The Effect Of Skeletal Muscle Reduction On The Recovery Of Cervical Spondylotic Myelopathy After Posterior Cervical Single Open-door Laminoplasty

Background:The World Health Organization announced in 2016 that cervical spondylosis is one of the "top ten chronic diseases" affecting modern human health.Clinically,the disease is divided into four types according to the location and clinical manifestations of the disease,which are nerve root type,spinal cord type,vertebral artery type,and sympathetic nerve type.Among them,cervical spondylotic myelopathy is a common type,the incidence of which accounts for 10%-15% of cervical spondylosis,second only to radiculopathy of cervical spondylosis,is the most severe type of cervical spondylosis,which seriously affects the quality of life of patients.Moreover,the development of symptoms of this type of cervical spondylosis is gradual.The longer the course of the disease,the worse the postoperative recovery effect.Therefore,once the diagnosis is made,surgical treatment is often required as soon as possible.The posterior single-door operation is suitable for most patients,especially elderly patients with multiple segments.The operation is less time-consuming,relatively small in damage,simple in operation,and safe in clinical practice.application.Of course,even if patients undergo surgical treatment,not all patients will recover as expected after surgery.There are many factors that affect postoperative recovery,such as the patient’s age,course of disease,preoperative severity,and changes in spinal cord signal intensity in magnetic resonance imaging.Wait.The purpose of this study is to understand whether the reduction of skeletal muscle has an effect on postoperative recovery.Purpose:To explore the effect of skeletal muscle reduction on the recovery of patients with cervical spondylotic myelopathy undergoing single-opening posterior cervical spine surgery.Methods :From January 2018 to January 2020,a retrospective study of patients in the Department of Spine Surgery,Shengjing Hospital Affiliated to China Medical University,who underwent single-door cervical spine surgery for multi-segment cervical spondylotic myelopathy,strictly followed the inclusion and exclusion criteria in 48 cases.The degree of fatification of the lumbar paraspinal muscles(the erector spinae,multifidus,and psoas major)were measured.According to the Mercuri classification of the degree of fat infiltration,they were divided into observation group and control group.The observation group was 20 cases(the degree of paraspinal muscle fatification was 3-4grade),28 cases in the control group(the degree of paraspinal muscle fatty acid is 0-2 grade).The main observation indicators of clinical efficacy are intraoperative blood loss,operation time,improvement rate of Japanese Orthopaedic Association Scores(JOAs)at1 week,6 months and 1 year follow-up,and incidence of postoperative complications Situation and so on.Results:All patients were followed up for 12 months.There was no significant difference between the observation group and the control group in age,gender,course of disease,and operation time(P>0.05).There was no cervical spinal cord MRI-T2 WI hyperintensity in the two groups.Intraoperative blood loss: the observation group averaged 517.50 ± 136.96 ml,the control group averaged 332.14 ± 112.39 ml,and the control group had less intraoperative blood loss.The difference was statistically significant(P<0.05).The improvement rate(%)of JOA score at 1 week,6 months and 12 months after operation: 12.61 ±8.17,44.68 ± 13.19,64.15 ± 12.17 in the observation group and 8.51 ± 7.71,55.14 ± 11.78,respectively in the control group.74.24 ±11.41,there was no significant difference in the JOA score improvement rate between the two groups at 1 week after surgery(P>0.05).The JOA score improvement rate of the control group was significantly higher than that of the observation group at 6 months and 12 months after surgery.The difference was statistically significant(P<0.05).Complications: cerebrospinal fluid leakage,incision infection,nerve root palsy did not occur in the two groups.The incidence of cervical axial pain occurred in 4 cases in the observation group,with an incidence rate of 20%,and 2 cases in the control group,with an incidence rate of 7%.The incidence of cervical axial pain in the control group was lower than that in the observation group,and the difference was statistically significant(P<0.05).Conclusion: Reduction of skeletal muscles throughout the body,especially fat infiltration reaching Mercuri grade 3 and above,has a significant impact on the recovery of patients with cervical spondylotic myelopathy after single-opening of the posterior door,and the amount of intraoperative blood loss is high,and the incidence of postoperative axial symptoms is high.Therefore,we should pay attention to the evaluation of skeletal muscle quality before surgery,pay attention to strengthening postoperative muscle exercise(resistance exercise is preferred),strengthen nutrition,and actively treat skeletal muscle reduction,which will help patients recover after surgery.