Modified posterior cervical one-open-door laminoplasty for the treatment of multi-segment cervical spondylotic myelopathy

English Keywords:Cervical spondylotic myelopathy  Posterior cervical open-door laminoplasty  Laminectomy  Axial symptoms

English Abstract:

  【Abstract】 Objectives: To explore the clinical effects of modified cervical open-door laminoplasty for multiple-segment cervical spondylotic myelopathy. Methods: From June 2013 to December 2015, 60 patients with multiple-segment cervical spondylotic myelopathy undergoing posterior cervical single door laminoplasty were followed up. They were rdivided into two groups: 21 patients(17 males and 4 females) with the age of 66.2±10.0 years in modified laminoplasty group, and 39 patients(36 males and 3 females) with the age of 57.3±10.5 years in traditional laminoplasty group. The same mini titanium plates were used to fix the open-door lamina in all the patients. The operation time, intraoperative blood loss, postoperative hospital stay, surgery cost, follow-up results, preoperative and postoperative Japanese Orthopedic Association(JOA) scores, cervical curvature, cervical curvature index, neck motion range and axial symptoms were recorded and compared between the two groups. Results: There was no significant difference of gender, age, course of disease, operation time, intraoperative blood loss or postoperative hospital stay between the two groups(P>0.05). The average surgery cost of modified laminoplasty group was significantly lower than that of traditional laminoplasty group(P<0.05). Patients were followed up for 12-24 months. At 12 months after operation, all the patients in the two groups achieved bony fusion and significantly improved neurofunction. JOA score improved significantly in modified laminoplasty group, with the improvement rate of (60.46±9.65)%; while the improvement rate of traditional laminoplasty group was (46.41±24.33)%, there was no significant difference between the two groups(P>0.05). The loss of cervical curvature was 4.7°±1.9° in modified laminoplasty group and 8.9°±5.6° in traditional laminoplasty group, the difference was statistically significant between the two groups(P<0.05). The loss of cervical curvature index was (3.09±2.14)% in modified laminoplasty group and (6.27±3.42)% in traditional laminoplasty group, the difference was statistically significant between the two groups(P<0.05). The loss of neck motion range was 11.6°±7.8° in modified laminoplasty group and 13.0°±3.9° in traditional laminoplasty group, there was significant difference(P<0.01). Three cases in modified laminoplasty group and nineteen cases in traditional laminoplasty group presented with axial symptoms after operation, the difference was statistically significant(P<0.01). During the follow-up, all the patients in the two groups had no door closing or instrument failure. Conclusions: Modified cervical open-door laminoplasty is effective in nerve decompression when compared with traditional laminoplasty. Furthermore, it can decrease the incidence of postoperative cervical axial symptoms, relief axial pain and maintain the cervical curvature and neck motion range, also it reduces the surgery cost.