Zhong Huajian, Xu Chen, Wang Ruizhe, Wu Xiaodong, Wu Huiqiao, Sun Baifeng, Wang Xinwei, Chen Huajiang, Shen Xiaolong, Yuan Wen
Department of Orthopaedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
Front Surg. 2023 Jan 9;9:1065103. doi: 10.3389/fsurg.2022.1065103. eCollection 2022.
Four-level cervical spondylotic myelopathy (CSM) is a common disease affecting a large number of people, with the optimal surgical strategy remaining controversial. This study compared the clinical outcomes, radiological parameters, and postoperative complications of primarily performed surgical procedures such as anterior cervical discectomy and fusion (ACDF), open-door laminoplasty (LAMP), and laminectomy with fusion (LF) in treating four-level CSM. A total of 116 patients who received ACDF (38 cases), LAMP (45 cases), and LF (33 cases) were followed up for a minimum of 24 months were enrolled in this study and retrospectively analyzed. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) scoring system, the Neck Disability Index (NDI), and the Visual Analogue Scale (VAS). Changes in the curvature of the cervical spine were determined using the cervical curvature index (CCI) and the C2-C7 Cobb angle. Cervical mobility was evaluated using the C2-C7 range of motion (ROM) and active cervical ROM (aROM). Complications were recorded and compared among the three groups. All patients achieved significant improvement in JOA, NDI, and VAS scores at the final follow-up ( < 0.05), whereas no remarkable difference was found among the groups ( > 0.05). In addition, both C2-7 ROM and aROM were significantly reduced in the three groups and LAMP showed the least reduction relatively. As for complications, LAMP showed the lowest overall incidence of postoperative complications, and patients in the ACDF group were more susceptible to dysphagia, pseudoarthrosis than LAMP and LF. Considering improvements in clinical symptoms and neurological function, no remarkable difference was found among the groups. Nevertheless, LAMP had advantages over the other two surgical procedures in terms of preserving cervical mobility and reducing postoperative complications.
四节段脊髓型颈椎病（CSM）是一种影响众多人的常见疾病，最佳手术策略仍存在争议。本研究比较了前路颈椎间盘切除融合术（ACDF）、开门式椎板成形术（LAMP）和椎板切除融合术（LF）等主要手术方式治疗四节段CSM的临床疗效、影像学参数和术后并发症。本研究纳入了116例行ACDF（38例）、LAMP（45例）和LF（33例）且至少随访24个月的患者，并进行回顾性分析。使用日本骨科协会（JOA）评分系统、颈部功能障碍指数（NDI）和视觉模拟量表（VAS）评估临床疗效。使用颈椎曲度指数（CCI）和C2-C7 Cobb角确定颈椎曲度变化。使用C2-C7活动范围（ROM）和颈椎主动活动范围（aROM）评估颈椎活动度。记录并比较三组并发症情况。所有患者在末次随访时JOA、NDI和VAS评分均有显著改善（<0.05），但组间差异无统计学意义（>0.05）。此外，三组患者C2-7 ROM和aROM均显著降低，LAMP组降低相对最少。至于并发症，LAMP组术后并发症总发生率最低，ACDF组患者比LAMP组和LF组更容易出现吞咽困难、假关节形成。考虑到临床症状和神经功能的改善，组间差异无统计学意义。然而，在保留颈椎活动度和减少术后并发症方面，LAMP比其他两种手术方式更具优势。
