1.Expansive open-door laminoplasty combined with unilateral lateral mass screw in the treatment of ossification of posterior longitudinal ligament with cervical instability.
Yang ZHOU ; Chi LI ; Wang-Ying DAI ; Hong-Lin TENG ; Min-Yu ZHU ; Yu WANG ; Jing WANG
China Journal of Orthopaedics and Traumatology 2025;38(2):170-175
OBJECTIVE:
To investigate the effect of expansive open-door laminoplasty combined with single lateral mass screw fixation on the posterior longitudinal ligament ossification and cervical instability and its effect on sagittal balance.
METHODS:
A retrospective analysis of 65 patients with the posterior longitudinal ligament with cervical instability from May 2012 to July 2018 was conducted. The patients were divided into two groups according to the surgical method. Thirty-four patients were treated with open-door laminoplasty including 19 males and 15 females, aged 49 to 60 years old with an average age of (54.4±4.77) years old;symptoms lasted 8 to 39 months with an average of (21.0±8.2) months. Thirty-one patients were treated with single-door laminoplasty combined with single mass screw fixation including 17 males and 14 females, aged 50 to 59 years old with an average age of (55.4±3.2) years;symptoms lasted 7 to 48 months with an average of (23.7±13.1) months. General information of the two groups, including operation time, intraoperative blood loss, and postoperative complications was recorded. Sagittal vertical axis(SVA), C0-C2 and C2-C7 cobb angle were measured by X-ray before operation and at the last follow-up. Clinical efficacy was evaluated using the Japanese Orthopaedic Association(JOA) score.
RESULTS:
Surgery was successful in all patients. The operation time (109±15) min in the single-door laminoplasty combined with lateral mass screw fixation group was longer than that in the single-door group(128±16) min(P<0.05). There was no significant difference in intraoperative blood loss, postoperative axial symptoms and follow-up time between two groups(P>0.05). At the latest follow-up, both groups showed significant improvement in the motor and sensory components of the JOA score and the total JOA score compared to pre-surgery(P<0.05) and no significant change in bladder function score(P>0.05). There was no significant difference between two groups(P>0.05). At the latest follow-up, the C0-C2 Cobb angle increased in both groups compared to preoperative and more the single-door laminoplasty group(P<0.05). The angle of the C2-C7 Cobb angle decreased in both groups, and the reduction was greater in the single-door laminoplasty combined with lateral mass screw fixation group(P<0.05). There was a significant increase in C2-C7 SVA in the single-door laminoplasty group(P<0.05) and no significant change the single-door laminoplasty combined with lateral screw fixation group(P>0.05).
CONCLUSION
Posterior cervical laminoplasty with unilateral lateral mass screw fixation combined with single-door vertebral plate shaping surgery improves the neurological function and quality of life in patients with cervical spondylotic myelopathy complicated by ossification of the posterior longitudinal ligament and cervical instability. Compared with single-door vertebral plate shaping surgery, postoperative cervical lordosis and forward-tilt can be improved.
Humans
;
Middle Aged
;
Male
;
Female
;
Laminoplasty/methods*
;
Ossification of Posterior Longitudinal Ligament/physiopathology*
;
Bone Screws
;
Cervical Vertebrae/physiopathology*
;
Retrospective Studies
;
Joint Instability/surgery*
2.Imaging changes of the intervertebral disc after posterior cervical single door enlarged laminoplasty for cervical spinal stenosis with disc herniation.
Yan-Dong ZHANG ; Xu-Hong XUE ; Sheng ZHAO ; Gui-Xuan GE ; Xiao-Hua ZHANG ; Shi-Xiong WANG ; Ze GAO
China Journal of Orthopaedics and Traumatology 2025;38(6):572-580
OBJECTIVE:
To explore prevalence, incidence and possible factors of immediate herniated discs after posterior cervical expansive open-door laminoplasty (EODL).
METHODS:
Totally 29 patients with cervical spinal stenosis and intervertebral disc herniation who underwent EODL from October 2020 to December 2021 were collected, including 24 males and 5 females, aged from 43 to 81 years old with an average of (61.3±9.0) years old;the courses of disease ranged from 1 to 120 months with an average of (36.4±37.0) months. Three or more intervertebral discs on C3-C7 were observed. The clinical efficacy was evaluated according to Japanese Orthopaedic Association (JOA) score before operation, 3 days and 1, 3, 6 and 12 months after operation, respectively. The changes of herniated disc before and after operation were measured by multipoint area method and two-dimensional distance method, and incidence and percentage of herniated disc regression were further calculated. Cervical imaging parameters such as Cobb angle (C3-C7), intervertebral angle, T1 slope (T1S), spinal canal sagittal diameter, K-line angle, dural sac sagittal diameter were measured and compared before and after operation. Pearson correlation was used to analyze correlation between cervical sagittal imaging parameters and disc herniation changes before and after operation.
