A comparative study of laminoplasty with short segment transpedicular screw fixation versus laminoplasty with anterior fusion in treating extensional cervical spinal cord injury without radio graphic abnormality in adults

Background: Cervical spinal cord injury(CSCI) without major fracture or dislocation is often described as cervical SCI without radiographic abnormality (SCIWORA). Majority of this injury could be without radiographic abnormality but with disrupted anterior longitudinal ligament or intervertebral disc unless examined by MRI. The optimal surgical management of this cervical spinal cord injury remains controversial. This study is to evaluate the clinical advantages of laminoplasty combined with short-segment transpedicular screw fixation for managing this issue. Methods: SCIWORA patients were collected into two groups according to different surgical methods. Patients in group A received laminoplasty combined with transpedicular screw fixation, and patients in group B received anterior cervical fusion combined with laminoplasty. All cervical spine were assessed by X-ray, CT, MRI preoperatively and postoperatively to evaluate the decompression range, bonegraft fusion and instruments location. ASIA grade and JOA score were recorded to assess the neurological function recovery. Complications, surgery time, intraoperative blood loss and hospital stay were compared between two groups. Mean follow-up was at least 2 years. Results: In this study, Forty eight patients were in group A and 54 ones were in group B. All cases were decompressed fully and obtained fusion 6-month postoperatively. The ASIA grade was improved postoperatively, but no significantly different between two groups (p=0.907). The JOA was 6.12±1.76 preoperatively and improved to 11.98±2.98 postoperatively with the 53.13% neurofunction recovery rate in group A, with no significantly different compared with group B(vs 6.63±2.45, p=0.235; vs 12.62±3.59, p=0.303; vs 57.76%, p=0.590)respectively. Total 18 complications occurred but the occurrence was significant lower in group A(p=0.020). The average surgery time was 2.2±0.32 hours, intraoperative blood loss was 304±56ml and hospital stay was 8.2±3.1 days, significantly decreased compared with group B(vs 3.1±0.29, p=0.000; vs 388±61ml, p=0.000; vs 12±2.8days, p=0.000)respectively. Conclusions: Cervical laminoplasty combined with short-segment transpedicular screw fixation is a reliable option to treat SCIWORA patients with CSS. The advantages include achieving sufficient cervical decompression, maintaining cervical stability and avoiding extra anterior cervical fusion which increases surgery time, intraoperative blood loss, postoperative complications and hospital stay.

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