| Objective:To compare the clinical and radiologic outcomes between anterior decompression with fusion(ADF)and posterior open-door laminoplasty(LAMP)in the treatment of of type ? multilevel cervical spondylotic myelopathy.Methods:A retrospective study of the medical records of 65 patients with type ? MCSM who underwent surgery in our department from January 2014 to June 2018.They were divided into ADF group and LAMP group according to different surgical methods.There were 21 males and 9 females in the ADF group,aged from 37 to 79 years,with an average age of(62.5±10.7)years;There were 22 males and 13 females in the LAMP group,aged from 34 to 81 years,with an average age of(61.1±10.1)years.The main observation indicators were operation time,intraoperative blood loss,preoperative,1,3,6,12 and 24 months after surgery,and the Japanese Orthopaedic Association Scores(JOA)and improvement rate at the last follow-up.Visual analogue scale(VAS),cervical spine curvature,range of motion(ROM),and residual anterior spinal cord compression after LAMP.The incidence of axial symptom,C5 nerve root palsy and other complications were record.Results:The mean follow-up was(19.4±10.4)months in the ADF group and(18.5±10.9)months in the LAMP group.Both procedures can significantly improve the JOA score of patients.The average JOA score at the last follow-up in the ADF group was(14.5±1.0)scores,and the improvement rate was 64.0%±8.1%.The average JOA score at the last follow-up in the LAMP group was(13.4±1.4)scores,improvement rate was 49.1%±14.9%.The difference in JOA score(t=3.69,P?0.001)and improvement rate(t=3.856,P?0.001)between the two groups at the last follow-up was statistically significant.The VAS scores of the two groups were significantly reduced at 1 month after operation.The ADF group was(2.4±0.9)scores,and the LAMP group was(3.5±1.0)scores.The difference was statistically significant(t=4.628,P?0.001).At 3 month after operation,the average VAS score of the ADF group was(1.4±0.7)scores,and the LAMP group was(1.7±0.6)scores,the difference was statistically significant(t=1.861,P=0.034);the VAS score between the two groups was at the last follow-up,the difference was not statistically significant(t=0.776,P=0.22).The average cervical curvature before operation in the ADF group was 14.8°±7.2°,and at the last follow-up was 17.9°±4.5°;the average cervical curvature before operation in the LAMP group was15.5°±7.9°,and at the last follow-up was 11.9°±3.7°,the difference in cervical curvature between the two groups at the last follow-up was statistically significant(t=5.899,P?0.001).Both procedures resulted in a decrease in the ROM of the cervical spine after surgery.At the last follow-up in the ADF group was 12.3°±4.2°,and in the LAMP group was 17.8°±5.1°,the difference between the two groups was statistically significant(t=4.696,P=0.001).In the ADF group,the loss angle of cervical ROM was more.The incidence of postoperative complications was 16.7%in the ADF group and 25.7%in the LAMP group.The difference was not statistically significant(X~2=0.782,P=0.376).The LAMP group was divided into two subgroups based on the presence or absence of residual spinal cord compression in the postoperative MRI.Twelve patients had residual spinal cord compression after surgery.At the last follow-up,the averageJOA score of the subgroup with residual anterior spinal cord compression was(12.1±1.3)scores,the improvement rate was 32.1%±9.2%,and the average VAS score was(1.6±0.5)scores.The average JOA score of the subgroup without anterior spinal cordcompression was(14.0±1.5)scores,the improvement rate was 58.0%±16.4%,and the average VAS score was(1.1±0.5)scores.There were statistically significant differences in JOA score(t=3.714,P<0.001),improvement rate(t=5.049,P<0.001)and VAS score(t=2.808,P=0.004)at the last follow-up between the two subgroups.At the last follow-up,the cervical curvature,curvature loss angle,cervical ROM and ROM loss angle,thesubgroups with residual spinal anterior compression were 8.1°±7.1°,6.4°±2.5°,12.1°±4.5°,12.3°±6.5°;the subgroup without anterior spinal cord compression is 13.9°±6.8°,2.1°±1.4°,17.9°±5.8°,7.8°±4.2°.There were statistically significant differences in cervical curvature(t=2.356,P=0.034),curvature loss Angle(t=6.558,P<0.001),cervical ROM(t=3.015,P=0.004),and ROM loss Angle(t=2.486,P=0.007)between the two subgroups at the last follow-up.Conclusion:(1)The SC line type ? MCSM patients have better recovery after anterior approach surgery.Therefore,the SC line can help patients with type ? MCSM to choose the surgical method;(2)The pressure in front of the spinal cord contacts or exceeds the SC line before surgery,loss angle of cervical curvature and cervical range of motion after surgery are risk factors for residual anterior spinal cord compression after LAMP;(3)residual anterior spinal cord compression after LAMP hinders nerve function recovery. |
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