Assessment Of Clinical Effect Of Different Operative Methods For Cervical Spondylotic Myelopathy

Objective: To explore the therapeutic effect of three surgical procedures(anterior approach,posterior approach and posterior- anterior approach)for cervical spondylotic myelopathy.Method:Totally 111 patients with cervical spondylotic myelopathy operated by three surgical procedures from June 2002 to December 2007 in the Third Clinical Hospital of Hebei Medical University were retrospectively analyzed. Group A,54 cases who undertook anterior approach, their mean age was 57.1 years (ranged, 44-75 years);Group B,33 cases who received posterior approach (Laminoplasty), their mean age was 61 years (ranged, 41-73 years);Group C,24 cases who underwent posterior-anterior approach, their mean age was 62 years (ranged, 48-78 years). All cases were followed-up,neural function and Cervical sagittal alignment(D numerical value) were recorded.According to JOA score,preoperative score and postoperative follow-up score were compared, improvement rates were caleulated respectively.Result:All cases were regularly followed up.The duration of follow-up averaged 24months. The JOA score of three groups at 3, 6, 12, 24 months after operation improved compared with that before operation (P<0.05).But there was no significant difference among the three groups (P>0.05). Cervical sagittal alignment(D numerical value):there was no statistical difference at the preoperative among three groups(P=0.819). There was no statistical difference at the postoperative and the follow-up between group A and group C(P=0.434 ,P=0.492 , P=0.569),but there was significant difference between group B and group A/C(P<0.05). Both group A and C,the difference between the postoperative and the preoperative was stastically significant(P<0.001).In group B,there was statistical difference between the final follow-up and the postoperative(P<0.001),but no between the preoperative and the postoperative(P=0.076).Conclusion:According to compression segments,extent of disease,similar neurological improvement was made by the approach of anterior,posterior or anterior-posterior for CSM. Anterior operation and anterior-posterior operation were helpful to resume and maintain the sagittal alignment.Posterior operation was loss part of sagittal alignment.