Analysis Of Prognostic Factors In The Treatment Of Multilevel Cervical Spondylotic Myelopathy With Expansive Open-door Laminoplasty

Objective:To provide a basis for the selection of the timing of surgery for patients by analyzing the prognostic factors of Multilevel cervical spondylotic myelopathy(MCSM)treated with Expansive Open-Door Laminoplasty(EODL).Methods:The clinical data of 70 patients diagnosed with multisegmental spondylotic myelopathy and who underwent single-opening enlargement kyphoplasty from January2014 to November 2021 at our hospital were retrospectively analyzed with a follow-up period of at least 1 year.The duration of disease,age,sex,preoperative Japanese orthopedic association(JOA)score,maximum spinal cord compromise(MSCC),maximum canal occupancy(MCC),and spinal canal occupancy(MCC)were examined.Compromise(MCC),Compression Ratio(CR),Transverse Area(TA),Increasing Signal Intensity(ISI),Ossification of the Posterior Longitudinal Ligament(OPLL),and the spinal cord compression rate(MCC).The 12 factors,namely,the number of anteriorly compressed spinal cord segments and the number of posteriorly compressed spinal cord segments,were analyzed unilaterally,and the factors that were statistically different were analyzed by binary logistic regression,and the factors that influenced the prognosis of CSM patients after single-opening enlargement of the spinal canal were screened.ROC curves to assess the applied value of these factors.Results:1.The mean age of the group with excellent spinal cord function and the group with non-excellent spinal cord function were(55.80±10.58)and(60.12±12.55),respectively,and the sex ratio composition ratio were 30(68.18%)and 15(57.69%),respectively,and the disease duration were(26.65±7.10)and(24.54±7.82),respectively,and the differences were not statistically significant(P>0.05).2.Compared with the two groups in the group with non-excellent spinal cord function,the preoperative JOA scores[(11.93±1.35)points,(10.42±1.63)points]and TA[41.64±11.60)mm~2,(34.31±8.23)mm~2]were higher in the group with excellent spinal cord function,and the MSCC[(50.52±9.53)%,(59.54±11.41)%],and MCC[(49.59±10.33)%,(57.19±11.35)%]were decreased,and the differences were statistically significant(P<0.05).Meanwhile,comparing between the two groups of excellent spinal cord function and non-excellent spinal cord function,the CR of the excellent spinal cord function group was(36.95±.47)and(33.23±11.27)%,respectively,and the number of anteriorly compressed spinal cord segments was(3.30±0.76)and(3.23±0.25),respectively,and the number of posteriorly compressed spinal cord segments was(2.46±1.56)and((2.46±1.44),with no significant difference or the difference was not statistically significant(P>0.05).3.In the ISI grading of the group with excellent spinal cord function and the group with non-excellent spinal cord function,the OR(95%CI)of the group with clear border and high signal was elevated to 1.818(0.414-7.99)compared with the normal group,P<0.05,while the OR(95%CI)of the group with ambiguous 1.2(0.248-5.818)was also elevated compared with the normal group,P>0.05.Meanwhile,the OR(95%CI)of the group with ossification of the posterior longitudinal ligament 1.818(0.414-7.99),which was higher than the group without posterior longitudinal ligament ossification,but the difference was not statistically significant4.Binary logistic regression analysis showed that the preoperative JOA score ROC AUC was 0.720,and the critical value of 10.5 points was reached at a Jorden index of 0.389;the MCC ROC curve had an AUC of 0.684 and a critical value of 57.5points was reached at a Jorden index of 0.305;the MSCC ROC curve had an AUC of0.758 and a Jorden index of The critical value of 47.5 points was reached at 0.448;the critical value of 45.5 mm2 was reached at 0.705 AUC and 0.324 Yordon index in the TA ROC curve;all the above results were statistically significant.5.The sensitivity in the protective factor preoperative JOA scores combined with TA ROC curve was 96.2%and the specificity was 59.1%;the sensitivity in the risk factor MCC combined with MSCC ROC curve was 81.8%and the specificity was80.8%.Conclusion:1.The duration of disease,age,gender,CR,number of anterior spinal cord compression segments,number of posterior spinal cord compression segments and OPLL were not correlated with the prognosis of patients with MCSM.2.The preoperative JOA scores,TA,MCC,MSCC,and ISI correlated with the prognosis of MCSM patients after EODL.Patients in the good spinal cord function group had higher preoperative JOR scores and TA,while MCC and MSCC were lower.3.Preoperative JOA scores was a protective factor for spinal cord function after MCSM,and MCC,MSCC,TA and ISI were risk factors.4.Preoperative JOA scores、TA,MCC,MSCC,and ISI can be used for postoperative efficacy evaluation of MCSM,among which preoperative JOA scores has the highest sensitivity and TA has the highest specificity.And MCC combined with MSCC has greater prognostic evaluation value for MCSM patients after EODL.