Comparative Study In Treatment Of Cervical Spinal Canal Stenosis By Posterior Cervical Single-door And Double-door Laminoplasty

Objective: Comparative analysis treatment effects of cervical spinal canal stenosis by single open-door laminoplasty and double-door laminoplasty, to provide reference for clinical choice of the two operation modes.Methods: Clinical data of patients with cervical spinal stenosis cervical spine(64 cases) after single-door or double-door laminoplasty for the treatment from 1999 April to 2013 December in the First Affiliated Hospital of Dalian Medical University were analyzed, including treatment by single-door laminoplasty(single-door group)31cases and double-door laminoplasty(double- door group) 33 cases. To analysis age, sex, course of disease, preoperative JOA score, cervical sagittal diameter of spinal canal / sagittal diameter of vertebral body and the maximum sagittal diameter of spinal compression,postoperative complications, the improvement rate of JOA score before and after surgery, preoperative and postoperative sagittal diameters of vertebral body and spinal canal with pathological segment, the ratio of Pavlov, and operation time, bleeding in operation, hospitalization time and cost of hospitalization in two group of patients through observation and follow-up of patients.Results: In our group of clinical data, the single-door group patients mean age(57.45±11.87) years old, average course(23.67±13.26) months, preoperative JOA score(9.13±3.22), cervical sagittal diameter of spinal canal / sagittal diameter ofvertebral body(0.66±0.04), spinal canal sagittal diameter(maximum compression at 7.73±1.04) mm. Double-door group patients mean age(59.39±11.83) years old, average course(27.33±15.71) months, preoperative JOA score(10.54±3.96), cervical sagittal diameter of spinal canal / sagittal diameter of vertebral body(0.67±0.04), the largest sagittal diameter of spinal canal compressed(7.96±1.07) mm. The age, sex, course of disease, preoperative JOA score, cervical sagittal diameter of spinal canal / sagittal diameter of vertebral body and spinal compression at the maximum sagittal diameter and other indicators in the two group of patients were compared with no statistical difference(P>0.05). Single-door grouppatients, post-operative JOA score was(14.61±3.00), postoperative JOA score standard score improvement rate was(58.26±50.95)%, double-door grouppatients, post-operative JOA score was(14.66±2.69), postoperative JOA score standard score improvement rate was(54.50±50.67)%. No statistically significant difference between the two groups(P>0.05). Single-door group and double-door group patients post-operative Pavlov ratios were 0.81±0.21 and 0.85±0.05, no statistically significant difference between the two groups(P=0.30). In the total 64 patients, 2 patients had postoperative cerebrospinal fluid leakage and recovery after active treatment, postoperative axial symptoms occurred in 3 cases, the overall complication rate was 7.81%(5/64). The 31 cases of single-door laminoplasty patients, hematoma, infection did not occur after surgery, 1 patient had CSF lateral leaking and complications of axial symptoms in 2 cases; 33 patients with double-door laminoplasty, also hematoma, infection did not occur after surgery, 1 case had axial symptoms and 1 case of CSF lateral leakage. The occurrence of two groups of patients to compare postoperative complications was not statistically significant(P = 0.60). In the single-door and double-door laminoplastypatients, operative time were:(172.58 ± 80.72) min,(167.88 ± 33.33) min, the amount of bleeding during operation were:(297.74±190.42) ml,(244.85±103.08) ml, the time of hospitalization were:(20.87±7.01) days and(21.69±3.73) days, cost of hospitalization were(68539.75±18445.81)yuan、(65694.96±19608.84)yuan, there were no significant differences in two groups of patients(P>0.05).Conclusion: It is satisfactory in clinic that cervical posterior single-door laminoplasty and double-door laminoplasty are two kinds of surgical treatment of cervical spinal canal stenosis, and the treatment methods are effective for cervical spinal canal stenosis. But the two kinds of operation modes have their own advantages and disadvantages, The choice of operation should be considered according to the operation proficiency of surgeon, equipment conditions and the own condition of patient.