| Objective:To investigate the correlation of laminaplast opening position of single open-door laminoplasty and the degree of postoperative cervical 5 nerve root palsy;provide theoretical basis for LOS and the applications of single open-door laminoplasty, and help the prevention of postoperative complications, especially cervical 5 nerve root palsy.Methods : Spondylosis patients were randomly divided into two groups, then C3-7cervical single open-door Laminoplasty and titanium plate internal fixation were done.According to surgical approach, patients were divided into two groups, open size group(group A) and narrow size group(group B). The open size group(A) can be divided into normal group(A1) and paralysis group(A2) according to weather C5 palsy has occurred after surgeon. X, CT, MRI examination were taken in a week preoperative and postoperative in our hospital. The drift size of the spinal cord on MRI and enlargement rate of spinal canal on CT were calculated, functional status of spinal cord JOA score were calculated in two weeks before and after surgeons, the rate of the improvement JOA score was calculated. Make a note of cervical 5 nerve root palsy when happened in what time,which position and how degree. the correlation of the improvement rate of JOA, the drift size of the spinal cord on MRI and enlargement rate of spinal canal on CT of the four groups were analyzed.Results:(1) Preoperative JOA score, postoperative JOA score, rate of the improvement JOA score were compared between group A, group B, group A1 and group A2, no statistical difference(P>0.05) were found.(2) Operative time, blood loss, rate of JOA improvement score, drift size from the spinal cord were compared, the expansion rate of the spinal canal between groups A and B, group A1 and A2, was compared,differences cervical nerve root palsy incidence between group A and group B.Results showed that the differences between opening angle, operation time and blood loss, rate of the improvement JOA score were not statistically significant(P >0.05) in group A and B, in group A1 and A2; there was a statistically significant difference in C5 nerve root palsy incidence in group A and B(P< 0.05);the drift size of spinal cord, spinal canal enlargement ratio were statistically significant(P<0.05)between group A and B, in group A1 and A2.(3) The correlation between drift size of the spinal cord and rate of spinal canal enlargement was analyzed in group A, group B, group A1 and group A2. The results suggest the distance of the spinal cord drift and rate of spinal canal enlargement were linearly related, positive correlation, in group A, group B and group A1; were not obvious linearly related in group A2. We can think that when the spinal cord drift distance was <4mm, rate of spinal canal enlargement rate <70%, the distance of the spinal cord drift and rate of spinal canal enlargement were linearly related, positive correlation, when the spinal cord drift distance was >4mm, spinal canal enlargement rate >70%, linear relationship between the distance of the spinal cord drift and spinal canal enlargement were not obvious.(4) The correlation between drift size of the spinal cord, the rate of spinal canal enlargement and rate of the improvement JOA score was analyzed in group A, group B, group A1 and group A2. The results suggest that the distance of the spinal cord drift and rate of the improvement JOA score, rate of spinal canal enlargement and rate of the improvement JOA score, were linearly related, positive correlation, in group A, group B and group A1, and were linearly related, negative correlation, in group A2. We can think that when the spinal cord drift distance was =4mm, rate of spinal canal enlargement =70%, the rate of the improvement JOA score is highest and the effect of surgery is best.(5) The correlation between rate of JOA improvement score, drift size of the spinal cord, rate of spinal canal enlargement and degree of C5 never root palsy were analyzed in Grou p A2.The results suggest that rate of spinal canal enlagement and degree of C5 never root palsy was not abvously linaerly related; rate of JOA improvement score, drift size of the spinal cord and degree of C5 never root palsy were linearly related,negative correlation. We can think that we should control the spinal cord drift distance ≤4mm.Conclusion:(1)There was no significant difference between the door size of single open-door Laminoplasty and postoperative neurological improvement; widen the door and shaft side shift the door appropriately during the surgery can not only guarantee the effect of surgical decompression, but also limit the expansion of the spinal canal and spinal over after the shift, reduce the incidence and severity of C5 nerve root palsy.(2) The drift of spinal nerve is a major cause of C5 nerve palsy.(3)When the spinal cord drift distance was =4mm, rate of spinal canal enlargement =70%, the rate of the improvement JOA score is highest and the effect of surgery is best. |
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