A Comparative Study Of Traditional Unilateral Open-Door Cervical Expansive Laminoplasty And Laminoplasty With Expansion Of Nerve Root Canal For Treatment Of Cervical Spondylotic Myelopathy

BackgroundCervical spondylosis is one of the common clinical diseases of the spine.According to the different parts of the disease,it can be divided into four types: cervical spondylotic radiculopathy(CSR),cervical spondylotic myelopathy(CSM),cervical spondylotic vertebral arteriopathy(CSA)and sympathetic cervical spondylosis(SCS).Among them,cervical spondylotic myelopathy is a common type,and the incidence rate accounts for 10% to 15% of cervical spondylosis,only second to cervical spondylotic radiculopathy,and is the most severe type of cervical spondylosis.Compression of the spinal cord caused by the degenerative structure of the cervical vertebrae,involving multiple segments of the cervical vertebrae,resulting in extensive compression of the spinal cord.,seriously affecting patients' quality of life.The effect of non-surgical treatment is often poor,and the development of the symptoms of the disease is gradual.Once diagnosed,early surgery is often needed.The main surgical methods include anterior surgery,posterior surgery,and combined anterior and posterior approaches.Anterior surgery is mainly suitable for single-segment or double-segment lesions.Its advantages include small trauma,less bleeding,complete decompression and effective recovery of cervical curvature.However,the cause of cervical spondylotic myelopathy is cervical vertebrae.Due to structural degeneration,often involving multiple segments,the anterior approach is limited in the application of the disease.Studies have shown that the clinical superiority rate of the combined approach is superior to the simple anterior and simple posterior approaches,However,the combination of anterior and posterior procedures is a combination of two surgical procedures,the first posterior surgery,and the posterior anterior surgery,which greatly lengthens the operation time and surgical trauma,and has high requirements on the technique and physical strength of the operator.For patients,most patients cannot tolerate prolonged surgery and large surgical trauma,while cervical spondylotic myelopathy is caused by cervical degeneration.Its epidemiological characteristics are frequent in the elderly,while most elderly people cannot.It is resistant to anterior and posterior approaches,so the application of this procedure is also limited.For elderly patients with multiple segments,the posterior approach is often a priority,In numerous posterior approaches,the posterior cervical single-door laminoplasty is suitable for most patients,especially elderly patients.The procedure is less time-consuming,relatively less invasive,simple in procedure,high in safety,and widely used in clinical practice.Statistical studies over the years have shown that there are many shortcomings in traditional posterior cervical single-door laminoplasty,such as insufficient spinal cord decompression after surgery,the follow-up of patients is an outpatient review.unable to relieve the nerve root compression,and even cause the spinal cord to be oppressed again.Various improved procedures based on this procedure have relieved the pain for many patients with cervical spondylotic myelopathy.There are few comparisons between traditional posterior cervical single-door laminoplasty and posterior cervical single-door laminoplasty combined nerve root canal enlargement.This study compares the the clinical efficacy and differences between the two,and analyzes and discusses the results.I hope that in some cases,it can provide a reference for clinician's surgical optionsPurposeComparing the difference between posterior cervical single-door laminoplasty combined nerve root canal enlargement and traditional posterior cervical single-door laminoplasty in the treatment of cervical spondylotic myelopathy,to explore the surgical options for the treatment of cervical spondylotic myelopathy.Methods:Eighty patients with cervical spondylotic myelopathy were collected from the first affiliated hospital of henan university from October 2016 to October 2018.Patients in the traditional posterior cervical single-door laminoplasty group(control group)and the posterior cervical single-door laminoplasty combined nerve root canal enlargement group(treatment group)were collected for preoperative preparation,surgery and postoperative evaluation.Inclusion criteria: Patients with cervical spondylotic myelopathy with multiple stages(?3 segments)and nerve root compression,the lesion segment was C3-7.The patients were followed up for 12 months at least.There were 41 cases of the traditional posterior cervical single-door laminoplasty group,22 males and 19 females;aged 52-74 years old,with an average of(61.8 ± 7.7)years old.There were 39 cases of the posterior cervical single-door laminoplasty combined nerve root canal enlargement group,including 16 males and 23 females;aged 54-73 years,mean(62.2 ± 7.5)years old.All patients were informed and free to choose the procedure,the same set of instruments were used during the operation,the same internal fixation materials were used,and the same rehabilitation plan was used after surgery.At least 12 months of follow-up was performed to analyze the general condition of the patients before and after surgery.The patient's cervical vertebrae imaging and neurological function scores were compared before and after surgery,and the general situation of indicators such as cervical curvature loss,spinal cord posterior movement distance,total cervical motion loss angle,and neurological improvement rate were obtained.The postoperative complications such as infection,cerebrospinal fluid leakage,axial symptoms,re-closure,spinal cord injury,and nerve root palsy were recorded.The efficacy of the two procedures was evaluated comprehensively.ResultsThe age and gender of the patients had no effect on the surgical selection.There were no differences in the effects of the two surgical procedures on the length of the incision(cm),the operation time(min),the intraoperative fluoroscopy time(min),and the length of hospital stay(days).In terms of blood loss(mL),the traditional posterior cervical single-door laminoplasty group is superior to the posterior cervical single-door laminoplasty combined nerve root canal enlargement group.After the follow-up,it was found that the posterior cervical single-door laminoplasty combined nerve root canal enlargement group was significantly better than the traditional single-door group(P < 0.05)in the spinal retraction distance and the improvement rate of the JOA score(%).There was no significant difference between the two groups in terms of CCI(%)loss and ROM loss angle(°)(P > 0.05).In terms of adverse reactions and complications,the posterior cervical single-door laminoplasty combined nerve root canal enlargement group was lower in the incidence of axial symptoms than in the traditional posterior cervical single-door laminoplasty group(P < 0.05).There was no significant difference in the incidence of postoperative infection,cerebrospinal fluid leakage,re-closure,spinal cord injury and nerve root paralysis between the two groups(P > 0.05).ConclusionCompared with the traditional posterior cervical single-door laminoplasty,the posterior approach of the posterior cervical single-door laminoplasty combined nerve root canal enlargement can better relieve the spinal cord and nerve root compression,increase the spinal cord's backward distance,improve nerve function,and reduce The incidence of axial symptoms,in the surgical treatment of multi-segment cervical spondylotic myelopathy,single-door laminoplasty combined nerve root canal enlargement can be a priority.