Selective Laminoplasty For Cervical Spondylotic Myelopathy

Background:Multilevel cervical spondylotic myelopathy(MCSM)is a common clinical disease.Due to its serious clinical symptoms,the relative insidious onset,the rapid progresses,the impact on patient's health and life quality,so once diagnosed the surgery should be performed timely.The major surgical approach is posterior laminoplasty.For patients with csm who maintain the lordosis curve,the surgeon can remove pressure directly or indirectly,restore the effective diameter of spinal canal,avoid further deterioration by taking laminoplasty.The traditional C3-C7 laminoplasty has been widely used since the laminoplasty came out,but it could result loss of range of motion,sagittal malalignment,C5 nerve palsy and axial symptoms because of the damage to the extensor muscle and ligament,especially to semispinalis cervicis and the attachment to C7 spinous process.To minimize the damage,some scholars proposed selective laminoplasty.We have conducted selective laminoplasty Since September 2010,the Objective of the paper is to observe and compare the medium-term efficacy of selective laminoplasty and traditional laminoplasty for the treatment of cervical spondylotic myelopathy.Objective:To observe and compare the medium-term efficacy of selective laminoplasty and traditional laminoplasty for the treatment of cervical spondylotic myelopathy.Method:The clinical data of 130 patients(92 males and 38 females)with CSM from September 2010 to December 2015 were retrospectively analyzed,the average age was 57.2 years(range:35-81 years),37 cases were because of cervical ossification of the posterior longitudinal ligament.A total of 67 patients(49 males and 18 females)underwent selective laminoplasty.Age range:40-81 years(57.9±9.3 years);The course of the disease:3-240 months(31.2±45.1 months).Lesions:C2-C7 lesions in 9 cases,C2-C6 lesions in 10 cases,C3-C7 lesions in 21 cases,C3-C6 lesions in 17 cases,C3-C5 lesions in 5 cases,C4-C7 lesions in 5 cases.Hospitalization time:5-24 days(10.4± 4.3 days);The follow-up period was 24-84 months(40.1±18.9 months).20 cases were because of cervical ossification of the posterior longitudinal ligament.Hypertension in 18 cases(26.9%),Type ? Diabetes mellitus in 6 cases(9.0%),Coronary heart disease(CHD)in 3 patients(4.5%).A total of 63 patients(43 males and 20 females)underwent traditional laminoplasty.Age range:35-78 years(56.5+9.8 years);The course of the disease:3-168 months(29.1±32.9 months).Lesions:C2-C7 lesions in 6 cases,C2-C6 lesions in 11 cases,C3-C7 lesions in 19 cases,C3-C6 lesions in 16 cases,C3-C5 lesions in 6 cases,C4-C7 lesions,in 5 cases.Hospitalization time:6-21 days(11.3±2.9 days);The follow-up period was 24-66 months(38.5±17.6 months).17 cases were because of cervical ossification of the posterior longitudinal ligament.Hypertension in 19 cases(30.2%),Type ? Diabetes mellitus in 4 cases(6.3%),Coronary heart disease(CHD)in 3 patients(4.8%).Selective laminoplasty:(1)if cephalad lamina is C2,partial laminectomy of C2 and laminoplasty(C3-caudual lesion segment which is above C6)are performed;(2)if cephalad lamina is C3,laminoplasty(C3-caudual lesion segment which is above C6)is performed;(3)if caudual lamina is C7,partial laminectomy of C7 and laminoplasty(cephalad lesion segment-C6)are performed.Traditional laminoplasty:C3-C7 laminoplasty.The clinical date including C2-C7Cobb angle,C2-C5Cobb angle,C5-C7Cobb angle,C2-C7sagittal vertical axis(SVA),C7slope,T1 slope,K-line,K-line tilt,range of motion,the posterior drifting distance and clinical results were assessed before the operation and at the final follow-up.Results:All cases were followed up for at least two years.The JOA scores,number of hands action in ten seconds and hand-grip strength improved significantly,there were no difference in two group(p>0.05).Spinal cord drifted posterior significantly,there were no difference in two group(p>0.05).The postoperative incidence rate of axial pain was significantly lower in the selective laminoplasty(10.4%)compared to the traditional laminoplasty(31.7%).The selective laminoplasty could maintain the C2-C7Cobb angle(p=0.034),C2-C7SVA(p=0.019)and cervical range of motion(p<0.001).Conclusion:Medium-term efficacy of Selective laminoplasty and traditional laminoplasty is satisfied and reliable,Selective laminoplasty is less invasive and can decrease postoperative axial pain and maintain the cervical sagittal alignment.