Early Clinical Efficacy Of Centerpiece^TM Titanium Plate In Eolp For The Treatment Of Cervical Spinal Stenotic Myelopathy

PART ONE:Clinical application of Centerpiece^TM titanium plate in EOLP for posterior cervical surgeryObjective: To explore the early clinical efficacy of Centerpiece mini titanium plate for the treatment of cervical spinal stenotic myelopathy in cervical expansive open-door laminoplasty?Methods: Twenty-nine patients with multilevel cervical spinal stenotic myelopathy were enrolled in our hospital from January 2013 to June 2016.The patients were treated with 24 cases of male and 5 cases of female,Age was?58.0 ±11.4?years old,the duration of symptoms was?31.4±8.1?months.MRI showed 3segments of stenosis in 5 cases,4 segments of stenosis in 5 cases,5 segments of stenosis in 19 cases.Records the hospitalization time,operation time,the amount of intraoperative blood loss;postoperative portal shaft bone fusion time,complications.The neurological function scores and imaging parameters were compared with those before operation at 3 days,3 months,6 months,1 year and last follow-up.All patients underwent cervical vertebral X-ray,over-flexion X-ray,CT scan and MRI were performed by using the JOA score,improvement rate,FTT test and axial symptom VAS score.The cervical curvature index CCI and its degree of loss,Cobb angle of cervical spine and its degree of loss,cervical vertebral activity ROM and its degree of loss,C5 segmental level of spinal canal sagittal diameter,Pavlov ratio,vertebral enlargement rate,Cross-sectional area,open the door angle,open the door width,spinal cord drift distance,spinal canal occupying rate,spinal cord sagittal diameter changes.Results: The operation time was?152.0 ± 28.4?min,the intraoperative blood loss was?239.7±74.4?ml,the bone fusion time was?4.5 ± 1.5?months,and the follow-up time was?14.7±2.4?months.Hospitalization time was?8.6±2.5?days and the time of down to the ground was?2.9 ± 0.6?days.There were 12 cases of axial symptoms,3cases of C5 nerve root paralysis and 1 case Neurological deterioration;no general complications such as hematoma,infection,cerebrospinal fluid leakage.Clinical evaluation: the last follow-up JOA?13.52 ± 1.76?points was significantly better than preoperative?8.24±1.03?points?P <0.05?;improvement rate was?61.45 ±16.47?%.The last follow-up FTT test?28.38±2.77?times was significantly better than preoperative?22.34 ± 2.06?times?P <0.05?.The VAS score of the axial symptom was?0.96±0.22?points which was significantly lower than that of the preoperative group?P < 0.05?.Imaging evaluation: the last follow-up cervical curvature index loss was?0.80 ± 0,65?°,cervical Cobb angle loss was?0.98 ± 0.59?°,cervical vertebral disc ROM loss was?4.03 ± 0.47?°.The spinal canal sagittal diameter of C5 segmental level was increased by?4.83 ± 0.65?mm,the vertebral enlargement rate was?39.37 ± 7.48?%,the cross-sectional area of the spinal canal was increased by?126.31 ± 2.30?mm2,the open-door angle was?45.07 ± 3.35?° and the open-door width was?10.84 ± 1.27?mm.Spinal cord drift breadth DB ' was?2.32 ± 0.24?mm.The occupancy rate of cervical spinal canal was?24.79 ± 3.57?% which was significantly lower than that before operation?47.68 ± 6.55?%?P <0.05?,the increase of spinal cord sagittal diameter was?3.23 ± 0.39?mm.Conclusion: The Centerpiece^TM titanium plate is used to treat cervical spinal stenotic myelopathy in the expansive open-door laminoplasty.The spinal cord function is effective,the vertebral volume is effectively maintained,the cervical vertebra activity is small,the complication rate is low,the operation is safe and simple,early clinical efficacy is worthy of recognition.PART TWO:Efficacy and safety of anterior and posterior approach for the surgical treatment in cervical spinal stenotic myelopathyObjective: The surgical approach of cervical spinal stenotic myelopathy has been a hotspot in spinal surgery.However,there is no conclusion in the surgical approach for the treatment of cervical spinal stenotic myelopathy.To evaluate the efficacy and safety of the anterior and posterior approach in the treatment of cervical spinal stenotic myelopathy by Meta-analysis,and to provide a theoretical basis for the choice of surgical approach for cervical spinal stenotic myelopathy.Methods: A prospective,controlled clinical trial was conducted in the PubMed,Embase,The Cochrane Library,Web of Science,Wang Fang Data and CNKI databases to compare the anterior cervical approach versus posterior approach for cervical spinal stenotic myelopathy.The clinical trials were conducted between January 1990 and December 2016.The outcome measures included postoperative JOA score?Japanese Orthopaedic Association Scores?,IR?Improvement Rate?,reoperation rate,operative time,bleeding volume,and complications.Rev Man 5.3software was used for meta-analysis.Results: A total of 20 articles and 1263 patients were included.The results of the preoperative approach group and the posterior approach group showed that the postoperative JOA score was higher in the anterior approach group [MD = 0.72,95%CI?0.44,0.99?,P <0.00001],the improvement rate of the anterior approach group was higher [MD = 12.93,95% CI?7.04,18.83?,P <0.0001];And then the surgery group re-operation rate was lower[OR=3.21,95%CI?1.70,6.08?,P=0.0003],operation time was shorter [MD=53.43,95%CI?12.77,94.09?,P=0.01],Surgery less bleeding [MD = 122.88,95% CI?39.56,206.20?,P = 0.004].But there was no significant difference in the incidence of complications between the two groups [OR =1.49,95% CI?0.88,2.51?,P = 0.14].Conclusion: The anterior surgery can achieve better JOA score and improvement rate,but the postoperative surgery re-operation rate,intraoperative blood loss,surgery time than the former approach is moderate,but the incidence of complications between the two groups was no statistically significant difference.The above conclusions have yet to be included in the more high quality randomized controlled trials to support validation.