Curative Effect Observation Of Posterior Cervical Hybrid Surgery For Multilevel Cervical Spondylotic Myelopathy

Objective:This paper mainly discusses the clinical effects of posterior Hybrid surgical decompression,i.e.,posterior total laminectomy of cervical spine with lateral mass screws and nail rod fixation combined with single-door micro-steel plate internal fixation for the treatment of multi-segment cervical spondylotic myelopathy.Methods:The data of 24 patients with multi-segment cervical spondylotic myelopathy treated in the Third Orthopedic Department of Jingzhou Central Hospital from June2017 to September 2020 were retrospectively analyzed.All the patients were treated by the hybrid surgery of posterior total laminectomy with lateral mass screw fixation and single-door micro-steel plate,which was selected by the same surgeon in the same group.There were 11 males and 13 females,with the age ranging from 41 to 64 years old,and the average age of 55 years.The course of disease was from two months to three years,and the average course of disease was 20 months.Follow-up reexamination was performed in all patients at 1 week,3 months,6 months,12 months and the last time after operation.In our hospital,frontal and lateral X-ray films of cervical vertebra as well as plain and three-dimensional CT reconstruction were performed,and reexamination was performed in cervical MRI at 3 months after operation.The fixation method and decompression segment of the patient were recorded,and comparative analysis was performed using different indicators.The cervical curvature index(CI)before and after surgery was measured using Ishihara method.The total range of motion of the cervical spine is estimated using the X-ray measurement obtained from the cervical hyperextension and hyperflexion position,and the pre-and post-operative MRI of the cervical spine is observed to determine spinal cord compression,recovery and cervical spinal canal stenosis.Preoperative and postoperative spinal cord function was evaluated according to the Japanese Orthopedic Association Association Association Score(JOA),and visual analogue scale(VAS)was used to assess the degree of neck pain.Results:All the 24 patients in this group were under general anesthesia with satisfactory anesthesia effect.The operation time was 149.21±55.19 min,and the intraoperative blood loss was 357.06±176.35 ml.All the incisions were grade A healing,and they were followed up for 15–24 months,with an average of 16 months.His VAS score before surgery was 5.75 3.35 and that of his neck at the last follow-up was 1.63 1.47,both of which were obviously improved as compared with those before surgery.The JOA score was 8.31 2.75 before operation and 14.53 1.43 at the last follow-up visit,both of which were improved to different extents as compared with the JOA score before operation.The total cervical range of motion at the last follow-up was 32.18 10.21 compared with55.21 12.15 preoperatively,and there was a significant difference postoperatively(P <0.05).The cervical vertebra dysfunction score(NDI)at the last follow-up visit was 1.891.33,significantly different from the preoperative score of 16.89 6.80(P < 0.05).The cervical curvature index(CCI)was 9.59 3.61% at the last follow-up visit,which was improved as compared with 8.60 3.09% before surgery,but there was no significant difference between the pre-surgery and post-surgery(P > 0.05).The operations of all patients were successfully completed.There were no complications such as spinal cord injury or cerebrospinal fluid leakage during the operation.The symptoms of C5 nerve palsy occurred in two patients after the operation,and they were relieved after symptomatic treatment such as neurotrophic drugs.There was no loosening or fracture of the internal fixation device at the last follow-up visit,and the fixation position was good.Conclusion:In clinic,patients with multi-segment cervical spondylotic myelopathy often apply indirect decompression by posterior surgery,and the commonly used surgical methods include laminoplasty,laminectomy and decompression combined with lateral mass screw internal fixation.However,patients with cervical spondylotic myelopathy have different lesions in each segment,and some patients have concomitant cervical instability.For patients with cervical instability,laminectomy and lateral mass screw internal fixation were performed,and single-door miniature steel plate internal fixation was performed for the stable segments of cervical spine.This technique can maintain the mobility and height of cervical spine to the maximum extent and completely decompress,and reduce the risk of surgery and complications.The clinical effect is satisfactory.