Laminectomy versus laminoplasty for treating multi-segmental cervical canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD):a retrospective study with a minimum follow-up period of two years

Laminectomy versus laminoplasty for treating multi-segmental cervical canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD):a retrospective study with a minimum follow-up period of two years | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Laminectomy versus laminoplasty for treating multi-segmental cervical canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD):a retrospective study with a minimum follow-up period of two years Qian Zhang, Jun Wang, Rudan Guo, Xiaoling Yang, Yuefen Wu, Shunyi Tong, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4474933/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To conduct a comparative analysis on the clinical outcomes of two different posterior surgical procedures, namely laminectomy fusion fixation and single open-door laminoplasty, for the treatment of multi-segmental cervical canal stenosis accompanied by central cord syndrome without fractures or dislocations (CCSWOFD). Methods A total of 112 patients were recruited from our department between January 2012 and December 2021. The patients were divided into two groups: the LF group (n = 59), who underwent laminectomy fusion fixation, and the LP group (n = 53), who underwent single open-door laminoplasty. Comparative analysis was conducted on clinical outcomes and relevant radiological findings observed in both cohorts. Results The two groups did not show any significant differences in terms of intraoperative blood loss and length of hospital stay, with a p-value > 0.05. However, the LP group exhibited a significantly reduced surgical duration compared to the LF group, with a p-value < 0.05.The final follow-up revealed significant improvements in Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, intrinsic hand muscle strength (IHMS) score, Brain and Spinal Injury Center (BASIC) score, and neurological recovery rate (RR), compared to the preoperative values for both groups (P < 0.05). The LF group demonstrated superior performance compared to the LP group in terms of final JOA score, RR, IHMS score, and BASIC score (P < 0.05). Conversely, although a significantly lower range of motion (ROM) was observed in the LF group compared to the LP group (P < 0.05), it exhibited a superior C2-7 Cobb angle. Additionally, while there was an increase in C2-7 sagittal vertical axis (SVA) after surgery in the laminoplasty (LP) group, it showed a significant decrease in the laminectomy (LF) group compared to that observed in the LP group (P < 0.05). No statistically significant differences were found between the two groups when considering K-line positivity with respect to their final JOA scores and VAS scores (P < 0.05). However, significantly better outcomes were observed for the LF group in terms of IHMS scores and RR (P < 0.05). In cases where K-line negativity was present, superior final JOA scores, IHMS scores, and RR were seen in the LF group compared to those observed in the LP group (P < 0.05). Nonetheless, there were no notable discrepancies between both groups concerning complications; furthermore, a low incidence of complications was noted within each group. Conclusion In terms of restoring neurological function, alleviating pain, enhancing motor ability, and reducing spinal cord edema, both laminectomy fusion fixation and single open-door laminoplasty have demonstrated efficacy as surgical options. However, when considering the achievement of better final C2-7SVA,C2-C7 Cobb angle, JOA score, IHMS score, RR and BASIC score, laminectomy fusion fixation surpasses single open-door laminoplasty. Despite the shorter surgical duration and preserved range of motion associated with single open-door laminoplasty, laminectomy fusion fixation is considered the optimal primary treatment for canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD), particularly in cases involving multi-segmental ossification of the posterior longitudinal ligament (OPLL) with K-line (-). multi-segment laminectomy laminoplasty central cord syndrome without fracture or dislocation canal stenosis ossification of the posterior longitudinal ligament efficacy comparison Figures Figure 1 Figure 2 Figure 3 Introduction Central cord syndrome without fracture or dislocation (CCSWOFD) is commonly characterized by normal radiographs [ 1 ] or the absence of traumatic evidence on imaging studies [ 2 ] . These injuries predominantly affect older populations with degenerative changes in their cervical spine and primarily occur due to excessive extension, resulting in compression within the narrowed spinal canal [ 3 , 4 ] . In the United States, approximately 8.7% of individuals aged 60 and above experience CCSWOFD [ 5 ] , while it constitutes around 47% of all cases involving cervical spinal cord damage in Japan [ 6 ] . Moreover, there has been a noticeable increase in the incidence rate of this type of partial injury to the cervical spinal cord within China's aging