The mid-long-term effect of minnimally invasive expansive laminoplasty for cervical spondylotic myelopathy using microendoscopy

English Keywords:Cervical spondylosis  Laminoplasty  Minimally invasive  Mid-long-term  Effect

English Abstract:

  【Abstract】 Objectives: To evaluate the mid-long-term effect of minimally invasive expansive laminoplasty for cervical spondylotic myelopathy by using microendoscopy. Methods: From January 2010 to January 2013, 19 patients with cervical spondylotic myelopathy treated by cervical microendoscopic laminoplasty(CMEL) in our hospital were reviewed in this study. There were 12 males and 7 females with a mean age of 56 years (range, 38-72 years). The mean course of disease was 15 months(range, 8.7-21.3 months). Among these patients, 3 segments, 4 segments and 5 segments laminoplasty were performed in 3, 6 and 10 cases respectively. A total of 166 vertebral laminae was bilaterally slotted and fixed. The JOA score, the sagittal diameter of spinal canal/body rate of surgical segment, the range of motion(ROM) of cervical spine and the alignment of cervical spine were analyzed at preoperation, 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up respectively. Results: The mean operation time was 114.0±19.9min(range, 49-133min). The mean blood loss was 219.0±70.5ml(range 100-375ml). Dural rupture occurred in 1 case during operation and then it appeared hypotensive cranial pressure headache after operation, headache gradually eased after which was given rehydration and analgesic treatment for 5 days. All of the 19 patients achieved average 7.00±0.76 years followed-up(range, 5-8 years). The mean JOA scores at 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up were significantly increased compared to the preoperative ones(P＜0.05), and the improvement rate at the final follow-up was (70.0±6.9)%. The mean surgical segment sagittal diameter of spinal canal/body rate at 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up were significantly increased compared to the preoperative ones(P＜0.05). The mean cervical vertebra activity at 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up showed no significant difference compared to the preoperative ones(P＞0.05). The mean C2-C7 Cobb angle at neutral position at 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up showed no significant difference compared to the preoperative ones(P＞0.05). A total of 166 vertebral laminae was bilaterally slotted and fixed. At 3 months after surgery, 112 laminae were observed bone healing and the bone healing rate was 67.5%. At 1 year after surgery, 122 laminae were observed bone healing and the bone healing rate was 73.5%. 128 laminae were observed bone healing at the final follow-up and the bone healing rate was 77.1%. The micro-titanium plate and screw were fixed in good position, no titanium plate, screw fracture and screw loosening were found at the final follow-up. Conclusions: CMEL is a safe and reliable surgical method, which has a good mid-long-term therapeutic effect on cervical spondylotic myelopathy.