Treatment Of Cervical Spondylotic Myelopathy Complicated With Diffuse Idiopathic Skeletal Hyperostosis By Posterior Cervical Open-door Surgery

Objective:To investigate the effect of posterior cervical open-door surgery on the treatment of cervical spondylotic myelopathy complicated with diffuse idiopathic skeletal hyperostosis(DISH).Methods:This was a retrospective analysis for 26 patients diagnosed with cervical spondylotic myelopathy complicated with DISH from July 2010 to March 2018 in our hospital,including 17 males and 9 females,aged 50-76,average(61.8±7.6).The imaging data of26 patients were compared and analysed,and the imaging features were summarized.Posterior cervical open-door surgery was performed for 26 patients.Operation time,intraoperative blood loss and hospitalization time were recorded.The Japanese Orthopaedic Association(JOA)score was used to evaluate spinal cord function recovery,and the rate of neurological improvement was calculated.The patient neurological function before and after surgery was evaluated by the American Spinal Injury Association(ASIA)impairment scale.The imaging date was used to assess the stability of the cervical spine,the position of internal fixation and the compression of spinal cord before and after operation.Results:It was found that the most commonly affected area for patients with multilevel cervical spinal stenosis,and DISH of the cervical spine was in the C4-7 segment.Among all 26 cases,50.0%(13 cases)were accompanied by ossification of the posteriorlongitudinal ligament(OPLL).According to CT and MRI findings,the spinal cord compression or injury was most severe at the junction of the bone bridge and non-bone bridge,and C2-5 segment sclerotization was the most common junction for spinal cord compression or injury.All patients successfully underwent surgery.The operation time was(145.6±34.7)min,the intraoperative blood loss was(173.1±89.0)ml,and the hospital stay was(7.2±0.9)d.All patients had grade A healing.The average JOA score of the 26 patients was(12.5+1.4)at 3 months after surgery,which was significantly increased,compared with preoperative findings(9.0+1.6)(t=-8.31,P<0.05).At the last follow-up,the average JOA score was(14.5 ±1.3),which was also significantly increased,compared with the JOA score at 3 months postoperative(t=-13.88,P<0.05).The postoperative neurological improvement rate was 44.4%~88.9%,and the excellent and good rate was 92.3%.Ten cases scored excellent,and 14 cases scored good.The ASIA score was improved from preoperative C in 5 cases and D in 21 cases to C in 1 case,D in14 cases,and E in 11 cases.The last follow-up X-ray showed that the internal fixation was feasible without loosening or fracture.Continuous signal recovery of cerebrospinal fluid in anterior and posterior space of spinal cord were revealed by cervical MRI.Conclusion:Cervical spondylotic myelopathy complicated with DISH occurs or exacerbates on the basis of cervical spinal stenosis.Posterior cervical open-door surgery can be selected to achieve satisfactory results.