Posterior Cervical Open-door Laminoplasty Combined with Pedicle Screw Fixation for Cervical Spinal Stenosis with Instability

Abstract：Objective To investigate the the necessity and curative effect of posterior cervical open-door laminoplasty combined with pedicle screw fixation for cervical spinal stenosis with instability.Methods 31 cases of cervical stenosis with unstable patients were selected to record the operation time,intraoperative bleeding and complications.Using JOA score of Japanese Orthopaedic Association (JOA) to assess neurological function;The physiological curvature of cervical vertebra was observed by X-ray.The position of vertebral pedicle screw was assessed by CT 3 d reconstruction.Results All the patients completed the operation successfully,with an average operation time of 132min (110～180 min) and 320 mL(250～450 mL) of average blood loss.All patients were followed up for 12 months to 28 months with an average of 15 months.At the end of the follow-up,the JOA score was improved to (15.19±0.75) from (11.16±2.07) points before surgery,and the difference was statistically significant (t =-15.03,P＜0.01).The curvature of the cervical vertebra was increased from the preoperative (6.52 ± 7.34) degree to the last follow-up (9.00 ± 11.01) degree,and the difference was statistically significant (t =2.79,P＜0.01).In this group,the total number of screws was 136,of which the screw perforation rate was 10.3 ％,all of which perforated the outer wall.There were 3 cases of cerebrospinal fluid leakage and 1 patient with C5 nerve root paralysis.None of the patients underwent incision infection,nerve injury or the rupture of the portal axis.Conclusion One-stage posterior cervical open-door combined with pedicle screw fixation is a safe and effective method for patients with cervical spinal stenosis and instability.