Clinical Research Of Elaborative Decompression Under Microscope Through Anterior Cervical Approach In The Treatment Of Cervical Spondylotic Myelopathy

Objective To compare the effect of elaborative decompression under microscope through anterior cervical approach and the traditional open cervical anterior decompression in the treatment of cervical spondylotic myelopatfiy.Methods A retrospective analysis of the clinical data of 67 cases of cervical spondylotic myelopathy in our hospital from January 2016 to January 2017 were conducted.They were divided into microscopical group(with elaborative decompression under microscope through anterior cervical approach,n=3 5)and open group(with traditional open cervical anterior decompression,n=32).The operative time,intraoperative blood loss,postoperative drainage volume,drainage tube retention time,hospital stay and postoperative complications between the two groups were compared.Before and after 1 months,3 months,six months,and 1 years time points,the Janpanese Orthopaedic Association(JOA)score,improvement rate and cervical disability index score were used to evaluate postoperative neurological function improvement.At the same time,VAS visual analogue pain score was used to evaluate neck and upper limb pain,and SF-36 life quality score was used to evaluate the quality of life of the patients also.Results The operative time,intraoperative blood loss,intraoperative blood transfusion volume,postoperative drainage volume,drainage tube retention time,hospital stay in microscopical group were(80.3± 13.26)min,(30.15±18.53)ml,(31.24± 16.53)ml,(1.26±0.53)d,(7.63±2.15)d,and the operative time,intraoperative blood loss,intraoperative blood transfusion volume,postoperative drainage volume,drainage tube retention time,hospital stay in open group were(79.5± 11.37)min,(51.53± 19.17)ml,(62.37± 18.24)ml,(2.04±0.68)d,(8.26±2.47)d.The intraoperative blood loss,intraoperative blood transfusion volume,postoperative drainage volume,drainage tube retention time,hospital stay in microscopical group were lower than those in open group,and the difference were statistically significant(P<0.05).The Janpanese Orthopaedic Association(JOA)score and its improvement rate at 1 months,3 months,six months after operation in microscopical group were higher than those in open group,and the difference were statistically significant(P<0.05).There were no significant differences in JOA score and its improvement rate before operation and 1 years after operation points between the two groups(P>0.05).The cervical disability index score at 1 months,3 months,six months,after operation in microscopical group were higher than those in open group,and the differences were statistically significant(P<0.05).There were no significant differences in cervical disability index score before operation and 1 years after operation points between the two groups(P>0.05).The VAS of neck and upper limb pain at 1 months,3 months after operation in microscopical group were lower than those in open group,and the difference were statistically significant(P<0.05).There were no significant differences in VAS of neck and upper limb pain before operation,six months,1 years after operationpoints between the two groups(P>0.05).The SF-36_life quality score-physical score at 1 months after operation in microscopical group were higher than that in open group,and the difference was statistically significant(P<0.05).There were no significant differences in SF-36 life quality score-physical score before operation,3 months,six months,1 years after operation points between the two groups(P>0.05).The SF-36 life quality score-mental score at 1 months,3 months,six months after operation in microscopical group were higher than those in open group,and the difference were statistically significant(P<0.05).There were no significant differences in SF-36 life quality score-mental score before operation,1 years after operation points between the two groups(P>0.05).Conclusion Compared with traditional open cervical anterior decompression,elaborative decompression under microscope through anterior cervical approach has advantages such as precise decompression,less trauma,less bleeding,less pain and quicker postoperative recovery.It could significantly improve postoperative neurological function and quality of life,which is worth promoting and applying by domestic spinal surgeons in cervical anterior surgery.