Objective:To examine the clinical effect of the enlarged anterior cervical intervertebral cone-shape decompression and fusion(EACDF) for treating degenerative cervical kyphosis (DCK).Methods:This study is a retrospective case series research. From September 2018 to September 2023, the data of 51 patients with DCK who underwent EACDF at Department of Orthopaedics, the Second Affiliated Hospital, Naval Medical University were analyzed retrospectively. Among the 51 patients, there were 28 males and 23 females, with an age of (61.6±9.8) years old (range:39 to 74 years), and an body mass index of (25.9±2.7) kg/m 2 (range:20.7 to 31.7 kg/m 2). Patients underwent EACDF with expanded decompression by distracted intervertebral space, partial resections of posterior edge of vertebral body and uncinate vertebral joint. The operation duration, blood loss and length of hospital stay were recorded. The visual analog scale (VAS) of neck pain and arm pain, cervical disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) score were recorded in patients before and immediately after surgery, as well as at follow-up. Imaging parameters such as C 2-7 Cobb angle of cervical global curvature, Cobb angle at the operative segment, C 2-7 sagittal vertical axis (C 2-7 SVA), T 1 slope and the height of operative segment were measured. The fusion rate and surgical complications of two groups were recorded. Fourty-five patients who underwent anterior cervical corpectomy with fusion (ACCF) during the same period were included to compare the effectiveness of deformity correction between the two groups. Repeated measures ANOVA was used for intra group data comparison and Dunnett- t test was used for pairwise comparison, and mixed design ANOVA was used for inter group data comparison. Results:All patients were successfully completed the operation. The follow-up period after surgery was (40.4±13.4) months (range:12 to 72 months). The neck pain and arm pain VAS, NDI and JOA in the two groups immediately after surgery, at 2 months, 12 months after surgery, and the final follow-up were significantly improved compared with those before operation (all P<0.05). In both groups, postoperative the C 2-7 Cobb angle, Cobb angle at the operative segment, C 2-7 SVA, T 1 slope, and height of operative segment were significantly improved immediately after surgery, at 2 months, 12 months, and the final follow-up (all P<0.05). The C 2-7 Cobb angle, Cobb angle at the operative segment, and height of operative segment immediately after surgery, at 2 months, 12 months, and the final follow-up in the EACDF group were significantly higher than those in the ACCF group (all P<0.05). There were no significant differences in C 2-7 SVA and T 1 slope between the two groups(all P>0.05). At the final follow-up, the angle of every intervertebral space correction in the EACDF group was (9.3±1.6) °(range:6.5° to 12.3°), while in the ACCF group was (3.1±1.8) °(range:1.2° to 5.6°), with a significant difference between the two groups ( P<0.05). Patients at the both groups got bone graft fusion at the final follow-up. Conclusions:The clinical effect of EACDF for treating DCK is satisfactory. EACDF maybe superior to ACCF in restoring intervertebral height, correcting and maintaining cervical curvature.

