| Background and ObjectiveCervical spondylotic myelopathy is on the pathological basis of cervical disc degeneration that caused different degrees of spinal cord and dysfunction.The clinical manifestations are often damage to the plane below the sensory loss,the motor nerve damage,decreased muscle strength,increased muscle tension and other symptoms.In the past,Therapy of cervical spondylotic myelopathy are non-surgical therapy and operation therapy,At present,the therapy principle of cervical spondylotic myelopathy has been transformed into early diagnosis and operation.Clinical application of the surgical approach has been divided into anterior approach and posterior approach.The posterior approach is mainly used for the treatment of multiple segmental cervical spondylotic myelopathy,including "Laminectomy" and "Laminoplasty" and so on.However,these two kinds of traditional surgical procedures may cause serious damage to the posterior ligamentous complex and the cervical back muscle.Retaining most of the normal anatomical structure of the cervical spine under the premise of effective expansion of the spinal canal,improving neurological function and reducing the postoperative cervical posterior structural damage caused by complications are still urgent issues.Therefore,,We put forword a new way of posterior cervical surgical treatment named cervical micro endoscopiclaminoplasty(CMEL)for CSM.CMEL is on the lamina bilateral “long groove”longitudinal incision decompression ? Posterior ligamentous Complex retroposition ? mini titanium plate fixation in the MED,CMEL has achieved good clinical results.But CMEL underwent "first restroposition then fixation" of PLC with fixed titanium mini-plating,and its floating safety is not high and the installation of fixed titanium mini-plating operation is also cumbersome and time-consuming.Therefore,We have improved CMEL in the application.The titanium mini-plating has been changed from fixing hole to sliding way type,Modified Cervical Micro Endoscopic Laminoplasty(mCMEL)underwent “first fixation then restroposition”of PLC with slided titanium mini-plating.mCMEL will to improve the operation safety,the ease of operation and observe the clinical effects of two kinds of operative methods as well.METHODSSixty-two patients of cervical spondylotic myelopathy diagnosed from March 2012 to September 2014 were selected from our ward,Sixty-two patients with CSM were treated with CMEL and mCMEL.All cases were divided into two groups.Thirty-one patients with traditional CMEL underwent“first restroposition then fixation”of Posterior ligament complex with fixed titanium mini-plating(GroupA);Other thirty-one patients with mCMEL underwent“first fixation then restroposition”of Posterior ligamentous Complex with slided titanium mini-plating(GroupB).Our goal is to make a comparison between the operation time and intraoperative estimate blood loss of 2 groups.Effect and axial symptom were evaluated according to JOA(Japanese Orthopedic Association)scores and Zengyan Criterion respectively.Patients received follow-up right,3,6,12 months after operation and then once a year.RESULTSAll patients were followed up,The followe-up time ranged from 6 to 36 months with an average of 14 months.The average operation time and intraoperative estimate blood loss in B group were less than those in A group,There was significantdifference between two groups(P<0.05),Twelve months after operation,the rate of JOA scoring improvement was 65% in A group and 63% in B group.The difference between two groups(P>0.05)is not big.The occurrence rate of axial symptom was16.1% in A group and 19.3% in B group.There was no clear difference between two groups(P>0.05).CONCLUSIONThe CMEL and mCMEL have a similar effect on clinical practice.however.Compared with primary method,the mCMEL has advantages of more security,shorter average operation time,less intraoperative estimate blood and earier operation.It has achieved more satisfactory treatment results. |
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