Comparison Of The Effect Between Anterior Cervical Hybrid Decompression And Fusion And Posterior Expansive Open-door Laminoplasty For Treatment Of Multilevel Cervical Spondylotic Myelopathy

Objective To compare the clinical effect between anterior cervical hybrid decompression and fusion(ACHDF)and posterior approach and posterior expansive open-door laminoplasty(ELAP)in treatment of multilevel cervical spondylotic myelopathy(MCSM).Methods Data of 42 patients meeting to inclusion criteria from January 2016 to April2018 retrospectively analyzed.All the patients were treated with ACHDF(ACHDF group,n=20)or ELAP(ELAP group,n=22).All patients were followed up for 12 to24 months.The JOA scores were compared between the patients of the two groups at preoperative,6 months postoperative and latest follow-up.The neurological improvement rate(IR)the latest follow-up was compared between the patients of both groups.The VAS scores were compared between the patients of the two groups at preoperative,1 month postoperative,3 months postoperative and latest follow-up.The cervical curvature change,cervical range of motion(ROM),the ratio of the cervical spinal canal volume to the cervical spinal cord volume,and intervertebral height change at preoperative and latest follow-up were compared between the two groups.The differences in intraoperative blood loss,operative time,and postoperative complication rate between the two groups were compared.Result The intraoperative blood loss in the ACHDF group was significantly shorter than that the ELAP in group(P<0.05),but there was no statistically significant in the operation time loss between the two groups(P>0.05).The differences in JOA scores,neurological improvement rate,cervical range of motion,cervical curvature,loss angle,and intervertebral height between the two groups have statistically significant at the latest follow-up.Both of the cervical range of motion and cervical spinal canal volume to cervical spinal cord volume in the two groups decreased significantly at the latest follow-up(P<0.05).Both the VAS scores in the two groups decreased significantly at 1month postoperative,3 months postoperative and the latest follow-up,but the difference between the two groups was statistically significant(P<0.05).At the latest follow-up,the differences in postoperative complication rates between the two groups have no statistically significant.Conclusion Anterior cervical hybrid decompression and fusion and posterior expansive open-door laminoplasty can remove the compression and achieve more good outcomes for the treatment of multilevel cervical spondylotic myelopathy.ACHDF group could achieve more satisfactory outcomes and a better neurological improvement rate at the latest follow-up.ACHDF group has a better effect on reconstructing intervertebral height,maintaining the cervical curvature effectively and,lower bleeding at postoperative.ELAP group has a better effect on maintaining cervical range of motion,but has a disadvantage in recovering intervertebral height and maintaining the cervical curvature at postoperative.