RESULTS:
All patients obtained grade A wound healing, and 14 of them were followed up for 3(1.00, 5.25) months. There were no immediate or long-term postoperative complications. Totally 101 herniated intervertebral discs were measured, of which 79 regression numbers were obtained by area measurement. The number of intervertebral disc regressions by distance measurement was 77. There was no statistically significant difference in Cobb angle, intervertebral angle, T1S and K-line angle of C3-C7 (P>0.05), however, there were statistically significant differences in sagittal diameter of spinal canal, sagittal diameter of dural sac, and JOA score before and after operation(P<0.05). The regression ratio of disc herniation ranged from 5% to 50%, and regression ratio of disc herniation was greater than 25% in 45.57%(36/79). Disc herniation in C4,5 was positively correlated with sagittal plane diameter in C5(r=0.423, P=0.028). There was a negative correlation between changes of C3,4 and C3,4 intervertebral angle (r=-0.450, P=0.041). The improvement rate of cervical JOA score immediately after operation was (59.54±15.07) %, and postoperative follow-up improved to (76.57±14.66) %.
CONCLUSION
Herniated disc regression immediately after EODL is a common occurrence, and EODL should be selected as far as possible under the premise of satisfying surgical indications. The regression of disc herniation is positively correlated with spinal canal sagittal diameter, and spinal canal should be enlarged as far as possible in the appropriate scope during EODL, so as to create more opportunities and conditions for disc regression and achieve better clinical results.
Humans
;
Female
;
Male
;
Intervertebral Disc Displacement/diagnostic imaging*
;
Spinal Stenosis/diagnostic imaging*
;
Laminoplasty/methods*
;
Middle Aged
;
Aged
;
Cervical Vertebrae/diagnostic imaging*
;
Adult
;
Aged, 80 and over
;
Intervertebral Disc/surgery*
3.Prediction of cervical curvature loss after expansive open-door laminoplasty based on sagittal parameters.
China Journal of Orthopaedics and Traumatology 2025;38(8):810-815
OBJECTIVE:
To evaluate the impact of preoperative cervical sagittal parameters on the loss of cervical lordosis (LCL) after expansive open-door laminoplasty (EOLP) and explore the optimal predictors.
METHODS:
A retrospective analysis was performed on the clinical data of 94 patients with cervical spondylotic myelopathy who underwent EOLP from January 2019 to January 2021, including 61 males and 33 females, aged 34 to 75 years old with an average age of(53.1±9.7) years old. Preoperative routine anteroposterior, lateral, and dynamic X-ray films of the cervical and thoracic spine were taken to comprehensively assess various cervical sagittal parameters: T1 slope (T1S), C2-C7 sagittal vertical axis (C2-C7 SVA), C2-C7 cervical lordosis (CL), T1 slope-cervical lordosis (T1S-CL), cervical lordosis/T1 slope (CL/T1S), C2-C7 cervical range of motion (ROM), thoracic kyphosis (TK), cephalad vertebral level undergoing laminoplasty (CVLL), and C2,3 disc angle. Statistical analysis was conducted to identify the independent risk factors of preoperative sagittal parameters for postoperative LCL.
RESULTS:
A total of 94 patients meeting the inclusion and exclusion criteria were enrolled, with a postoperative follow-up period of 12 to 24 months. Pearson correlation analysis showed that T1S, T1S-CL, CVLL, and C2,3 disc angle were significantly correlated with postoperative LCL, while C2-C7 SVA, CL, CL/T1S, C2-C7 ROM, and TK had no significant correlation with postoperative LCL. Regression analysis further indicated that T1S (β=0.426, P<0.001), T1S-CL (β=0.716, P<0.001), C2,3 disc angle (β=0.351, P<0.001), and CVLL (β=-3.348, P<0.001) were significantly correlated with postoperative LCL.
