Retrospective Study Of Spinous Process Shortening In The Prevention Of Axial Symptoms After Posterior Cervical Improved Open-door Laminoplasty

Objective To verify the efficacy and safety of spinous process shortening in the prevention of axial symptoms after posterior cervical 3-7 open-door laminoplasty,and to provide a basis for the improvement open-door laminoplasty,and broaden the thinking of clinical treatment.Methods In the theoretical part,through the study of ancient and modern literatures,the understanding of the disease name,etiology,pathogenesis and comprehensive treatment of cervical axial symptoms in traditional Chinese medicine was discussed,and the occurrence mechanism,diagnostic criteria and treatment progress of cervical axial symptoms in modern medicine were summarized and reviewed.The clinical study retrospectively collected and analyzed 43 patients who underwent posterior cervical 3-7 open-door laminoplasty from January 2014 to December 2015,including 20 patients in the spinous process retention group and 23 patients in the spinous process shortening group.In the intraoperative spinous process shortening group,the cervical 3-7 spinous processes were resected after the exposure of the lamina,and the spinous process retention group retained the structure of the spinous processes,the routine cervical 3-7 open-door laminoplasty was performed.Improved Japanese orthopaedic association cervical spine score(improved JOA)was used to evaluate the therapeutic effect and the differences between the groups.The incidence of axial symptoms in the two groups was evaluated according to visual analogue scale of pain and four-level classification of axial symptoms.Results In the clinical research,the improved JOA score of the spinous process retention group and the spinous process shortening group after surgery was better than that before surgery,and the difference was significant(p<0.01).There was no statistical difference between the improved JOA score of the spinous process retention group and the spinous process shortening group after surgery(p>0.05).There was no significant difference in the improvement rate of JOA score between the spinous process retention group and the spinous process shortening group before and after surgery(p>0.05).Within 3 years after surgery,the VAS score of patients in the spinous process shortening group was lower than that in the spinous process retention group,with statistical differences(P<0.05).According to the four levels of classification,there were 20 cases,3 cases of Good,9 cases of minor,8 cases of major,and 0 cases of severe in the spinous process retention group.The incidence of axial symptoms was 40.0%.There were 23 cases,Good 13,minor 8,major 2 and severe 0 in the spinous process shortening group.The incidence of axial symptoms was 8.7%.The incidence of axial symptoms in the spinous process shortening group was lower than that in the spinous process retention group,and the difference was statistically significant(p<0.05).Conclusion cervical spinous process shortening in posterior improved open-door laminoplasty can reduce the incidence of postoperative cervical axial symptoms,and can reduce postoperative cervical and back pain in patients with obvious effects,worthy of clinical application.