Posterior cervical laminoplasty by using two different vertebral plates for multi segmental cervical spondylotic myelopathy

English Keywords:Cervical spondylotic myelopathy  Cervical laminoplasty  Internal Fixators  Silk thread suspension  Clinical effect

English Abstract:

  【Abstract】 Objectives: To investigate the outcomes of posterior cervical laminoplasty by using two different vertebral plates for multi segmental cervical spondylotic myelopathy. Methods: From January 2007 to January 2011, 92 patients with multi segmental cervical spondylotic myelopathy undergoing posterior C3-C7 single door laminoplasty were followed up, all patients were divided into two groups: group A, laminoplasty by using silk thread suspension, 49 cases(37 males and 12 females) with the age of 58.0±13.6 years, course of disease of 11.3±6.7 months, preoperative JOA score of 8.23±1.21, cervical curvature of 18.2°±6.4°, VAS score of 4.46±1.64; group B, laminoplasty by using mini titanium plate, 43 cases(32 males and 11 females) with the age of 56.6±14.7 years, course of disease of 10.9±8.5 months, preoperative JOA score of 8.12±1.56, cervical curvature of 17.9°±8.3°, VAS score of 4.65±1.12. The operation time, blood loss during operation, postoperative drainage, follow-up results, cervical curvature and axial symptoms were recorded and compared between 2 groups. Results: The operation time, blood loss, postoperative volume showed no significant difference between 2 groups(P>0.05). 7 cases in group A and 8 cases in group B presented with radiative pain in shoulder, which resolved after dehydrate medication, physical therapy and other treatments in 1 week, all patients had no C5 nerve root palsy. Patients were followed up for 24-47 months, with an average of 38 months. 12 months after operation, neurofunction improved significantly in group A, the JOA score was 14.57±2.95, with the improvement rate of 72.29%; while in group B, the postoperative JOA score was 14.31±2.86, with the improvement rate of 69.48%, which showed no significant difference(P>0.05) between 2 groups; the cervical curvature in group A after 12 months was 15.9°±5.7°; while that in group B was 18.1°±7.9°, group B had better cervical alignment than group A(P<0.05). The preoperative and postoperative 3 month VAS score showed no difference between 2 groups, but the difference was significant after 12 months(P<0.05), group A had better result than group B. During the follow-up, two groups had no door closed, and no instrument failure was noted in group B. Conclusions: Cervical expansive open-door laminoplasty with either mini titanium plate fixation or silk thread suspension can effectively maintain the spinal canal enlargement and achieve better clinical outcome, but the mini titanium plate can decrease the incidence of postoperative long-term neck pain.