CONCLUSION
For patients with cervical spondylotic myelopathy treated with EOLP, T1S, T1S-CL, CVLL, and C2,3 disc angle are important factors for predicting cervical lordosis loss, among which CVLL may be the most critical predictive indicator.
Humans
;
Male
;
Female
;
Middle Aged
;
Laminoplasty/methods*
;
Aged
;
Cervical Vertebrae/physiopathology*
;
Retrospective Studies
;
Adult
;
Lordosis/surgery*
;
Spondylosis/surgery*
4.Advances in surgical strategies for ossification of posterior longitudinal ligament involving the C 2 segment.
Teng LIU ; Guoning GU ; Chenguang ZHAN ; Haishan LI ; Huizhi GUO ; Yongxian LI ; Guoye MO ; Kai YUAN ; Shuncong ZHANG ; Zhidong YANG ; Yongchao TANG
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(6):742-747
OBJECTIVE:
To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C 2 segment.
METHODS:
The literature about the surgery for cervical OPLL involving C 2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized.
RESULTS:
For cervical OPLL involving the C 2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification.
CONCLUSION
OPLL involving the C 2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C 2 segment.
Humans
;
Longitudinal Ligaments/surgery*
;
Ossification of Posterior Longitudinal Ligament/surgery*
;
Treatment Outcome
;
Osteogenesis
;
Decompression, Surgical/methods*
;
Cervical Vertebrae/surgery*
;
Laminoplasty/methods*
;
Kyphosis/surgery*
;
Retrospective Studies
5.A medium- and long-term comparative observation on volumetric changes of cervical disc herniation after symmetrically or asymmetrically decompression and conservative treatment for cervical spondylotic myelopathy.
A D ZHU ; C L ZHANG ; X YAN ; S FU ; D Z LI ; C DONG ; Y K WANG
Chinese Journal of Surgery 2023;61(8):666-674
Objective: To compare the volumetric changes of cervical disc herniation (CDH) after cervical microendoscopic laminoplasty(CMEL),expansive open-door laminoplasty (EOLP) and conservative treatment. Methods: A retrospective study was conducted involving 101 patients with cervical spondylotic myelopathy(CSM),at the Department of Orthopaedic Surgery,the First Affiliated Hospital of Zhengzhou University from April 2012 to April 2021. The patients included 52 males and 49 females with an age of (54.7±11.8) years(range:25 to 86 years). Among them, 35 patients accepted CMEL treatment,33 patients accepted EOLP treatment,while 33 patients accepted conservative treatment. Volume data of CDH were measured by three-dimensional analysis of the initial and follow-up MRI images. The absorption rate and reprotrusion rate of CDH were calculated. The happening of resorption or reprotrusion was defined when the ratio was greater than 5%. The clinical outcomes and quality of life were evaluated by the Japanese Orthopaedic Association (JOA) score and the neck disability index (NDI).Quantitative data was analyzed by one-way ANOVA with post LSD-t test (multiple comparison) or Kruskal-Wallis test. Categorical data was analyzed by χ2 test. Results: The follow-up time of the CMEL group,EOLP group and the conservative treatment group were (27.6±18.8)months,(21.6±6.9)months and(24.9±16.3)months respectively with no significant difference(P>0.05). Changes of CDH volume in patients:(1) There were 96 CDH of 35 patients in the CMEL group,among which 78 showed absorption. The absorption frequency was 81.3%(78/96) and the absorption rate was ranged 5.9% to 90.9%;9 CDH showed reprotrusion,the reprotrusion frequency was 9.4% (9/96) and the reprotrusion rate was 5.9% to 13.3%;(2) There were 94 CDH of 33 patients in the EOLP group,of which 45 showed absorption. The absorption prevalence was 47.9% (45/94) and the absorption rate was 5.0% to 26.7%;20 CDH showed reprotruded,with the reprotrusion frequency of 21.3% (20/94) and the reprotrusion rate was 5.8% to 28.3%;(3) There were 102 CDH in 33 patients of the conservative group. Among them, 5 showed absorption. The absorption frequency was 4.9% (5/102),and the absorption rate was 7.2% to 14.3%;58 CDH showed reprotruded with the re-protrusion ratio of 56.9% (58/102) and the re-protrusion rate was 5.4% to 174.1%. The absorption ratio and reprotrusion ratio of the CMEL group were statistically different from EOLP group or the conservative group (P<0.01).The absorption ratio and reprotrusion ratio of the EOLP group was different from conservative group (all P<0.01). In terms of clinical outcomes, the excellent/good rate of the JOA score and NDI scores in the CMEL group were different from that of conservative group (all P<0.01) but not from that of the EOLP group(P>0.05). Conclusions: CMEL is an effective method for the treatment of CSM,making CDH easier to resorption compared to the EOLP or conservative treatment,thus making a better decompression effect on the nerves. This study enlightened on a new strategy for the clinical treatment of CSM.
