M R I ( cervical spondylo tic m yelopathy, CSM ) CSM,,,, [ 1, 2 ] 1 2
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1 , (cervical spondylo tic m yelopathy, CSM ) , CSM, X M R I, JOA 3618%,, ; 12. 1%,, ; (P < 0. 05) 931, % 81. 8%, JOA 6414% 7014% ; (P > 0105) CSM,,, : R R : A A COM PARATIVE RESEARCH OFM UL TIL EVEL CERV ICAL SPONDYLOTICMY ELOPATHY TREATED BY TWO D IFFERENT ANTER IOR OPERATIVE M ETHOD SgL IU P eng, ZH A O J ianhua, L I Q ihong. D ep artm ent of O rthop a2 ed ics, D ap ing H osp ital and Institu te of F ield S u rg ery, T h ird M ilitary M ed ical U niversity, Chong qing, , P. R. Ch ina Corresp ond ing au thor: ZH A O J ianhua, E 2m ail: z haoj ianhua1964@y ahoo. com Abstract ObjectiveTo compare the outcom es of tw o operative m ethods, the anterio r decomp ression in sub section and the an terio r decom p ression in one section, w h ich w ere u sed to treat m u ltilevel cervical spondylo tic m yelopathy (CSM ). M ethodsd ata of m ultilevel CSM undergo ing the anterio r decomp ression in subsection (33 cases, the subsection group) and the anterio r decomp ression in one section (19 cases, the one section group) from July 1999 to January 2004 w ere retro spectively analyzed. T he incidence of perioperative com p lication s and the rate of fu sion w ere evaluated by the po stoperative X2ray and M R I exam ination s, and im p rovem en t of the neu ro logical function w as evaluated by the JOA sco re. ResultsT he incidence of perioperative comp licationsw as 36. 8% in the one section group, m ainly including imm igration of the p late and grafts, w h ich w as settled by the revision surgery; w h ile the incidence of perioperative comp ilcationsw as 12. 1% in the subsection group, m ainly including the imm igration of the titanium m esh. T here w as a significant difference betw een the tw o group s (P < 0. 05) % of the patients in the one section group and 8118% of the patien ts in the sub section group developed bony fu sion by the end of the fo llow 2up ( 9231 m on, averaged 1112 mon), and there w as no significant difference betw een the tw o group s (P > 0. 05). A cco rding to the JOA sco re, the ratio of the imp rovem ent in the neuro logical function w as 70. 4% in the subsection group and 64. 4% in the one section group. T here w as no significant difference betw een the tw o group s (P > 0. 05). ConclusionT he anterio r decom p ression in sub section is m o re rational fo r the su rgical treatm en t on the m u ltilevel CSM than the an terio r decom p ression in one section. It can p rovide an equal decom p ressive effect bu t a m o re stab le local m echan ical environm ent righ t after the surgery and can m aintain it w ell, w h ich is critical fo r the bony fusion. Key wordscervical spondylo tic m yelopathym ultilevelinternal fixation A nterio r surgery Com parison : 1 (, ) ; 2 :,,, :, E2m ail: zhao jianhua1964@ yahoo. com M R I ( cervical spondylo tic m yelopathy, CSM ) CSM,,,, [ 1, 2 ] 12
2 CSM, 83% ; CSM, [ 225 ] CSM, CSM, : ; 3 ; g, 52, : 19, 33 1 JOA [ 6 ] (P > 0. 05),,,,,,, X,, M R I ;, ;, ; 8 15, ; ,, ,, ;, ;,,, 18 ; , C 47, C 5, C 47, C 6, C 4 C 7 C 6,, C 46, C 6 7 C 47, C , C 37, C 4 C 6, C 5, C 37,, C 3 C 7 C 5, 1 2 mm, C 37, C : 1 5 2,, 610 d : 3 d, , , X,, Cobb [ 7 ] 4 2 M R I JOA, : = (- ) g(17- ) 100% Tab. 1 1General data of the patien ts in the two groups Group (n= 19) O ne section group (n= 19) (n= 33) Subsection group (n= 33) () A ge range (year) ( ) Sex (m ale: fem ale) () H isto ry (month) Range A verage () L evel JOA P reoperative JOA Sco res Range A verage
