Correlation Analysis Of Imaging Characteristics And Clinical Effect Before And After Operation For Multisegmental Cervical Spondylotic Myelopathy

Anterior cervical spine surgery and posterior cervical spine surgery are currently more mature procedures for the treatment of Multilevel Cervical Spondylotic Myelopathy（MCSM）.Due to different surgical approaches and intraoperative requirements,the spinal cord and nerve function are restored.On the premise of satisfactory results,the imaging characteristics of the cervical spine have become another criterion for evaluating the degree of satisfaction with surgery.Intervertebral fusion of long segment of anterior cervical spine surgery and destruction of posterior ligament complex of posterior cervical spine surgery have changed the imaging characteristics of cervical spine.So far,scholars at home and abroad have repeatedly analyzed the relationship between imaging characteristics of cervical spine and MCSM surgery.The discussion mainly considers that the normal physiological curvature of the cervical spine may provide favorable conditions for the functional recovery of the spinal cord and nerves.Therefore,MCSM surgery should be thoroughly decompressed while maintaining the original physiological structure of the cervical spine as much as possible.Objective:To investigate the change of balance of cervical sagittal position before and after cervical anterior and posterior cervical surgery in patients with multi-segment myeloid cervical spondylosis and the comparison of surgical efficacy.Method:A retrospective study of patients with multi-segment myeloid cervical spondylosis diagnosed in our hospital from January 2015 to December 2017 and undergoing surgical treatment were divided into two groups according to different surgical methods:group A anterior cervical decompression implantation Bone fusion and internal fixation were performed in 40 cases,and in group B,40 cases were treated with posterior cervical single-door open-end spinal canalplasty.The Japanese orthopaedic association（JOA）score,C₇ sagittal vertical distance（SVA）,C_2-7 Cobb angle,and T₁-Slope on the X-ray film were counted before and after the last follow-up.Number of patients with axial symptoms and C₅ nerve root palsy.Result:There was no significant difference in gender,age,and incidence between the two treatment groups（P> 0.05）.Group A:operation time（112.78 ± 9.12）min,intraoperative blood loss（77.84 ± 54.37）ml,preoperative JOA score（7.65 ± 1.96）,postoperative JOA score（14.62 ± 0.98）,and neurological function improvement rate（74.38 ± 7.12）%,preoperative C_2-7 Cobb angle（18.33 ± 11.63）°,postoperative C_2-7 Cobb angle（19.31 ± 11.26）°,preoperative C₇ sagittal balance（18.73 ± 4.43）mm,postoperative C₇ sagittal Balance（15.05 ± 8.25）mm,T₁-Slope（24.83 ± 7.50）° before surgery,T₁-Slope（25.93 ± 8.18）° after surgery;Group B:operation time（120.60 ± 7.96）min,and intraoperative blood loss（258.25）± 54.16)ml,preoperative JOA score（8.05 ± 1.40）,postoperative JOA score（14.73 ± 0.55）,neural function improvement rate（72.58 ± 5.31）%,preoperative C_2-7 Cobb angle（18.48 ± 6.88）°,Post C_2-7 Cobb angle（11.91 ± 6.49）°,C₇ sagittal balance before operation（18.20 ± 7.16）mm,C₇ sagittal balance after operation（31.31 ± 8.03）mm,T₁-Slope（24.52 ± 6.60）before operation°,T₁-Slope（17.53 ± 4.96）° after operation.The preoperative JOA score,postoperative JOA score,neural function improvement rate,preoperative C_2-7 Cobb angle,preoperative C₇ sagittal balance,and preoperative T₁-Slope showed no significant difference between the two groups（P>0.05）.).Comparison of intraoperative blood loss,operation time,postoperative C_2-7 Cobb angle,postoperative C₇ sagittal balance,and postoperative T₁-Slope between the two groups showed significant differences（P<0.05）.Comparison of JOA score and C₇ sagittal balance before and after operation in group A showed statistically significant differences（P<0.05）.There was no significant difference in C_2-7 Cobb angle and T₁-Slope before and after surgery（P>0.05）.Comparison of JOA score,C_2-7 Cobb angle,C₇ sagittal balance,and T₁-Slope of patients in group B before and after surgery showed significant differences（P<0.05）.There were no patients with axial symptoms and C₅ nerve root palsy after operation in group A,and 4 patients（10.0%）with axial symptoms were found in group B.The difference between the groups was statistically significant（P<0.05）.There were 2 patients（5.0%）,and there was no significant difference between the groups（P>0.05）.Conclusion:For patients with multi-segment spinal cord cervical spondylosis,no matter whether anterior or posterior cervical surgery is selected,good neurological recovery can be achieved,but the anterior cervical approach can reduce bleeding volume,operation time,and reduce axial symptoms.C₅ The incidence of nerve root palsy and anterior cervical spine surgery is superior to posterior cervical surgery in maintaining the sagittal balance of the cervical spine.