Abstract:

Objective To analyze the efficacy of anterior cervical Hybrid surgery and posterior cervical expansive open-door laminoplasty （EODL） in the treatment of multilevel cervical spondylotic myelopathy， and to discuss the selection of surgical methods for the patients with multilevel cervical spondylotic myelopathy. Methods The retrospective analysis was conducted of 70 patients with multilevel cervical spondylotic myelopathy who underwent surgery at Affilated Beijing Traditional Chinese Medicine Hospital of Capital Medical University from July 2017 to July 2020. Based on the different surgical methods， the patients were divided into anterior group （n=35 ）and posterior group（n=35）. The patients in anterior group underwent Hybrid surgery ［anterior cervical discectomy and fusion （ACDF） combined with artificial cervical disc replacement （ACDR）］，and the patients in posterior group underwent EODL. The hospitalization time， operation time， intraoperative blood loss， and postoperative drainage volume of the patients in two groups were recorded； the efficacy was evaluated by Japanese orthopaedic association （JOA） score， JOA improvement rate， neck disability index （NDI）， visual analogue scale （VAS） for pain， and postoperative satisfaction score； the complications of the patients in two groups after surgery were recorded. Results Compared with posterior group， the intraoperative blood loss， postoperative drainage volume， hospitalization time， and operation time of the patients in anterior group were significantly decreased （P<0.01）， and the preoperative score had no significant difference （P>0.05）. At the final follow-up after surgery， compared with posterior group， the JOA score and JOA improvement rate of the patients in anterior group were significantly increased （P<0.01）， and the NDI score and VAS score were significantly decreased （P<0.01）.Compared with before surgery， the JOA scores of the patients in two groups at the final follow-up after surgery were increased （P<0.01）， and the NDI and VAS scores were significant decreased （P<0.01）. The postoperative satisfaction of the patients in two groups was high based on the postoperative satisfaction score.There was no significant difference in the incidence of postoperative complication of the patients between two groups （P>0.05）. Conclusion Both the anterior cervical Hybrid surgery and EODL achieve the satisfactory results in the treatment of multilevel cervical spondylotic myelopathy. Hybrid surgery has the advantages of less bleeding and shorter surgery time， and the most suitable surgical method should be chosen clinically based on the actual situation of the patients.

Key words: Cervical spondylotic myelopathy, Posterior cervical spine, Spinal canal decompression, Anterior cervical vertebra surgery, Hybrid surgery