Male
;
Female
;
Humans
;
Adult
;
Middle Aged
;
Aged
;
Aged, 80 and over
;
Retrospective Studies
;
Intervertebral Disc Displacement/surgery*
;
Conservative Treatment
;
Quality of Life
;
Treatment Outcome
;
Spondylosis/surgery*
;
Cervical Vertebrae/surgery*
;
Spinal Cord Diseases
;
Laminoplasty/methods*
;
Decompression
6.A case-control study:the clinical efficacy of total laminectomy with lateral mass screw fixation and single open-door laminoplasty for cervical spinal cord injury without fracture and dislocation.
Qiu-Wei LI ; Lin WANG ; Hong WANG
China Journal of Orthopaedics and Traumatology 2022;35(2):136-141
OBJECTIVE:
To compare the clinical effects of total laminectomy with lateral mass screw fixation and single open-door laminoplasty in the treatment of cervical spinal cord injury without fracture and dislocation.
METHODS:
The clinical data of 75 patients with cervical spinal cord injury without fracture and dislocation treated from December 2014 to April 2020 were retrospectively analyzed, including 65 males and 10 females, aged from 33 to 83 years old with an average of (60.1±11.4) years. According to surgical method, the patients were divided into observation group (36 cases) and control group (39 cases). The observation group was treated with C3-C6 single open-door laminoplasty. In the control group, the C3-C6 whole lamina was opened by "uncovering", and the lateral mass screw was fixed and fused. The general conditions including operation time, intraoperative blood loss, hospital stay and complications such as axial pain, cerebrospinal fluid leakage, postoperative C5 nerve palsy were recorded. Visual analogue scale(VAS), Nurick pain scale, Japanese Orthopaedic Association(JOA) scores and American Spinal Injury Association(AISA) injury scale were used to evaluate the improvement of clinical symptoms and related functional recovery 12 months after operation.
RESULTS:
There were no statistically significant differences in operation time, intraoperative blood loss and hospital stay between two groups(P>0.05). There were statistically significant differences in JOA, VAS, ASIA and Nurick scores of the all patients between 12 months after surgery and before surgery (P<0.05), and there was no significant difference between groups. There was significant difference in the incidence of C5 nerve root palsy and axial pain between two groups(P<0.05), but there was no significant difference in the complications of cerebrospinal fluid leakage between two groups (P>0.05).
CONCLUSION
Total laminectomy with lateral mass screw fixation and single open-door laminoplasty in treating cervical spinal cord injury without fracture and dislocation can obtain satisfactory results in restoring nerve function, alleviating pain and improving daily behavior, but single open-door laminoplasty has the advantages of less trauma and low incidence of complications.
Adult
;
Aged
;
Aged, 80 and over
;
Bone Screws
;
Case-Control Studies
;
Cervical Cord/surgery*
;
Cervical Vertebrae/surgery*
;
Female
;
Humans
;
Laminectomy/methods*
;
Laminoplasty/methods*
;
Male
;
Middle Aged
;
Retrospective Studies
;
Treatment Outcome
7.Clinical observation on correction of abnormal cervical sagittal parameters by cervical pulling method guided by cervical motion segment extension.
Shuai PEI ; Hong JIANG ; Peng-Fei YU ; Jin-Tao LIU ; Yu-Wei LI ; Bo XU ; Zhi-Jia MA ; Yu ZHU ; Xiao-Feng SHEN
China Journal of Orthopaedics and Traumatology 2022;35(8):747-751
OBJECTIVE:
To observe the radiological change and curative effect of cervical spondylosis treated with cervical vertebra pulling therapy in young people.
