Objective To compare the clinical outcome of anterior cervical hybrid decompression and fusion (ACHDF) vs posterior laminoplasty (LP) with titanium microplate fixation for four-level cervical spondylotic myelopathy(CSM). Methods Between January 2008 and June 2015,67 consecutive patients with four-level CSM treated in Huzhou Central Hospital were enrolled in this study and divided into 2 groups according to the surgical approach:37 patients (anterior group) underwent anterior cervical decompression using three-level plate fixation and self-locking cage hybrid fixation,30 patients (posterior group) underwent LP with titanium microplate fixation.The following factors were compared between the two groups:duration of operation,intraoperative blood loss,amount of postoperative drainage,and length of stay(LOS) ,Japanese Orthopedic Association (JOA) scores and Visual Analogue Scale for Neck Pain(VASNP) scores measured before surgery, and at 3 periods of follow-up (3,6 months after surgery,and in June 2016).And postoperative complications were also recorded.Results No significant difference existed between the two groups in the duration of operation (P>0.05).Compared with posterior group,anterior group had less intraoperative blood loss and amount of postoperative drainage,and shorter LOS (P<0.05).At each period of postoperative follow-up,the JOA scores and VASNP scores showed significant improvement in both groups(P<0.05),but the VASNP scores and cervical curvature were better in anterior group than in posterior group (P<0.05).No obvious complications of nerve and vascular were found in both groups.Conclusion Both ACHDF and LP with titanium microplate fixation provide satisfactory clinical outcomes for patients with four-level CSM.ACHDF is associated with less intraoperative lesions and better cervical curvature improvement than LP with titanium microplate fixation.The choice of surgical approach should depend on the conditions of patients and surgeon's experience,but ACHDF should be concerned priority to LP with titanium microplate fixation.%目的 比较颈椎前路混杂减压融合内固定术和后路椎管成形术结合微型钛板内固定术治疗四节段脊髓型颈椎病的临床疗效.方法 选取2008年1月—2015年6月湖州市中心医院收治的67例四节段脊髓型颈椎病患者,按照手术方式不同,将其分为前路组(37例)和后路组(30例).前路组采用颈椎前路减压三个间隙短节段钢板内固定和一个间隙自锁融合器融合术,后路组采用后路椎管成形术结合微型钛板内固定术.比较两组手术时间、术中出血量、术后引流量、住院时间,记录两组术前、术后3、6个月及末次随访时JOA评分、颈痛视觉模拟评分(VAS),并对术后并发症进行分析.结果 两组手术时间比较,差异无统计学意义(P>0.05);前路组术中出血量、术后引流量均小于后路组,住院时间短于后路组(P<0.05).两组在术后3、6个月及末次随访时,JOA评分较术前升高,颈痛VAS较术前降低(P<0.05).术后3、6个月和末次随访时,前路组颈痛VAS均低于后路组,颈椎曲度均高于后路组(P<0.05).两组均未见明显神经血管并发症.结论 颈椎前路混杂减压融合内固定术和后路椎管成形术结合微型钛板内固定术均能够有效改善四节段脊髓型颈椎病的神经功能,但与后路手术相比,前路手术能够减少术中损伤,更好恢复并改善颈椎曲度,是治疗四节段脊髓型颈椎病的一种优先选择方案.
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