The application of anchoring nails in the expansive laminoplasty treating the multi-segments cervical spondylotic myelopathy

English Keywords:Cervical spondylotic myelopathy  Expansive laminoplasty  Multi-segments  Anchoring nail

English Abstract:

  【Abstract】 Objective：To investigate the clinical application value of anchoring nails in expansive laminoplasty treating the multi-segments cervical spondylotic myelopathy.Method：From January 2009 to January 2011，25 patients with multi-segments cervical spondylotic myelopathy received operations of the cervical expansive laminoplasty.Among them，there were 21 male patients and 4 female patients.Their ages ranged from 35 to 78 years with a mean age of 63.5 years.The course of disease ranged from 1.6 to 18 years and a mean was 3.6 years.3 segments were involved in 18 patients，4 segments in 7 patients and 20 patients combined with developmental or degenerative cervical spinal stenosis.All patients had clinical symptom of cervical cord compression.The JOA scores were 3-11 points and a mean was 6.7±2.2 points before the operation.All of them received operations of cervical expansive laminoplasty，the segments were from C3 to C7，and C3，C5，C7 segments were anchorred with the anchoring nails.Result：During the operation，all nails were smoothly placed.The mean operative time was 75min and ranged from 60min to 100min.The mean volume of bleeding was 200ml and ranged from 100ml to 500ml.There was no complication such as spinal cord injury，cerebrospinal fluid leakage，hematoma outside of the scleromeninx and so forth.There was a patient having neck and shoulder pain after operation，and the pain disappeared with symptomatic treatment of 2 months.All patients were obtained follow-up for 0.5-2.5 years with an average of 1.9 years.The JOA scores were 10-16 points and a mean was 13.8±1.4 points at the last follow-up after operation.There were statistically significant differences compared with the results before operatin（P＜0.01）.The average improvement rate was （68.1±7.5）% and the rate of excellent and good results was 88%.Postoperative radiograph showed，the physiological curvature of cervical vertebra was basically normal，and average ratio of the middle sagittal diameter between the cervical vertebral canal and vertebral body was 1.2.The anchoring nails had no loosening.There was no case with cervical instability and door re-closure.Conclusion：The anchoring nail method is simple and reliable during the expansive laminoplasty treating the multi-segments cervical spondylotic myelopathy.It can avoid "door re-closure" and clinical efficacy is satisfactory.