cervical spondylosis spinal cord function classification difference was significant linear (Pearson correlation coefficient=0.815, P=0.000<0.01). No significant change in the postoperative Cobb angle with the preoperative (P=0.310>0.05), the lamina door opening angle after3months and6months after surgery no significant difference (t=0.388, P=0.527>0.05).Did not occur in all patients surgery dural tear, nor postoperative cerebrospinal fluid leakage, wound infection, fat liquefaction adverse reactions.2patients after the neck axial symptoms, the incidence of7.69%, after go collar neck flexion functional exercise, returned to normal after six months;5nerve root palsy symptoms in one cases appear neck fully recovered after conservative treatment after6weeks.ConclusionsSingle open-door laminoplasty through to expand the canal volume increased activity space of the spinal cord, indirect avoid herniated disc, hyperplasia of the facet joints and the yellow ligament hypertrophy of the nerve compression, cervical spondylotic myelopathysurgery to provide a safe, effective method. All patients were followed up for single door anchor method results confirmed laminoplasty treatment of cervical myelopathy as a surgical clinical achieved more satisfactory results, also does not change the original cervical lordosis, the phenomenon did not occur after surgery and then close the door, but in order to clear whether they affect the scope of the functions and activities of the cervical spine stability, and cause the degeneration of adjacent segments, need more Center, a large sample, comparative clinical studies and longer-term follow-up.