The Effect Of Modified Expansive Open-door Laminoplasty With Cervical Pedicle Screw Fixation On Cervical Curvature

Objective: The expansive open-door laminoplasty has been widely used totreat multi-level cervical spinal cord compression disease. Although theincidence of cervical kyphosis after open-door laminoplasty was significantlower than total laminectomy, it is still a problem for clinicians. Vairous waysof modified expansive open-door laminoplasty preserving and reconstructingcervical posterior ligamentous complex have been created by some scholars toreduce the loss of cervical curvature and strengthen the stability of cervical. Butthey did not take full account of the effect of cervical instability and abnormalcervical curvature on cervical curvature after operation. Therefore, C3-7expansive open-door laminoplasty with cervical pedicle screw fixation wasused in the treatment of multi-level cervical spinal cord compression withabnormal cervical curvature or cervical instability. This study retrospectivelyobserved weather or not the surgery could improve and maintain the cervicalcurvature, recover the neural function, reduce the occurrence of axial symptomand enhance the quality of life.Methods: According to the inclusion criteria and exclusion criteria todetermine the object of study from the patients have been diagnosed asmulti-level cervical spinal cord compression in the Spinal Surgery Department,Affiliated Hospital of Luzhou Medical College during August2008to Match2012. The patients were divided into two groups on the basis of surgery method: C3-7expansive open-door laminoplasty with cervical pedicle screwfixation was treatment group(Group A); classical C3-7expansive open-doorlaminoplasty was control group(Group B). The cervical canal sagittal diameterratio, cervical curvature, stability of cervical, VAS of axial symptom, NDI andJOA scores which were obtained before operation, half a month post-operation,three months post-operation, half a year post-operation and last follow-up oftwo groups were comparatively analyzed.Results:94patients met the inclusion criteria. There were41patients inGroup A, including32male and9female. The mean age was54.6(range33-71)years old, the mean course time was7.1(range1-90) months, the meanfollow-up time was29.9(range24-48) months, the pre-operation mean cervicalcanal sagittal diameter ratio was0.71(range0.51-0.79), the pre-operation meanJOA scores was9.8(range1-16). There were53patients in Group B, including40male and13female. The mean age was53.8(range39-74) years old, themean course time was6.3(range1-72) months, the mean follow-up time was28.4(range24-72) months, the pre-operation mean cervical canal sagittaldiameter ratio was0.70(range0.52-0.81), the pre-operation mean JOA scoreswas8.6(range1-16). The sex ratio, age, course time, follow-up time,pre-operation cervical canal sagittal diameter ratio, bleed during operation,disease composition and pre-operation JOA scores were no significantdifference between two groups（P>0.05）. It was comparable of the baselines.The last follow-up cervical curvature of Group A were better than pre-operation,there was a significant difference（P<0.05）. The last follow-up cervical curvature of Group B were worse than pre-operation, there was a significantdifference （P<0.05）.The half a month post-operation, three monthspost-operation and half a year post-operaion JOA scores of Group A were betterthan Group B, there were significant difference（P<0.05）. In a comparison ofJOA scores at half a year post-operation or last follow-up, there was nosignificant difference between the two groups（P>0.05）. The VAS of axialsymptom of Group A were better than Group B during the whole follow-upperiods, there were significant difference（P<0.05）. The NDI of Group A werebetter than Group B during the whole follow-up periods, there were significantdifference（P<0.05）.Conclusions: The C3-7expansive open-door laminoplasty with cervicalpedicle screw fixation was used in the treatment of multi-level cervical spinalcord compression with cervical curvature abnormality or cervical instabilitycould correct abnormal cervical curvature effectively, maintain the normalcervical curvature and reduce the occurrence of axial symptom. Secondly, thissurgery could stabilize cervical vertebra, provide earlier cervical stability inearly period post-operation and enhance the quality of life. Lastly, this surgeryshowed good clinical effects. What is more, the neural function recovery wasfaster and better than classical expansive open-door laminoplasty.