| Objective: To compare the outcomes of modified cervical laminectomy with fusion versus cervical laminoplasty for the treatment of multilevel cervical spondylotic myelopathy.Methods: A retrospective analysis was made from Jun.2017 to Dec.2019,39 cases of multilevel cervical spondylotic myelopathy who were treated by posterior operation in our department.Among of them,17 cases(in the modified group)were treated with potentially removing part of lamina and retaining spinous processes of C3 and C7 while totally removing the lamina of C4~C6 with fusion,22 cases(in the tradition group)were done with single-open-door cervical laminoplasty.The operation time,the blood loss,the rate of postoperative C5 nerve palsy,cerebrospinal fluid leakage,incision-related complications(including wound deep infection,wound dehiscence),the incidence of axial pain in neck,preoperative and postoperative march,June,the last follow-up mJOA score(modified Japanese Orthopaedic Association,mJOA)score,cervical Cobb Angle,and the cervical motion(the Range of motion,ROM)were recorded and caompared respectively.Results: The mean of follow-up was 17±5.2 months ranged from 6 to 30 months.Operation time was 100-134 min in the modified group,with an average of 115.02±12.26 min,and 120-180 min in the traditional group,with an average of 150.34±21.28 min.The operation time in the modified group was shorter,and the difference was statistically significant(P<0.05);intraoperative bleeding Amount: 150-366 ml in the modified group,with an average of 238.41±53.44 ml,and 220-410 ml in the traditional group,with an average of 330.68±42.10 ml.The modified group had less intraoperative blood loss,and the difference was statistically significant(P<0.05);no C5 nerve palsy occurred in the modified group,while 1 cases of C5 nerve palsy occurred inoccurred in the traditional group;1 cases of cerebrospinal fluid leakage occurred in the modified group,while no cerebrospinal fluid leakage occurred in the traditional group.no incision-related complications occurred in the modified group,and one incision infection occurred in the cervical laminoplasty group.3 cases(17.65%)of axial neck pain occurred in the modified group,12 cases(54.55%)of axial neck pain occurred in the traditional group,and the incidence of axial neck pain in the modified group was lower than that in the traditional group,with statistically significant difference(P<0.05).mJOA scores of preoperative,postoperative 3 months,6 months and the last follow-up: The modified groups were 6.45±2.25 points,12.43±1.45 points,13.43±2.55 points,12.89±1.45 points,and the traditional groups were 6.25±1.85 points,12.39±1.57 points,13.19±2.47 points,and 10.91±1.74 points,respectively.The postoperative mJOA scores of the two groups were significantly higher than preoperative.there were no significant difference in mJOA scores between the two groups at the 3rd and 6th month after surgery(P>0.05),while the mJOA scores in the modified group wear higher than that in the traditional group at the last follow-up,with statistically significant difference(P<0.05).Cervical Cobb Angle of preoperative,postoperative 3 months,6 months and the last follow-up: The modified groups were 8.05±1.35°,5.14±1.87°,4.55±1.55°,4.35±1.25°,and the traditional groups were 13.15°±1.45°,6.55±2.25°,5.55±1.65°,and 4.15±1.65°,respectively.Compared with the preoperative,the Coob Angle of patients in both groups decreased.at the last follow-up.The modified groups decreased by 3.45±1.97°,the traditional group decreased by 8.13±1.53°,while the Cobb angle of the traditional group decreased more,the difference was statistically significant(P<0.05).ROM of preoperative,postoperative 3 months,6 months and the last follow-up: the modified groups were 38.91±15.62°,28.12±8.24°,27.22±6.34°,27.12±5.24°,and the traditional groups were 40.31±12.72°,26.73±4.62°,26.53±4.62°,25.75±3.64°,respectively.At the last follow-up,compared with the preoperative,ROM decreased in both the groups.The ROM of modified groups decreased by 10.45 ± 1.67 °,the ROM of traditional group decreased by 14.13 ± 1.53°,while the ROM of the traditional group decreased more,the difference was statistically significant(P<0.05).Conclusion: Compared with cervical laminoplasty,the modified total laminectomy is a safe and effective method for surgical treatment of multi-segment cervical Spondylotic myelopathy.It has the advantages of simple operation,short operation time,sufficient decompression and low incidence of postoperative cervical axial pain. |
