Comparison Of Two Kinds Of Posterior Cervical Approach For The Treatment Of Multilevel Cervical Spondylotic Myelopathy

Background:In 2016,the World Health Organization(WHO)announced that cervical spondylosis is among the "top ten global diseases" affecting modern human health,and ranked the second.At present,cervical spondylotic myelopathy,especially multilevel cervical spondylotic myelopathy(MCSM),is the most serious of all types of cervical spondylosis recognized by the academic community,with the highest disability rate.The academic community has gradually suggested that once the diagnosis of cervical spondylotic myelopathy is confirmed,surgical intervention should be the preferred treatment strategy if there is no obvious contraindication.However,multilevel(?3 segments)cervical spondylotic myelopathy is often associated with a variety of serious symptoms and an increased risk of surgery.The surgeon's best surgical choice for MCSM to improve the efficacy and safety of surgical intervention remains The main challenge.In recent years,suture anchors has been widely used in the treatment of multilevel cervical spondylotic myelopathy with posterior cervical single open-door laminoplasty and has achieved good results.However,whether the curative effect is superior to laminectomy assisted by lateral mass screw remains to be studied.Objective:Retrospective analysis of the efficacy of two posterior approaches for the treatment of multilevel cervical spondylotic myelopathy in order to provide relevant reference for the relevant treatment.Methods:To review the clinical data of 116 patients with multilevel cervical spondylotic myelopathy who were admitted to the orthopedic department of the First Affiliated Hospital of Zhengzhou University from January 2014 to March 2017,and to perform an outpatient appointment for all patients to obtain relevant information.According to the similarities and differences of surgical procedures,the two groups were divided into two groups: in the observation group 56 patients(23 males,33 females)underwent posterior cervical single-door laminoplasty assisted by suture anchors,with an average age of 61.48 years(range,50~80 years)and the course of disease was 9~32 months,with an average of(18.20±6.09)months;the responsible segments: 49 cases in three segments and 7 cases in four segments.In the control group,60 patients(29 males,31 females)underwent laminectomy assisted by lateral mass screw,with an average age of 59.88 years(range,50~78 years);and the duration of disease was 8~35 months,with an average of(19.42±6.44)months;the responsible segments: 52 cases in three segments and 8 cases in four segments.The perioperative data of each group and the clinical data of JOA score,VAS score,JOA improvement rate,C2-7 Cobb angle,cervical ROM and complications were recorded in detail before and during follow-up,and statistical analysis was performed.Results:All patients was made an appointment for outpatient follow-up,the observation group was followed up for 12 to 24 months(18.34±3.12)months,and the control group was 12 to 24 months(17.83±3.00).All the clinical data of 116 patients were included in the results analysis.The operation time and intraoperative blood loss of the observation group were significantly lower than those of the control group(P<0.05).There was no significant difference in hospital stay and postoperative drainage volume between the two groups(P>0.05).There were no differences in preoperative JOA scores,VAS scores,C2-7 Cobb angle and ROM between the two groups(P>0.05).At 3 months after operation and the last follow-up,there was no difference in JOA score,VAS score,RR and Cobb angles between the two groups(P>0.05).The Cobb angles of the two groups were decreased at 3 months and at the last follow-up,but the difference wasn't statistically significant(P>0.05).The ROM of the two groups was decreased at 3 months and at the last follow-up,and the difference was statistically significant(P<0.05),there was significant difference between the two groups(P<0.05).There were no differences in the incidence of C5 nerve root paralysis,cerebrospinal fluid leakage and incision fat liquefaction between the two groups(P>0.05).The incidence of axial symptoms in the observation group was significantly lower than that in the control group(P<0.05).No other significant complications occurred during the postoperative and follow-up period.Conclusion:Two kinds of posterior cervical approach for the treatment of multilevel cervical spondylotic myelopathy could obtain good neurological recovery and cervical curvature,but posterior cervical single open-door laminoplasty assisted by suture anchors had less bleeding,easy operation,better preservation of cervical vertebra activity,reducing the risk of complications such as axial pain,it was worthy of clinical promotion.