population. Central cord syndrome is a commonly observed incomplete injury to the cervical spinal cord, frequently occurring in the absence of fractures or dislocations. The clinical definition of central cord syndrome was initially proposed by Schneider et al. in 1954 [ 7 ] . Despite the lack of visible fractures or dislocations in the cervical region, a majority of patients present with pre-existing degenerative conditions like herniated discs, ossification of the posterior longitudinal ligament (OPLL), and hypertrophy of the ligamentum flavum [ 8 ] .The clinical presentation entails varying degrees of paralysis in both the upper and lower extremities, with a predilection for greater severity observed in the upper extremities. Additionally, patients may demonstrate diverse levels of sphincter control dysfunction and sensory impairment. When an external force is applied to the patient's neck region, two significant factors that contribute to narrowing of the spinal canal and subsequent development of central cord syndrome are cervical disc herniation with or without osteophyte formation and ossification of the posterior longitudinal ligament (OPLL). Patients presenting with central cord syndrome and neurological symptoms typically require surgical intervention rather than conservative therapy [ 9 ] . Currently, there is an ongoing debate regarding the indications, timing, approach, and prognostic factors for surgical treatment [ 10 ] . Depending on the extent of spinal cord injury and canal stenosis, either anterior or posterior cervical surgery may be performed. Anterior procedures such as anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are commonly employed; however, they are more suitable for patients with involvement in fewer than three segments. One advantage of these anterior procedures is that they provide direct access to the affected area without having to manipulate or retract important structures such as nerves or blood vessels located at the back of the spine. This approach allows for better visualization and easier removal of discs or bone fragments. Conversely, posterior approaches are commonly regarded as more favorable for managing multi-segmental cervical canal stenosis due to their reduced incidence of complications, this may be attributed to factors such as reduced manipulation of vital structures like blood vessels and esophagus during surgery. Minimizing these risks can play a role in enhancing patient results and expediting the recovery process [ 11 ] . The techniques of laminectomy fusion fixation and single open-door laminoplasty are widely employed among the posterior surgical options for cases of CCSWOFD. However, there is currently a lack of comprehensive statistical analysis comparing these two surgical procedures to ascertain their relative superiority. Therefore, this retrospective study was undertaken to examine the clinical outcomes associated with laminectomy fusion fixation and single open-door laminoplasty for treating multi-segmental spinal cord stenosis combined with CCSWOFD. The aim is to assess their comparative efficacy and offer insights for surgical decision-making in subsequent clinical settings. 1. Materials and Methods 1.1 General Information From January 2012 to December 2021, a total of 112 patients diagnosed with central cord syndrome but without fracture or dislocation were selected for this study. The patients underwent either posterior laminectomy fusion or single open-door laminoplasty at our department. Prior to the surgery, preoperative anteroposterior and lateral X-ray films, CT scans, and magnetic resonance imaging (MRI) of the cervical spine were obtained to evaluate the extent of spinal cord compression and injury. Inclusion criteria for patient selection included: (1) presence of multi-segment cervical canal stenosis involving three or more segments, as evidenced by a spinal canal anteroposterior diameter less than 12 mm on imaging; (2) absence of significant cervical kyphosis; (3) manifestation of symptoms related to central cord injury; (4) availability of complete preoperative and postoperative data with a minimum follow-up period lasting at least 24 months. Patients with spinal canal stenosis affecting only one or two segments, as well as those presenting evident cervical kyphosis unsuitable for posterior surgeries, were excluded from the study. Additionally, patients with a history of surgery on the corresponding segment, combined spinal deformity, tumor or infection were also excluded. Individuals with concurrent diseases that may impact neurological function assessment such as motor neuron disease, Parkinson's disease, cerebral palsy and cerebral infarction were likewise excluded from the study. Finally, cases where postoperative follow-up data was incomplete or had a follow-up time less than two years were not considered in our analysis. 