METHODS:
A total of 65 patients(shedding in 5 patients and final inclusion in 60 patients) with cervical spondylosis who were treated from January 2018 to September 2019 were randomly divided into treatment group and control group according to the digital table method. There were 30 patients in treatment group, including 14 males and 18 females, aged from 20 to 44 years old with an average of(29.83±6.99) years, who were treated with cervical vertebra pulling therapy(once a week, 4 times in total). The control group consisted of 30 cases, 12 males and 18 females, aged from 18 to 43 years old with an average of (31.77±5.93) years, who received sitting traction therapy(once a week, 4 times in total). The changes of C2-C7 Cobb angle, arc-chord distance and T1 slope (T1S) in two groups were observed before treatment and 1 month after treatment, for intra-group and inter-group comparison;and the changes of numerical rating scale(NRS) in two groups were observed before treatment and 1, 3 months after treatment, for intra-group and inter-group comparison.
RESULTS:
Sixty patients were followed up for (3.2±0.3) months. There were no significant differences in NRS, C2-C7 Cobb angle, arc-chord distance and T1S between two groups before treatment (P>0.05). One month after treatment, the NRS, C2-C7 Cobb angle, arc-chord distance and T1S were(1.67±0.76) scores, (16.55±6.01)°, (10.95±4.04)mm, (18.95±4.19)° in treatment group and(1.40±0.86) scores, (10.23±5.94) °, (6.11±4.17) mm, (13.34±4.25)° in control group respectively. C2-C7 Cobb angle, arc-chord distance and T1S in treatment group were better than those in control group (P<0.05); there was no significant difference in NRS between two groups (P>0.05). Compared with before treatment, there were statistically significant differences in C2-C7 Cobb angle, arc-chord distance and T1S in treatment group(P<0.05), but no statistically significant differences in control group(P>0.05). Three months after operation, NRS of treatment group was (1.60±0.62) scores and that of control group was (4.17±0.70) scores. The treatment group was better than the control group(P<0.05). The scores of treatment group after treatment were lower than those before treatment(P<0.05), and there was no significant difference in control group before and after treatment(P>0.05).
CONCLUSION
Cervical vertebra pulling method and cervical vertebra sitting traction can relieve the pain symptoms of patients with cervical spondylosis, but the effect of cervical vertebra pulling method is more durable;cervical vertebra pulling method can correct abnormal cervical sagittal parameters.
Adolescent
;
Adult
;
Cervical Vertebrae/surgery*
;
Female
;
Humans
;
Laminoplasty/methods*
;
Lordosis/surgery*
;
Male
;
Neck
;
Retrospective Studies
;
Spondylosis/surgery*
;
Young Adult
8.Analysis of clinical efficacy of C expanded half lamina excision combined with unilateral open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome.
Ming FANG ; Jian-Meng LU ; Xing-Wu WANG ; Yong-Li WEI ; Wu-Liang YU ; Min-Hao LU
China Journal of Orthopaedics and Traumatology 2020;33(8):735-740
OBJECTIVE:
To explore the clinical efficacy of C expanded half lamina excision combined with unilateral open door laminoplasty for multiple segmental cervical spinal cord compression syndrome.
METHODS:
The clinical data of 58 patients with multiple segmental cervical spinal cord compression syndrome underwent surgical treatment between September 2014 and May 2018 were retrospectively analyzed. There were 34 males and 24 females with a mean age of 64.4 years old (ranged from 46 to 78 years old). Among them, 28 cases received the surgery of C expanded half lamina excision combined with C-C unilateral open-door laminoplasty (improvedgroup), and 30 cases received a single C-C unilateral open-door laminoplasty (traditional group). Operation time, intraoperative blood loss, complications including C nerve root palsy and axial symptoms were compared between two groups. To evaluate the situation of the imaging indicators by measuring the space available for the spinal cord through cross sectional MRI of cervical spine at the narrowest segment of C (including intervertebral disc levels of C). Pre- and post-operative Japanese Orthopedic Association(JOA) score, Neck Disability Index(NDI) score, and improvement rate of neurological function, were recorded and analyzed between the two groups.
RESULTS:
All the patients were followed up for 12 to 18 months with an average of(14.5±1.8) months for improved group and (14.5±1.9) months for traditional group, and no significant difference was found between the two groups (>0.05). There was no significant difference in intraoperative blood loss and C nerve root palsy between the two groups (>0.05). The operation time (119±10) min vs (126±12) min and axial symptoms 7.1%(2/28) vs 26.6%(8/30) was significant difference between the two groups (<0.05). Preoperative and postoperative space available for the spinal cord of C was (93.61±9.02) mm and (153.50±12.76) mm respectively, which was obtained obvious improvement in all patients(<0.05). At the final follow up, JOA scores of improved group and traditional group were 14.36±1.70 and 14.03±1.82 respectively, and NDI scores were 10.36±2.55 and 12.47±3.46 respectively, there was significant difference between two groups (<0.05). However, there was no significant difference between two groups for the improvement rate (68.36±0.12)%VS (65.01±0.12)%of neurological function(>0.05).