3 364 : : 75% ; : 50%74% ; : 25%49% ; : 24% 1. 4 SPSS 11. 0, Cobb t, ς 2, P < , g 931, ; 5 10 ; , 36. 8% ; 5 (26. 3% ), 2 (1015% ), 1 ; 5, 4, 12. 1% ; 3 (911%, 2, 1 ), 1 (3%, 4 ), 24,,, (P < 0. 05) , X X, 6 11, 84. 2% (16g19) ; 913, 81. 8% (27g33), (P > 0. 05) 3 5 M R I, (1 2) Cobb, (P < 0. 05), 3 Cobb, 69 ; Cobb Cobb JOA : 70. 4%, 17, 11, 2, 3 ; 6414%, 7, 6, 4, 2 (P > 0. 05) CSM CSM,, CSM 52 CSM,, ( ),,,,,,, [ 3 ] M R I,,, 1 2 CSM, CSM 3. 2CSM,,,, Tab. 2Cobb (, θ xs) 2D ifferen t values of Cobb angle at differen t times of the follow-up in two groups(, θ xs) Group O ne section group Subsection group Case 2 Po stoperation2 p reoperation months after operation2po stoperation months23 months months26 months after operation after operation2po stoperation P < Compared w ith one section group, P < 0105
![4%, 17, 11, 2, 3 ; 6414%, 7, 6, 4, 2 (P > 0. 05) 3 3. 1CSM CSM,, CSM 52 CSM,, ( ),,,,,,, [ 3 ] M R I,,, 1 2 CSM, CSM 3. 2CSM,,,, Tab.](/docs-images/42/22880507/images/page_3.jpg "2Cobb (, θ xs) 2D ifferen t values of Cobb angle at differen t times of the follow-up in two groups(, θ xs) Group O ne section group Subsection group Case 2 Po stoperation2 p reoperation 3 2 3 months")
4 X M R Ia X b M R I cx dx e6 X 2X M R I a X b M R I cx d 9 X e 9 M R I F ig. 1The X-ray and M R I exam ination s for the patien t in the one section group at he p reoperative X2ray film bt he p reoperative M R I ct he X2ray film on the 2nd day after operation dt he X2ray film on the 2nd day after the revision surgery et he X2ray film 6 month s after the revision surgeryf ig. 2The X-ray and M R I exam ination s for the patien t in the subsection group at he p reoperative X2ray film bt he p reoperative M R I ct he X2ray film on the 2nd day after operation dt he X2ray film 9 month s after operation et he M R I 9 month s after operation,, [ 3, 8 ],,,,, ;,, [ 8 ],, [ 3, 8211 ] 19, 36. 8%,, 5,,,,, ;,,,, [ 9, 10 ], 33, (P < 0105 ), 1 4, (P > 0. 05),, [ 12 ]
5 366,,,,, [ 12 ], CSM X, : ; ;,, B reig (1978), ; [ ],, [ 16, 17 ] Cobb,, (69 ), 3 Cobb,, : ;, ;, 2,,, 4 1,.., 1999, 19 (2) : Edw ards CC 2nd, R iew KD, A nderson PA, et al. Cervical m yelopathy, current diagno stic and treatm ent strategies. Sp ine J, 2003, 3 (1) : , 3,,,.., 2004, 18 (6) : W ada E, Suzuki S, Kanazaw a A, et al. Subto tal co rpectom y versus lam inop lasty fo r m ultilevel cervical spondylo tic m yelopathy: a long2term fo llow 2up study over 10 years. 2001, 26 (13) : Sp ine, 5 Ep stein N. A nterio r app roaches to cervical spondylo sis and o ssification of the po sterio r longitudinal ligam ent: review of operative technique and assessm ent of 65 m ultilevel circum ferential p rocedures. Surg N euro l, 2001, 55 (6) : ,.., 2003, 13 (4) : ,,,.., 2004, 14 (7) : W ang JC, M cdonough PW, Kanim L E, et al. Increased fusion rates w ith cervical p lating fo r three2level anterio r cervical discectom y and fusion. Sp ine, 2001, 26 (6) : Po rter RW, C raw fo rd N R, Cham berlain RH, et al. B iom echa2 nical analysis of m ultilevel cervical co rpectom y and p late constructṡ J N euro surg, 2003, 99 (1) : Singh K, V accaro A R, Kim J, et al. Enhancem ent of stability fo llow ing anterio r cervical co rpectom y: Sp ine, 2004, 29 (8) : a biom echanical study. 11,,,.., 2004, 18 (1) : ,,,.., 2005, 15 (2) : Suda K, A bum i K, Ito M, et al. L ocal kypho sis reduces surgical outcom es of expansive open2doo r lam inop lasty fo r cervical spondylo tic m yelopathy. Sp ine, 2003, 28 (12) : Houten JK, Cooper PR. L am inectom y and po sterio r cervical p lating fo r m ultilevel cervical spondylo tic m yelopathy and o ssification of the po sterio r longitudinal ligam ent: effects on cervical alignm ent, sp inal co rd comp ression, and neuro logical outcom e. N euro surgery, 2003, 52 (5) : H eller JG, Edw ards CC 2nd, M urakam i H, et al. L am inop lasty versus lam inectom y and fusion fo r m ultilevel cervical m yelopathy: an independent m atched coho rt analysis. Sp ine, 2001, 26 ( 12) : W ang M Y, Shah S, Green BA. C linical outcom es fo llow ing cervical lam inop lasty fo r 204 patients w ith cervical spondylo tic m yelopathy. Surg N euro l, 2004, 62 (6) : Zdeblick TA, Bohlm an HH. Cervical kypho sis and m yelopathy: treatm ent by anterio r co rpectom y and strut2grafting. J Bone Jo int Surg (Am ), 1989, 71 (2) : (: : ) (: )
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