Clinical effect comparison between traditional open-door laminoplasty and reserved bilateral semispinalis modified open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome

English Keywords:Multiple segmental cervical spinal cord compression  Single open-door laminoplasty  Axial symptoms  Cervical range of motion  Cervical curvature

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical effect of traditional open-door laminoplasty and reserved bilateral semispinalis modified open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome. Methods: From January 2013 to May 2014, The data of 66 cases with multiple segmental cervical spinal canal compression syndrome who underwent open-door laminoplasty in our hospital were retrospectively analyzed． Among them, 36 cases were treated by traditional open-door laminoplasty, the bilateral of C2 and C7 spinous ligaments and muscle tissue attachment were retained(tradition group). The other 30 patients underwent modified open-door laminoplasty together with preservation of bilateral of the semispinalis cervicis(improved group). Operation time and intraoperative blood loss were recorded． Visual analogue scale/score(VAS), Japanese Orthopaedic Association(JOA) score(17-score method), neck disability index(NDI), cervical curvature, range of motion of cervical vertebra and axial symptom severity were compared and analyzed before operation, three months after operation and at final follow-up． Results: The operation time was 140.49±36.57min in tradition group and 122.35±46.57min in improved group(P＞0.05). The intraoperative blood loss was 233.66±165.39ml in tradition group and 281.18±208.11ml in improved group(P＞0.05)． And no spinal cord injury, door shaft fracture, cerebrospinal fluid leakage, epidural hematoma, infection, implant loosening or breakage and other complications were noted in both groups. Two patients in tradition group and one patient in improved group were complicated with C5 nerve root palsy, which was alleviated after correspondent treatment. A total of 66 patients were followed up for 12-24 months, with a mean of 17.10±3.57 months in the tradition group and 16.40±2.57 months in the improved group, no significant difference was found between the two groups(P＞0.05). There was no significant difference in the recovery rate of JOA between 2 groups at last follow-up(P>0.05). No significant difference was found between 2 groups with respect to NDI score at preoperation and three months after operation(P>0.05), but at last follow-up, there was significant difference between two groups(P＜0.05), as well as between preoperation and last follow-up with respect to NDI score in each group(P＜0.05). No significant difference was found between 2 groups with respect to VAS score at preoperative(P＞0.05), but at three months after operation and last follow-up, there were significant differences between 2 groups(P＜0.05), as well as preoperative and last follow-up with respect to VAS score in each group(P＜0.05). At last follow-up, the cervical curvature decreased 3.73°±1.38° in tradition group and 1.47°±1.01° in improved group(P＜0.05). The decrease degree of neck range of motion was 6.63°±2.09° in tradition group and 4.53°±1.70° in improved group at last follow-up(P＜0.05). Postoperative development or deterioration of axial symptoms occurred in 30.56％ of patients in tradition group and 3.33％ of patients in improved group, which showed significant difference(P＜0.05)． Conclusions: Compared to the traditional single-door operation, this new modified open-door laminoplasty procedure retains the integrity of cervical rear structure and decreases the incidence of axial symptoms, loss of cervical curvature and range of neck motion.