Posterior laminectomy and lateral mass screw fixation for the treatment of severe cervical spondylotic myelopathy

Abstract Background:Severe and complex cervical spondylotic myelopathy(CSM) requires surgical treatment, usually laminoplasty or laminectomy with lateral mass screw internal fixation. However, the operative effects of these surgical approaches are unclear.Therefore, we aimed to evaluate the clinical effects of posterior cervical laminectomy and lateral mass screw internal fixation in patients with severe and complex CSM.Methods:We retrospectively analysed 60 patients with severe and complex CSM who underwent posterior cervical laminectomy and lateral mass screw internal fixation between May 2013 and June 2020. C-spine radiographs, computed tomography scans, and magnetic resonance images were used to detect curvature and fusion of the cervical spine, restenosis, and loose/broken internal fixation screws. Clinical efficacy was evaluated using Japanese Orthopaedic Association (JOA)scores, the neck disability index (NDI), Odom’s classification, and the visual analogue scale (VAS) for pain.Results: At the last follow-up, there was no restenosis or loosened/broken internal fixations. The anterior curvature angle of lordosis (n=46) at the last follow-up was not different from that at baseline (P>0.05). The cervical kyphosis angle (n=14) at the last follow-up was improved compared with that at baseline (P<0.05), as were the JOA, NDI, and VAS scores (all P<0.05). Odom’s classifications at the last follow-up were excellent, good, and fair in 45, 12, and 3patients, respectively.Conclusions: Posterior cervical laminectomy and lateral mass screw internal fixation achieved satisfactory clinical results in severe and complex CSM cases:the cervical spine was stabilised, achieving spinal decompression while preventing excessive backward drift of the cervical spinal cord.