Objectives:To explore the effects of guttering on the lateral mass technique in enlarging the cross-sectional area of the spinal canal after unilateral open-door cervical laminoplasty.Methods:A retro-spective analysis was conducted on the clinical data of patients with cervical ossification of posterior longitudi-nal ligament treated with unilateral open-door cervical laminoplasty between February 2021 and February 2024.37 patients who underwent the conventional technique were included in the conventional group;31 pa-tients undergone guttering on the lateral mass technique were included in the lateral mass group.The opera-tive time,intraoperative blood loss,postoperative drainage volume,and incidence of complications were compared between the two groups.At preoperation,immediately after surgery,2 months after surgery,and the final follow-up,the neck pain was evaluated using the visual analog scale(VAS),the cervical function was assessed with the neck disability index(NDI),and the neurological function was appraised with the Japanese Orthopaedic Association(JOA)score.C2-7 Cobb angle,C2-7 sagittal vertical axis(SVA),and T1 slope were measured on the cervical lateral X-rays to eliminate the possibilities of guttering on the lateral mass affecting cervical stability and cervical curvature;The spinal canal area was measured on the CT cross-sectional image and the percentage increase in spinal canal area was compared between the two groups.Results:All the pa-tients underwent the surgery successfully.No serious complications such as spinal cord injury or infection oc-curred.There were no significant differences in operation time,intraoperative blood loss,postoperative drainage volume between the two groups(P＞0.05).The neck pain VAS scores,NDI and JOA scores in both groups showed significant improvement immediately after surgery,2 months after surgery,and at final follow-up(P＜0.05).There were no differences in neck pain VAS scores and NDI between the two groups at preoperation,immediately after surgery,2 months after surgery and final follow-up(P＞0.05).There was no statistical differ-ence in preoperative JOA scores between the two groups(P＞0.05),but there were statistically significant differ-ences in JOA scores between the two groups immediately after surgery,2 months after surgery,and at final follow-up(P＜0.05).There were no statistical differences in C2-7 Cobb angle,C2-7 SVA,and T1 slope in both groups immediately after surgery,at 2 months after surgery,and at final follow-up,comparing with those before operation(P＞0.05).No significant differences were found between the two groups in C2-7 Cobb angle,C2-7 SVA,and T1 slope at preoperation,immediately after surgery,at 2-month after surgery,and at the fi-nal follow-up(P＞0.05).The average cross-sectional area of the spinal canal in both groups showed significant improvement immediately after surgery,at 2-month after surgery,and at final follow-up(P＜0.05).There was no statistical difference in the preoperative average cross-sectional area of the spinal canal between the two groups(P＞0.05).However,the average cross-sectional area of the spinal canal in the lateral mass group imme-diately after surgery,at 2-month after surgery,and at the final follow-up was larger than that in the conven-tional group,and the differences were statistically significant(P＜0.05).Conclusions:Compared with the con-ventional unilateral open-door cervical laminoplasty,guttering on the lateral mass technique can significantly expand the cross-sectional area of the spinal canal and improve postoperative neurological function recovery.

Objectives:To explore the effects of guttering on the lateral mass technique in enlarging the cross-sectional area of the spinal canal after unilateral open-door cervical laminoplasty.Methods:A retro-spective analysis was conducted on the clinical data of patients with cervical ossification of posterior longitudi-nal ligament treated with unilateral open-door cervical laminoplasty between February 2021 and February 2024.37 patients who underwent the conventional technique were included in the conventional group;31 pa-tients undergone guttering on the lateral mass technique were included in the lateral mass group.The opera-tive time,intraoperative blood loss,postoperative drainage volume,and incidence of complications were compared between the two groups.At preoperation,immediately after surgery,2 months after surgery,and the final follow-up,the neck pain was evaluated using the visual analog scale(VAS),the cervical function was assessed with the neck disability index(NDI),and the neurological function was appraised with the Japanese Orthopaedic Association(JOA)score.C2-7 Cobb angle,C2-7 sagittal vertical axis(SVA),and T1 slope were measured on the cervical lateral X-rays to eliminate the possibilities of guttering on the lateral mass affecting cervical stability and cervical curvature;The spinal canal area was measured on the CT cross-sectional image and the percentage increase in spinal canal area was compared between the two groups.Results:All the pa-tients underwent the surgery successfully.No serious complications such as spinal cord injury or infection oc-curred.There were no significant differences in operation time,intraoperative blood loss,postoperative drainage volume between the two groups(P＞0.05).The neck pain VAS scores,NDI and JOA scores in both groups showed significant improvement immediately after surgery,2 months after surgery,and at final follow-up(P＜0.05).There were no differences in neck pain VAS scores and NDI between the two groups at preoperation,immediately after surgery,2 months after surgery and final follow-up(P＞0.05).There was no statistical differ-ence in preoperative JOA scores between the two groups(P＞0.05),but there were statistically significant differ-ences in JOA scores between the two groups immediately after surgery,2 months after surgery,and at final follow-up(P＜0.05).There were no statistical differences in C2-7 Cobb angle,C2-7 SVA,and T1 slope in both groups immediately after surgery,at 2 months after surgery,and at final follow-up,comparing with those before operation(P＞0.05).No significant differences were found between the two groups in C2-7 Cobb angle,C2-7 SVA,and T1 slope at preoperation,immediately after surgery,at 2-month after surgery,and at the fi-nal follow-up(P＞0.05).The average cross-sectional area of the spinal canal in both groups showed significant improvement immediately after surgery,at 2-month after surgery,and at final follow-up(P＜0.05).There was no statistical difference in the preoperative average cross-sectional area of the spinal canal between the two groups(P＞0.05).However,the average cross-sectional area of the spinal canal in the lateral mass group imme-diately after surgery,at 2-month after surgery,and at the final follow-up was larger than that in the conven-tional group,and the differences were statistically significant(P＜0.05).Conclusions:Compared with the con-ventional unilateral open-door cervical laminoplasty,guttering on the lateral mass technique can significantly expand the cross-sectional area of the spinal canal and improve postoperative neurological function recovery.