CONCLUSION
C expanded half lamina excision combined with unilateral open-door laminoplasty is an effective method to treat multiple segmental cervical spinal cord compression syndrome, for it can not only fully relieved spinal cord compression, but also achievedgood effect in preventing complications such as axial symptoms by reducing stripping of muscles from C2 spinous process.
Aged
;
Cervical Vertebrae
;
surgery
;
Cross-Sectional Studies
;
Female
;
Humans
;
Laminectomy
;
Laminoplasty
;
Male
;
Middle Aged
;
Retrospective Studies
;
Spinal Cord Compression
;
Treatment Outcome
9.Meta-analysis of calcium chemotherapeutic effect of anterior cervical subtotal vertebroplasty and posterior laminoplasty.
Hai-Tao SU ; Jia-Jie PENG ; Lin ZHOU ; Wei-Wu HONG ; Zhi-Rong FAN ; Jiang-Lin WU ; Yi-Hao LIANG
China Journal of Orthopaedics and Traumatology 2020;33(6):576-584
OBJECTIVE:
To systematically assess the efficacy of anterior cervical corpectomy and fusion (ACCF) versus posterior laminoplasty (LAMP) for cervical ossification of posterior longitudinal ligament (OPLL).
METHODS:
PubMed and EMBASE, Cochrane Library, CBM, CNKI, Wanfang and VIP were collected from 7 databases of ACCF, LAMP from 1970 to May 2018. According to the criteria, the articles were included and independently screened by two authors. The quality of the articles was assessed by using the MINORS scale (methodological index for non randomized studies). After extracting the data from the article, the JOA score, cervical curvature, operation time, bleeding volume, excellent and good rate, recovery rate, adverse events and secondary surgery were analyzed by using Review Manager 5.3 software.
RESULTS:
Finally, a total of 22 articles with 1 678 patients were included in this Meta-analysis, with 810 patients in ACCF group and 868 patients in LAMP group. Meta analysis results showed that the ACCF group had higher postoperative JOA scores[MD=0.63, 95%CI(0.05, 1.20), = 0.03], higher excellent rate [=1.85, 95%CI (1.14, 3.02), =0.01] and higher recovery rate [=11.90, 95%CI (5.75, 18.05), =0.000 1]. But the LAMP group has a shorter operative time [MD=52.19, 95%CI (29.36, 75.03), <0.000 01], less complications [=1.56, 95%CI (1.03, 2.35), =0.04] and less reoperations [=3.73, 95%CI (1.62, 8.57), =0.002]. There was no significant different in postoperative lordosis [MD=3.15, 95%CI(-0.14, 6.43), =0.06] and blood loss[SMD= 0.26, 95%CI(-0.05, 0.57), =0.10] between two groups.
CONCLUSION
The recovery of functionof ACCF group was better, but operation time, complications and reoperations of LAMP group were all better than ACCF group. There was no difference in postoperative lordosis and intraoperative blood loss between two groups. However, there are some limitations in this study. Therefore, higher quality and larger sample size clinical studies are needed to further verify.
Calcium
;
Cervical Vertebrae
;
Decompression, Surgical
;
Humans
;
Laminoplasty
;
Ossification of Posterior Longitudinal Ligament
;
Spinal Fusion
;
Treatment Outcome
;
Vertebroplasty
10.Comparison of the anterior and posterior approach in treating four-level cervical spondylotic myelopathy.
Ji-Liang ZHAI ; Shi-Gong GUO ; Li NIE ; Jian-Hua HU
Chinese Medical Journal 2020;133(23):2816-2821
BACKGROUND:
The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.
METHODS:
A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed.
RESULTS:
There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.
CONCLUSIONS
Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.
Blood Loss, Surgical
;
Cervical Vertebrae/surgery*
;
Decompression, Surgical
;
Humans
;
Laminoplasty
;
Retrospective Studies
;
Spinal Cord Diseases/surgery*
;
Spinal Fusion
;
Spondylosis/surgery*
;
Treatment Outcome

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