One-stage anterior-posterior approach for multilevel cervical spondylotic myelopathy

English Keywords:Cervical spondylotic myelopathy  Laminoplasty  Anterior decompression  Fusion

English Abstract:

  【Abstract】 Objective：To evaluate the clinical results of one-stage anterior-posterior approach for multilevel cervical spondylotic myelopathy（CSM）.Method：A total of 28 patients（16 males and 12 females）　suffering severe CSM underwent one-stage combined anterior-posterior approach，the average age was 51.3 years（range：32-63 years）.The affected level was C2/3 in 5　cases，C3/4 in 21　cases，C4/5 in 26 cases，C5/6 in 28 cases and C6/7 in 16　cases.The clinical results including 　JOA scores，the number of hand action in ten seconds，hand-grip strength，visual analog scale（VAS） of axial pain，and Cobb angle of sagittal alignment（C2-C7）　were assessed retrospectively.Result：The average surgical time was 6.5h，the average blood loss was 375ml．Ａll cases were followed up for one　year.No neurological deterioration due to spinal cord injury，CSF leakage，or wound infection was noted.The JOA scores improved from preoperative　９．８±２．１ to 15.9±1.2 of 1 year later，with the average improve rate of（84.7±9.2）%.The number of hands action in ten seconds improved from preoperative １１．２±３．１　of left and １０．８±１　of right to postoperative 18.2±2.6 of left and 17.8±3.9 of right，and hand-grip strength improved from preoperative １８．７±７．１kg of left and １９．２±３．６kg of right to postoperative ３３．２±６．３ of left and ３５．８±２．５　of right（P<0.05）.Cervical kyphosis decreased from ２１．５°±５．７°　to 19.60°±4.10°（P>0.05）．All cases showed satisfactory decompression and good bony fusion on MRI or CT.No ASD and instrument failure were noted．Conclusion：Combined anterior-posterior approach is less invasive and can decrease postoperative axial pain；anterior approach can manage compression effectively.