Objective:To examine the clinical effect of the enlarged anterior cervical intervertebral cone-shape decompression and fusion(EACDF) for treating degenerative cervical kyphosis (DCK).Methods:This study is a retrospective case series research. From September 2018 to September 2023, the data of 51 patients with DCK who underwent EACDF at Department of Orthopaedics, the Second Affiliated Hospital, Naval Medical University were analyzed retrospectively. Among the 51 patients, there were 28 males and 23 females, with an age of (61.6±9.8) years old (range:39 to 74 years), and an body mass index of (25.9±2.7) kg/m 2 (range:20.7 to 31.7 kg/m 2). Patients underwent EACDF with expanded decompression by distracted intervertebral space, partial resections of posterior edge of vertebral body and uncinate vertebral joint. The operation duration, blood loss and length of hospital stay were recorded. The visual analog scale (VAS) of neck pain and arm pain, cervical disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) score were recorded in patients before and immediately after surgery, as well as at follow-up. Imaging parameters such as C 2-7 Cobb angle of cervical global curvature, Cobb angle at the operative segment, C 2-7 sagittal vertical axis (C 2-7 SVA), T 1 slope and the height of operative segment were measured. The fusion rate and surgical complications of two groups were recorded. Fourty-five patients who underwent anterior cervical corpectomy with fusion (ACCF) during the same period were included to compare the effectiveness of deformity correction between the two groups. Repeated measures ANOVA was used for intra group data comparison and Dunnett- t test was used for pairwise comparison, and mixed design ANOVA was used for inter group data comparison. Results:All patients were successfully completed the operation. The follow-up period after surgery was (40.4±13.4) months (range:12 to 72 months). The neck pain and arm pain VAS, NDI and JOA in the two groups immediately after surgery, at 2 months, 12 months after surgery, and the final follow-up were significantly improved compared with those before operation (all P<0.05). In both groups, postoperative the C 2-7 Cobb angle, Cobb angle at the operative segment, C 2-7 SVA, T 1 slope, and height of operative segment were significantly improved immediately after surgery, at 2 months, 12 months, and the final follow-up (all P<0.05). The C 2-7 Cobb angle, Cobb angle at the operative segment, and height of operative segment immediately after surgery, at 2 months, 12 months, and the final follow-up in the EACDF group were significantly higher than those in the ACCF group (all P<0.05). There were no significant differences in C 2-7 SVA and T 1 slope between the two groups(all P>0.05). At the final follow-up, the angle of every intervertebral space correction in the EACDF group was (9.3±1.6) °(range:6.5° to 12.3°), while in the ACCF group was (3.1±1.8) °(range:1.2° to 5.6°), with a significant difference between the two groups ( P<0.05). Patients at the both groups got bone graft fusion at the final follow-up. Conclusions:The clinical effect of EACDF for treating DCK is satisfactory. EACDF maybe superior to ACCF in restoring intervertebral height, correcting and maintaining cervical curvature.