| Objective: The effects of modified single-open portal spinal canal enlargement plasty with bilateral hemispinous muscle preserved by transmuscular space approach on postoperative neurological recovery,maintenance of cervical curvature and range of motion,and cervical degeneration in patients with multi-segment cervical myelopathy were comparatively analyzed.Methods: From January 2013 to December 2016,64 patients who underwent posterior cervical single-door spinal canal enlargement plasty due to multi-segment cervical myelopathy were collected and met the exclusion criteria and inclusion criteria.According to their surgical methods,29 cases were divided into the single-door myeloplasty group(modified group)and 35 cases in the traditional single-door myeloplasty group(traditional group),with a follow-up time of 6.16±0.79 years in the modified group and 6.52±1.01 years in the traditional group.Retrospectively analyzed and evaluated the gender,age,body mass index,course of disease,follow-up time,operation time,intraoperative blood loss,incision length,postoperative hospital stay,postoperative drainage and other clinical data of all included patients,and collected and analyzed NDI and JOA of the two groups of patients before surgery,one month after surgery and at the last follow-up score,VAS)and other clinical function evaluations,collected and compared the cervical spine curvature(C2-C7 Cobb angle)and intervertebral space height on lateral cervical spine radiographs before,one month and last follow-up between the two groups,and compared the severity of axial symptoms and the occurrence of other complications in the two groups.Results: There were no significant differences in sex composition ratio,age,disease course,follow-up time,BMI and other aspects of the two groups(P>0.05).There were no significant differences in intraoperative blood loss,incision length,postoperative hospitalization and drainage placement time between the two groups(P>0.05),and the average operation time was 97.29±21.05 min in the traditional group and 114.14±26.36 min in the modified group,which was statistically significant(P<0.05).There were no significant differences in VAS score,NDI score and JOA score before and1 month after surgery between the two groups(P>0.05),and there were significant differences in VAS score,NDI score and JOA score at the last follow-up between the two groups(P<0.05).There were significant differences in VAS score,NDI score and JOA score at preoperative,1 month after surgery and last follow-up between the two groups(P<0.05).There was a significant difference in axial symptom scores between the two groups at 3 months and at the last follow-up(P<0.05).There were significant differences between the two groups in cervical curvature and cervical spine mobility between the two groups at the last follow-up and preoperative(P<0.05).There were significant differences in cervical curvature and cervical spine mobility at preoperative,1-month and last follow-up between the two groups(P<0.05).There were no significant differences in intervertebral space height in C2-C3,C3-C4,C4-C5,C5-C6 and C7-T1 segments at preoperative and last follow-up between the two groups(P>0.05),and there was a significant difference in the last follow-up of C6-C7 intervertebral space height between the two groups(P<0.05).Conclusion: Single-open portal spinal canal enlargement plasty with bilateral hemispinous muscle preserved by transmuscular space approach had a lower incidence of axial symptoms in both long-term and postoperative short-term surgery,and the short-term postoperative recovery of cervical nerve function and the maintenance of cervical curvature and cervical range of motion had no obvious advantages compared with the traditional group,but the advantages were obvious under long-term follow-up,and it was of great significance for delaying the degeneration of C6-C7 segments of the cervical spine. |
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