Objectives:To investigate the differences in clinical outcomes and postoperative imaging parameters between crossed open-door expansive laminoplasty and conventional open-door expansive laminoplasty.Background:Under the background of the further development of today’s social economy,the improvement of people’s living standards and lifestyle changes,the incidence of various types of cervical spine diseases has also begun to increase year by year,and it has become one of the common diseases in orthopedics.Among them,spinal myelopathy(CSM)can cause damage and disorders of spinal cord nerve function in people,and is the most serious type of cervical spine disease.Laminoplasty for the treatment of multi-segment cervical myelopathy(MCSM)has the advantages of obvious improvement of spinal cord function and long-lasting curative effect.Since Hirabayashi first introduced single-door laminoplasty,several new surgical techniques and instrument improvements have been made to improve the procedure.At present,the widely used single-door surgery is micro-titanium plate fixation,which is relatively more reliable,which can greatly reduce the occurrence of re-closing the door,and is a fixation method of single-door surgery that is currently commonly used by spine surgeons.However,there are still complications such as loss of cervical lordosis,limited movement of the cervical spine,and axial pain after surgery.To this end,we have improved the traditional single-door spinal canaloplasty(referred to as traditional single-door)on one side,and adopted a cross-type micro-titanium plate single-door surgery(referred to as cross-type single-door).Methods:A retrospective analysis of 108 patients treated with posterior cervical single-opening laminoplasty at our hospital from June 2018 to December 2022 was performed,and 67 patients were finally included in this study according to the corresponding inclusion and exclusion criteria.The patients were divided into a crossover group and a conventional group according to the surgical procedure.Clinical and imaging data were collected including age,BMI,follow-up time,duration of symptoms,intraoperative bleeding,postoperative drainage,preoperative and postoperative cervical curvature at 3,6 and 12 months,cervical ROM,posterior cervical extensor abundance NEM(superficial extensor abundance SEA/VBA and deep extensor abundance DEA/VBA),VAS score,JOA score,using t-test,u test,and the data were repeatedly measured by applying generalised estimating equations to compare and analyse the differences in clinical outcomes and postoperative imaging parameters between the crossover and conventional groups.Results:(1): There was no statistical difference in the baseline data between the two groups except the intraoperative blood loss(P>0.05),and the intraoperative blood loss in the crossover group was significantly higher than that in the traditional group(P<0.001).(2): There were no significant differences between the two groups in JOA before,3 months,6 months and 12 months after surgery(P>0.05).There was no significant difference in VAS scores between the two groups at 3 months before and after surgery,and VAS at 6 months after surgery and 12 months after surgery were lower than those in the traditional group,and there were statistical differences(P<0.001).(3): There was no significant difference in physiological curvature between the two groups before treatment,and the physiological curvature of 3 months,6 months after surgery and 12 months after surgery in the crossover group was higher than that in the traditional group,and the difference was statistically different(P<0.001).There was no significant difference between the two groups in cervical spine ROM before treatment and 3 months after surgery(P>0.05),but there were significant differences 6 months after surgery and 12 months after surgery(P<0.001).(4): There was no significant difference in extensor muscle abundance between the two groups before surgery.There were no differences between deep and superficial extensor C3 and C7 between the two groups 3,6 and 12 months after surgery(P>0.05),and there were significant differences(P<0.001)in the remaining segments(C4,C5,C6)of the two groups 3,6 and 12 months after surgery,and the muscle content in the cross group was higher than that in the traditional group.Conclusions:(1)The single-opening laminoplasty in the crossover group and the single-opening laminoplasty in the lateral group both achieved satisfactory results in terms of neurological recovery in MCSM,with no significant difference between the two,but in terms of postoperative relief of neck and shoulder pain,the crossover group had a significant advantage over the lateral group.(2)From the perspective of postoperative cervical spine curvature loss,the cross group is also better than the traditional group due to its certain biomechanical stability.At 6 months after surgery,there were significant differences between the crossover group and the traditional group ROM at 12 months after surgery,and the degree of ROM loss in the crossover group was lower than that in the traditional group,and the crossover group increased the laminar gap due to the left and right staggered doors,and the cervical posterior extension space was larger,coupled with the relatively good preservation of the posterior cervical posterior muscles,so the postoperative cervical spine range of motion loss was relatively small.(3)After the measurement and statistical analysis of the superficial and deep muscle abundance of the extensor muscles of the cervical spine after surgery in the two groups,the degree of postoperative muscle atrophy in the crossover group was significantly lower than that in the traditional group,especially the C4-C6 level.(4)Intraoperative bleeding was higher in the crossed group than in the partial group due to the need to dissociate the ligamentum flavum between all segments of the open door. |