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Objective: cervical spondylotic myelopathy predilection in 40 to 60 years old, is a common orthopedic clinical, mainly to the pyramidal tract symptoms. Since 1958, Smith and Robinson was first described anterior cervical decompression and interbody surgery, the technique has been widely used in the surgical treatment of cervical spondylotic myelopathy, has become the \However, some scholars observed in some patients after bad, especially the curvature of the fusion segment varying degrees of kyphosis, had a certain impact on the recovery of neurological function in patients, which could affect the efficacy of anterior cervical surgery. And some patients in the postoperative rehabilitation process or long-term presence of neck, shoulder and back stiffness, pain, limited mobility and other symptoms of neck axis (axial symptom, AS). This study will focus on the analysis of postoperative fusion segment curvature change with axial symptoms, to explore to reduce postoperative the neck axial symptoms occur key, thereby reducing, or even to avoid the occurrence of symptoms of patients with neck axis, reduce the suffering of patients. Methods: cervical spondylotic myelopathy in 70 cases, all cases were determined according to the Japanese Orthopedic Association the standard (JOA score) score. All cervical myelopathy patients were divided into two groups according to the surgical approach is different: the bone graft group, anterior cervical disc excision and autogenous iliac bone grafting without internal fixation, 30 cases. Fixation group, anterior cervical disc excision and autogenous iliac bone graft, additional internal fixation, 40 cases. Routine preoperative cervical positive lateral, hyperextension, flexion dynamic lateral X-ray and CT, MRI examination. Preoperative and postoperative neurologic evaluation criteria for efficacy evaluation using the Japan JOA17 law cervical spinal cord disease. JOA score improvement rate (the rate of the improved JOA score RIS) = (postoperative score - preoperative score) / (17 - preoperative score) × 100%. Efficacy based on the rate of improvement is divided into four levels, excellent: good: to improve the rate of 50% to 74% can: improve the rate of 25% to 49%, the difference: the rate of improvement in 25% improvement rate of 75% or more. After 1 week, 3 months, 6 months, 12 months, 24 months follow-up, observed and recorded clinical symptoms, signs, and recovery of neurological function; shooting cervical cervical and lateral X-chip (in some cases surgery after photo CT or MRI piece) observed interbody fusion pseudarthrosis and internal fixation for loose, slipping or breaking; analysis of the fusion stage of intervertebral height changes, changes in lordosis; and observe comparing two groups of patients with neck axial symptoms. Results: The patients with bone graft group JOA score increased from 9.05 ± 2.39 points preoperative to postoperative 13.62 ± 2.45, preoperative and postoperative JOA score, P lt; 0.0001, according to a = 0.05, the difference was statistically significance. JOA score of patients with internal fixation group by 8.97 ± 2.64 points preoperative to postoperative 13.85 ± 2.37, preoperative and postoperative JOA score, P lt; 0.0001, according to a = 0.05, the difference was statistically significant. The rate of improvement of the bone graft group (RIS) to 57.35 ± 31.83%, excellent rate of 80.00% to 61.10 ± 28.35%; rate of improvement of the internal fixation group (RIS), excellent rate of 82.50 percent, compared the two groups, t = 0.54, P gt; 0.05, according to a = 0.05, the difference between the rate of improvement was not statistically significant. The intervertebral height bone graft group compared with the preoperative dropped by an average of 0.8 ± 1.1 mm, internal fixation group compared with the preoperative increase of 1.5 ± 0.7 mm, the two groups, t = 10.99, P lt; 0.01 difference was statistically significant. Physiological curvature of cervical fusion segment bone graft group compared with the preoperative average reduction of 1.33 ± 3.43 °; fixation group compared with the preoperative average increased 2.51 ± 6.75 °, between the two, t = 2.93, P lt; 0.01 difference statistics significance. Neck axial symptoms, the incidence of bone graft group was 46.67%; internal fixation group was 17.50%, and the two groups, the χ to 2 = 5.625,0.01 lt; P lt; 0.05, the difference was statistically significant. Interbody fusion of bone graft group was 93.33%, 2 patients pseudarthrosis; interbody fusion fixation group was 100%. Complications of bone graft group three cases: wound infection cases, the gooseneck malunion two cases; fixation group complications in two cases: one cases of incision infection, cerebrospinal fluid leak. Steel plate and screw loosening or fracture fixation group within the fixed-related complications occurred. Were no spinal cord, nerve root injury, esophageal injury, laryngeal, recurrent laryngeal nerve injury, and other serious complications. Conclusion: The incidence of anterior cervical fusion segments postoperative curvature change with postoperative neck axial symptoms related. Anterior cervical surgery to restore and maintain the cervical intervertebral height of fusion segments and physiological curvature can reduce or even avoid the occurrence of postoperative neck axial symptoms.
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