Postoperative factors affecting neurological recovery after laminoplasty for cervical spondylotic myelopathy.

Abstract

Objective To elucidate possible postoperative factors affecting neurological recovery af-ter cervical expansive open-door laminoplasty in treatment of patients with multilevel cervical spondyiotic myelopathy. Methods This study involved the patients with multilevel cervical spondylotic myeiopathy who underwent expansive open-door laminoplasty between May 2001 and December 2006. They were classified into two groups according to the degree of neurological recovery: an excellent recovery group (group A), the recovery rotes greater than 75%, and a poor recovery group (group B), the recovery rates lower than 25%. Comparisons of various preoperative clinical and imaging parameters such as patient's age, gender, duration between symptom onset and surgery, follow-up time, preoperative JOA score, preoperative range of motion (ROM), preoperative cervical curvature index(CCI), preoperative Pavlov ratio, segments of myelopathy and so on, revealed that the mean age and mean preoperative JOA scores were significantly different. The cases with the age older than 60 years and preoperative JOA scores less than 6 were excluded. Therefore, group A re-mained 24 cases (group A1) and group B 18 cases (group B1). The same analyses were repeated between group A1 and group B1. There was no significant difference between two groups among the above mentioned parameters. Postoperative ROM and its reduction rate, postoperative CCI and its reduction rate, Pavlov ratio and its increasing rate were analyzed by t test, and the relationship between these six parameters and im-proving rate of JOA scores were also analyzed. Results Except postoperative ROM, other five indexes were statistical differences between A1 and B1 groups. Except postoperative ROM in group A1 and postoperative ROM and its reduction rate in group B1, other indexes had statistical correlation with improving rate of post-operative JOA scores. Conclusion Modulating postoperative ROM, maintaining cervical lordosis and achieving sufficient canal diameter may improve neurological recovery in selected patients. Key words: Laminectomy; Cervical spondylosis; Prognosis