Surgical Approach For Cervical Spondylotic Myelopathy

Objective: To investigate the cervical spinal surgical approach of choice and different surgical clinical treatment efficacy of cervical spondylotic myelopathy(CSM.Methods: A retrospective review was performed on 387 cases of the cervical spondylotic mydopathy were treated with different surgical approaches in The Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University from Aug.2003 to Dec.2010, including single-segment discectomy in 153 cases; two disc excision in 78 cases; three disc excision in 10 cases; single vertebra subtotal in 72 cases; 30 cases were double subtotal vertebral body; single ten single vertebral discs removed subtotal 10 cases; posterior surgery in 34 cases, including the posterior single door laminoplasty in 23 patients; posterior lateral mass open-door with screw fixation in 11 cases. Grouped according to different segments, Function of nerves was assessed according to Japanese orthopaedic association system before and after surgery and Hirabayashi method to calculate the average improvement rate after surgery.Results: 343 patients were followed up from 3 months to 7 years with an average of (33+/-5.41) months. The rate followed up was 88.63%. Postoperative follow-up JOA score improved in varying degrees, different groups are given a higher average rate of improvement. The mean difference between groups was not statistically significant difference in improvement rate (P> 0.05).Conclusion: Selection of CSM surgical approach should be based on disease progression in patients, imaging and other related comprehensive evaluation of the objective basis for inspection. Individualized surgical solutions could improve surgerical efficacy and reduce complications. Take as long as the timing of surgery, individual select the appropriate surgical approach, complete decompression, spinal cord function can be achieved improved significantly clinical efficacy.