Comparison of effectiveness between three modified channel-assisted laminoplasty for the treatment of cervical degenerative diseases

English Keywords:Cervical  Laminoplasty  Channel  Unilateral exposure

English Abstract:

  【Abstract】 Objectives: Comparing with traditional open-door laminoplasty, to explore the clinical effects of three modified channal-assisted laminoplasty for the treatment of cervical degenerative diseases. Methods: The data of 122 patients who underwent open-door laminoplasty from October 2020 to October 2022 were retrospectively analyzed. 27 patients who underwent bilateral channel-assisted laminoplasty were defined as BCA group; 31 patients who underwent unilateral inter-muscular approach and unilateral channel-assisted laminoplasty were defined as IM-UCA group; 34 patients who underwent unilateral exposure and unilateral channel-assisted laminoplasty were defined as UCA group; 30 patients underwent traditional open-door laminoplasty were defined as LP group. There were no significant differences in age, sex, body mass index(BMI) and diagnosis between the 4 groups(P>0.05). Surgical parameters such as the operative time, blood loss, postoperative drainage volume, and average length of stay were compared. Clinical parameters such as visual analogue scale(VAS) score of neck pain, neck disability index(NDI), Japanese Orthopaedic Association(JOA) score were all recorded and compared. There was no statistical difference between the 4 groups in preoperative VAS, NDI, and JOA score(P>0.05). The C2-C7 Cobb angle, T1 slope, C2-C7 sagittal vertical axis(C2-C7 SVA) were measurement on lateral cervical X-rays and bone canal area on CT cross-section before surgery, immediately after surgery, 2 months and 12 months after surgery, and at final follow-up. The differences in the above parameters between the three surgical methods were compared. Result: All the patients underwent the operation successfully. The LP group and UCA group weren′t statistically different in the operative time(P>0.05), while the IM-UCA group was longer, and the BCA group was the longest(P<0.05). The BCA group had the least intraoperative blood loss and postoperative drainage, followed by the IM-UCA group and the UCA group(no difference between the two groups, P>0.05), and the LP group had the most blood loss and drainage. There was no statistically significant difference in the average length of hospital stay among the 4 groups(P>0.05). The postoperative scores of NDI and JOA in the 4 groups were significantly improved compared with those before operation(P<0.05). There was no statistically significant difference in NDI and JOA scores among the 4 groups immediately after surgery, 2 months after surgery, 12 months after surgery, and at final follow-up(P>0.05). In the LP group, there were significant differences in the neck pain VAS scores immediately after surgery, 12 months after surgery, and at final follow-up compared with before surgery. There was no difference in the neck pain VAS scores 2 months after surgery compared with before surgery(P>0.05). In the UCA group, BCA group, and IM-UCA group, the neck pain VAS scores of immediate postoperation were similar with the values before surgery(P>0.05). The neck pain VAS scores in the 3 groups at 2 months after surgery, 12 months after surgery and final follow-up were significantly different from those before surgery(P<0.05). The C2-C7 Cobb angle in the LP group at 12 months after surgery and final follow-up showed significant differences compared with those before surgery(P<0.05). There was no difference in C2-C7 Cobb angle among the 4 groups before surgery, immediately after surgery, or 2 months after surgery(P>0.05). There were significant differences in C2-C7 Cobb angle among the 4 groups at 12 months after surgery and final follow-up(P<0.05). In the 4 groups, compared with before surgery, there was no difference in T1 slope and C2-7 SVA levels immediately after surgery, 2 months after surgery, 12 months after surgery, and final follow-up(P>0.05). There was no difference in C2-C7 Cobb angle between the 4 groups immediately after surgery, 2 months after surgery, 12 months after surgery, and at final follow-up(P>0.05). In the 4 groups, there was no difference in the increased cross-sectional area of spinal canal immediately after surgery, 2 months after surgery, 12 months after surgery, and final follow-up(P>0.05). There was no difference in the increased cross-sectional area of spinal canal among the 4 groups before surgery, immediately after surgery, 2 months after surgery, 12 months after surgery, and final follow-up(P>0.05). Conclusions: Compared with the LP group, the UCA group significantly reduced surgical trauma; Compared with the IM-UCA group and BCA group, the UCA group significantly reduced operative time, and the therapeutic effect of UCA laminoplasty was satisfactory.