1.2 Surgical methods The patients underwent the administration of general anesthesia and were positioned in a prone posture. The head was placed facing downwards on the head frame, while the abdomen was elevated. No pressure was applied to the eyes, and standard sterilization procedures were followed to prepare the surgical area. A posterior median incision was performed. In the LP group, a 12 cm incision was made from the lower edge of the C2 spinous process to the upper edge of the C7 spinous process. Sequentially, an incision was performed on the skin, subcutaneous tissue, and fascial layers. The paravertebral muscles on both sides were dissected along the spinous process. Medially exposed were bilateral laminae of C3-C6 up to the facet joint. Following confirmation of decompression segments through C-arm X-ray fluoroscopy, bone grafting was conducted by removing the spinous processes of C3-C6. A groove was created at the inner edge of each facet joint on both sides (C3-C6) for careful grinding with a drill that selectively removed only the outer cortical bone while preserving the integrity of the inner cortical bone. Access to open and expose laminae from C3-C6 on one side was gained using a 45°angled nerve hook. Subsequently, steel plates measuring 8-12 mm in length were individually placed at levels corresponding to C3-C6 and secured with screws for internal fixation. Intraoperative fluoroscopy confirmed the accurate positioning of internal fixation devices. The surgical site was thoroughly irrigated with copious amounts of normal saline solution for effective cleansing and bleeding control purposes. Once active bleeding ceased observationally, strips cut from spinous process bones were implanted alongside portal shafts . In the LF group, a 15 cm longitudinal incision was made along the spinous process. The skin, subcutaneous tissue, and posterior cervical fascia were incised, and the paravertebral muscle tissue was dissected layer by layer. Fluoroscopy verified accurate positioning of the screws. The connecting rod of appropriate length was pre-bent and positioned at the tail of each screw to match the physiological curvature. The cervical spine's physiological lordosis was restored by extending the neck backwards.. The bilateral lamina edges were gradually polished using grinding drills until reaching the inner cortical bone. Residual connective bone tissue and ligamentum flavum tissue on the polished side of laminae were meticulously removed with forceps in an "uncapping" manner. Subsequently, the C3-C6 laminae were fully exposed while completely eliminating any pressure factors during surgery. Exploration revealed an intact dura mater with noticeable bulging and normal pulsation. Thorough polishing was performed on the bilateral lateral masses of C3-C6, and the removed lamina bone tissue was prepared into 2-3 mm granular bone grafts for fusion. 1.3 Postoperative Management The patient's postoperative vital signs were closely monitored, while a 3-day course of methylprednisolone and antibiotics was administered and continued. The timely removal of drainage tubes was determined based on an evaluation of the color and volume of wound discharge. In order to promote optimal healing, cervical braces were provided to patients for a duration of 4 weeks, during which gradual introduction of gentle movements such as nodding and turning the head followed the removal of drainage tubes. 1.4 Observation Indicators (1) Surgical Complications The patients were monitored for a minimum duration of 24 months in order to observe any incidences of surgical site infection, cerebrospinal fluid leakage, symptoms associated with the axial region, fifth cervical nerve root paralysis, spinal epidural hematoma, and other potential complications. (2)Assessment of neurological function Neurological function assessment of patients was performed using the Japanese Orthopaedic Association (JOA) score both preoperatively and during their final follow-up. To calculate the rate of neurological recovery (RR), it was determined by: (final JOA score - preoperative JOA score)/(17 (maximum score) - preoperative JOA score) × 100% [13] . Following Yamazaki et al's methodology, a favorable prognosis was defined as a JOA score improvement rate >50%, while an unfavorable prognosis was defined as a JOA score improvement rate ≤50% [14] . (3) Assessment of Pain The assessment for neck and upper limb pain was performed before surgery and during the final follow-up using the Visual Analogue Scale (VAS) score. Pain intensity was evaluated on a numerical scale ranging from 0 to 10, with higher scores indicating more severe pain [15] . (4)Assessment of motor function The ASI motor score, which is a component of the American Spinal Injury Association Impairment Scale, serves as a standardized assessment method utilized to evaluate motor strength through the examination of myotomes [16] . Given its predominant impact on upper limb functionality [17] , we employed scores for intrinsic hand muscle strength to assess hand mobility, including bilateral digital flexor muscle strength and little finger abductor muscle strength. The evaluation utilizes a universally recognized six-point scale (ranging from 0 to 5) to assess the bilateral motor strength of each muscle group, with higher scores indicating improved hand