Abstract
Background
Severe and complex cervical spondylotic myelopathy(CSM) requires surgical treatment. The common methods of posterior cervical spine surgery are laminoplasty and laminectomy with lateral mass screw internal fixation. However, the operative effect of this surgical approach is unclear owing to the complexity and severity of CSM in patients who undergo this surgical treatment.Therefore, we aimed to evaluate the clinical effects of posterior cervical laminectomy and lateral mass screw internal fixation in patients with severe and complex CSM.
Methods
We retrospectively analysed 60patients (48men,12women; mean age59.7 years) with severe and complex CSM who underwent posterior cervical laminectomy and lateral mass screw internal fixation from May 2013 to June 2020. Forty-eight patients underwent laminectomy and lateral mass screw internal fixation;12 patients underwent laminectomy and lateral mass screw internal fixation with 1–2 segmental laminoplasty. C-spine radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) were used to detect any curvature and fusion of the cervical spine, restenosis, and loose/broken internal fixation screws.Clinical efficacy was evaluated using Japanese Orthopaedic Association (JOA)scores, neck disability index(NDI), Odom’s classification, and the visual analogue scale(VAS) for pain.
Results
Overall effect was satisfactory at the last follow-up (average, 3.6 years [range, 6 months–6 years]), with no restenosis or loosened, slipped, or broken internal fixations. The anterior curvature angle of lordosis (n=46)was not significantly different from baseline at the last follow-up(P>0.05). The cervical kyphosis angle (n=14)was significantly improved at the last follow-up compared with the baseline value (P<0.05), as were the JOA, NDI, and VAS scores(all P<0.05). Odom’s classifications at the last follow-up were excellent, good, and fair in 45, 12, and three patients, respectively.
Conclusions
Posterior cervical laminectomy and lateral mass screw internal fixation achieved satisfactory clinical results in severe and complex CSM cases.Combining this surgical method with laminoplasty of 1–2 spinal segments stabilised the cervical spine and provided spinal decompression while preventing excessive backward drift of the cervical spinal cord, resulting in fewer complications.
Posterior Laminectomy and Lateral Mass Screw Fixation for the Treatment of Severe Cervical Spondylotic Myelopathy
