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 (P0.05);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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