The Analysis Of Axial Symptom After Expansive Open-door Laminoplasty Using Suture Anchors

Backgroud:Axial symptom refers to nuchal pain, neck stiffness,weakness, shoulder pain, activity of the obstacles and other semptoms.We can find palpable point of tenderness and muscle spasm in the physical examination.Hosonoetal fist reported to axial symptom after cervical laminoplasty in 1996,and then Kawaguchi defined it as axial symptom .It was reported that these symptoms proved to be more serious than has been believed, and sustainable existence, even more than 10 years after surgery. It has great impact on the life of patients.Serious cases are difficult to achieve a satisfyactory effect by physical therapy, drugs and functional exercise.Purpose:For the treatment of multilevel cervical spondylosis, a modification of the Hirabayashi technique was introduced which uses 2.0 mm suture anchors throughout the area of expansion from C3-C7. The aim of the study is to observe the incidence of anxial symptoms. Methods From March 2003 to September 2009,the author retrospectively reviewed 61 consecutive patients who had undergone open-door laminoplasty during in 2th clinical hospital of Jilin university. Data were available for 36 of the 61 patients over a minimum 3-month follow-up. The average follow-up period was 8.1 months(range, 3 to 13 months).16 patients undergoing expansive open-door laminoplasty by suture anchors were classified as study group (group A).20 patients undergoing conventional expansive open-door laminoplaty served as controls(group B). We recorded age of patients, operative period, estimated blood loss, neurological status indicated by the JOA score and the severity of axial symptoms. And then analysised clinical data using SPSS 10.0 statistical software. Result The patients in two groups had no significant difference in age before surgy. The mean operative duration was 112.5±14.8 minutes in group A and 112±17.7 minutes in group B, showing no statistically significant difference(P=0.487> 0.05). The mean intraoperative estimated blood loss was 381±91ml in group A and 413±89ml in group B, showing no statistically significant difference (P=0.913>0.05).The mean JOA score in group A improved from 7.97±1.52 preoperatively to 12.25±2.37 postoperatively, for a recovery rate of 49.3±21.7% while the mean JOA score in group B improved from 8.05±1.69 preoperatively to 11.38±2.15 postoperatively, for a recovery rate of 40.4±17.4, showing statistically significant difference (P<0.05). The mean JOA score between group A and B had no difference before and after operation, showing no statistically significant difference (P>0.05). The recovery rate had no difference showing no statistically significant difference (P>0.05). The data show that the two methods have same correlation to the recovery of neurological symptoms.31% of patients after surgery suffer severed axial symptoms in group A, while 70% in group B. Difference between the two was statistically significant (P<0.05). Conclusion This modified open door laminoplasty using suture anchors method has the advantages of easy performing, less neck symptoms. The neurological function had no significant difference in statistical analysis. Two kinds of surgical for patients have no significant difference in neurological recovery, and the incidence of axial symptoms has no correlation to the recovery of neurological symptoms.