简介：AbstractBackground:The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.Methods:A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed.Results:There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.Conclusions:Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.

简介：目的将在颈的spondyloticmyelopathy(CSM)的广泛的门户开放政策的laminoplasty(EOLP)的临床的结果上估计不同绞链位置的影响。从2006年2月经历了EOLP到2007年2月的102个CSM病人全部的方法A在这使随机化的控制试用被注册。用一张随机的位桌子，有在侧面的团的内部边缘定位的绞链的57个病人作为门户大开的组被分类，当有在薄板边缘放的绞链的45个病人担任了狭窄打开组时。所有病人在24个月被观察，并且临床、放射学的结果统计上被分析。在那里的结果不是在操作持续时间，intraoperative流血体积，日本整形外科的协会(JOA)分数，颈的弯曲索引，运动的范围和神经功能恢复率的重要差别。神经功能令人满意地在两个组在外科以后被改进，当轴的症状的严厉比在门户大开的组(P=0.003)在狭窄打开组是显著地更低的时。尽管差别没到达统计意义，在门户大开的组的C5麻痹的发生在narrowopen组(5.3%对0)比那高(一跟踪菲希尔的准确测试，P=0.17)。绞链的结论合适的里面的移动能保证外科的解压缩的有效性，避免针的绳索的过多的向后的移动，减少C5麻痹的发生并且减轻轴的症状的严厉。

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