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[Combined cervical posterior-anterior operation for treatment of cervical spinal canal stenosis with reverse arch]
Wei Hu1, Xinlong Ma, Tianwei Sun
1Graduate School of Tianjin Medical University, Tianjin, 300070, P.R. China.
Objective:
To evaluate the effectiveness of combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch.
Methods:
Between May 2009 and February 2012, 13 cases of cervical spinal canal stenosis with reverse arch underwent posterior decompression with laminoplasty surgery in prone position and then anterior decompression with fusion surgery in supine position. There were 7 males and 6 females with an average age of 43.5 years (range, 38-62 years) and an average disease duration of 25 months (range, 18-60 months). All the patients had neck axial symptoms and spinal cord compressed symptoms, and lateral computer radiology (CR) of the neck showed reverse arch of cervical vertebrae. Segments of intervertebral disc protrusion included C3-6 in 4 cases, C4-7 in 4 cases, and C3-7 in 5 cases. After operation, anteroposterior and lateral CR was used to observe the cervical curvature change and fixation loosening, MRI to observe the change of the compression on spinal cord, visual analogue scale (VAS) score to evaluate the improvement of axial symptom, and Japanese Orthopaedic Association (JOA) score to assess the nerve function improvement.
Results:
All incisions healed by first intention. All patients were followed up 9-32 months (mean, 15.4 months). Internal fixator had good position without loosening or breaking and the compression on spinal cord improved significantly after operation. All the patients obtained bony fusion at 6 months after operation. The axial symptoms and the nerve function at last follow-up were improved. VAS score at last follow-up (3.25 +/- 1.54) was significantly lower than that at preoperation (6.55 +/- 1.52) (P < 0.05); JOA score at last follow-up (10.45 +/- 4.23) was significantly higher than that at preoperation (7.05 +/- 1.32) (P < 0.05); and cervical curvature value at last follow-up [(6.53 + 3.12) mm] was significantly higher than that at preoperation [(3.22 +/- 5.15) mm] (P < 0.05).
Conclusion:
Combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch is a safe and effective surgical method.