strength. (5)Assessment of intraparenchymal cord injury The Brain and Spinal Injury Center (BASIC) score was used to assess the extent of intramedullary high-signal and intraparenchymal cord injury. In brief, a spinal cord injury (SCI) with a BASIC score of 0 indicated normal T2 relaxivity of the spinal cord without any discernible pathological intramedullary signal. A BASIC score of 1 represented cases where there was confined pathological T2 hyperintensity primarily in the gray matter of the spinal cord. If the pathological intramedullary T2 hyperintensity extended beyond the margins of central gray matter and obscured the boundaries between gray and white matter, it would be assigned a BASIC score of 2.Conversely, if the entire transverse extent of the spinal cord is affected by pathological T2 hyperintensity without any remaining normal-appearing white matter, it would receive a BASIC score of 3. Lastly, an SCI with a BASIC score of 4 refers to an injury classified as BASIC Score 3 but also exhibits additional distinct areas of macroscopic intramedullary hemorrhage resulting in hypointense signals on T2 imaging [18] . (6) Assessment of employability The assessment of daily functional recovery and employability level was conducted using the Indian modifications of the (imNurick) scale, which is a standardized six-point grading system (ranging from 0 to 5).Grade 0 indicates absence of signs or symptoms related to root involvement, without any evidence of spinal cord disease. Grade 1 signifies the presence of spinal cord disease but no ambulatory difficulties. Grade 2 represents mild challenges in ambulation, yet the individual can independently rise from squatting or sitting on the ground without requiring external support. Grade 3 reflects moderate difficulty in walking and necessitates external support when transitioning from squatting or sitting positions. Grade 4 denotes dependence on assistance from another person or assistive device for ambulation. Lastly, grade 5 corresponds to being confined to a wheelchair or bedridden [19] . A higher grade implies poorer employability and daily functional outcomes. (7) Imaging Assessment Cervical Sagittal Balance Index (C2-7 SVA): This index provides valuable insights into the sagittal balance and degree of anteversion in the cervical spine. To quantify this index, we precisely measure the vertical distance between the posterior-superior edge of C7 vertebra and a vertically aligned line passing through the center of second cervical vertebra on a lateral X-ray image ( Fig.A ). The presence of a higher C2-7 SVA value indicates a potential compromise in the sagittal balance of the cervical spine [12] . Range of Motion (ROM) : Cervical range of motion (ROM) was evaluated through dynamic X-ray imaging during neck flexion and hyperextension, with specific focus on measuring the C2-7 Cobb Angle. The angle β represents flexion, where a negative value indicates reverse motion in the cervical spine (CS). Conversely, α denotes hyperextension, allowing ROM to be calculated as α+β. By subtracting postoperative ROM from preoperative ROM, an angle reflecting loss can be obtained ( Fig.B.C ). C2 – C7 Cobb angle : This measurement involves determining an angle between lower endplates of C2 and C7 on a standard lateral X-ray film ( Fig.A ). 1.5 Statistical analysis Version 22.0 of the SPSS software was used for statistical analysis purposes. The measurement data were presented as mean±standard deviation (x̄±s) and analyzed using t-tests, while count data were expressed in percentages and analyzed using χ 2 tests. Statistical significance was considered when the p-value < 0.05. 2. Results The age range of the patients was between 33 and 62 years. The LF group comprised 59 cases, including 31 males and 28 females, with ages ranging from 39 to 75 (with an average age of 57.75±18.72) years. Within this group, there were ten cases of multi-segmental cervical disc herniation, twenty-three cases of OPLL with K-line(-), and twenty-six cases of OPLL with K-line(+). Additionally, diabetes occurred in five cases and hypertension in eight cases among these individuals. The LP group consisted of fifty-three cases, including twenty-seven males and twenty-six females aged between thirty-eight and seventy-seven years (with a mean age of 58.77±19.45). Among them, twelve had multi-segmental cervical disc herniation while eighteen had OPLL with K-line(-) and twenty-three had OPLL with K-line(+). Moreover, four individuals had diabetes while six suffered from hypertension. The demographic characteristics of the two cohorts are presented in Table 1 . No significant differences were observed between the two groups in terms of gender, age, smoking status, diabetes, hypertension, number of disc herniation, number of ossified vertebral or intramedullary high-signal lesion (P>0.05). The duration of surgical procedures, overall blood loss, length of hospital stay, and number of lamina opened in both groups are presented in Table 2 . The two groups did not exhibit any statistically significant disparities in terms of overall blood loss (P=0.526), duration of hospitalization (P=0.428), and quantity of laminae opened (P=0.285).However, it is noteworthy that the LP group exhibited a comparatively shorter surgical duration than the LF group (P = 0.03). Table 3 presents the clinical outcomes and recovery of intraparenchymal cord injury in patients. No significant disparities were observed in preoperative JOA score, VAS score, IHMS score, BASIC score, and RR between the two groups(P>0.05). However, both groups exhibited statistically significant improvement in all parameters after surgery (P < 0.05). It is worth mentioning that the LF group demonstrated significantly superior JOA scores, IHMS score, BASIC score and RR compared to the LP group (P < 0.05). The C2-7 sagittal vertical axis (SVA) and range of motion (ROM) between the LF group and LP group were compared preoperatively and at the last follow-up, as shown in Table 4 . The preoperative C2-7 SVA was found to be comparable between the two groups with no significant difference observed (P > 0.05). However, at the last follow-up, a significant increase in C2-7 SVA was observed in the LP group while a decrease was noted in the LF group, indicating a statistically significant difference between these outcomes (P 0.05). However, at the final follow-up, both groups exhibited a decrease in range of motion; furthermore, there was a statistically significant difference detected between these two groups' outcomes (P 0.05). Nevertheless, at final follow-up evaluation, it was observed that this angle had increased to some extent in the LF group while decreasing slightly in the LP group; once again highlighting a statistically significant distinction between these outcomes(P <0 .05). The surgical indications for LF and LP were investigated in our study, where patients with OPLL were classified into subgroups based on their K-line status ( Table 5 ). Our results indicate that when a positive K-line was present, there were no significant differences observed between the two groups in terms of the final JOA score and IHMS score (P=0.125 and P=0.327 respectively).However, it is worth noting that the LF group exhibited significantly superior outcomes in terms of RR compared to the LP group (P=0.029). Conversely, when a negative K-line was observed, we discovered significantly higher final JOA scores, IHMS scores, and RR favoring the LF group over those observed in the LP group (P = 0 .016,P = 0 .019 and P = 0 .018 respectively). Table 6 The occurrence of postoperative complications was compared between the two groups, revealing similar rates of incision infection, cerebrospinal fluid leakage, axial symptoms, C5 nerve root palsy, and symptomatic spinal epidural hematoma (SEH) (P>0.05). Furthermore, there were no significant differences observed in the overall complication rates (P>0.05). 3 Discussion multi-segmental cervical canal stenosis refers to a specific anatomical configuration of the cervical canal, characterized by a consistent sagittal diameter-to-segment ratio below 0.75 for more than three consecutive segments. This condition predisposes individuals to compression or injury of the cervical spinal cord. The classification of spinal stenosis is determined by the underlying pathological conditions, primarily associated with intervertebral disc herniation and ossification of the posterior longitudinal ligament (OPLL) [20] . Central cord syndrome is a prevalent form of incomplete cervical cord injury frequently resulting from high-speed accidents, often coexisting with degenerative diseases in the cervical spine that contribute to varying degrees of spinal stenosis. The presence of spinal cord compression may initially manifest without apparent symptoms. However, as degenerative changes in the spine progressively diminish the protective space surrounding the spinal cord, trauma can lead to compression injuries at affected sites impacted by OPLL or intervertebral disc protrusion. The occurrence of canal stenosis in adults who experience external forces, such as accidents or injuries involving sudden excessive flexion and extension, is significantly influenced by the presence of cervical disc herniation and OPLL. These conditions act as inherent risk factors for the development of CCSWOFD [21] . Currently, there are two treatment options available for multi-level cervical canal stenosis combined with CCSWOFD: conservative therapy or early surgical intervention. A research conducted by Jin et al [22] discovered that a total of 17 patients were treated non-surgically; however, after 6 weeks, it was observed that 8 patients experienced varying degrees of neurological deterioration and recurrence. The current consensus recognizes the significant benefits of early surgical intervention in alleviating motor neuron dysfunction at both the injury site and distal spinal cord, as well as mitigating the loss of secondary motor neurons associated with CCSWOFD. In the mid- to long-term follow-up for all patients, Wang et al [23] reported no significant difference in JOA score between anterior and posterior approaches. However, when considering the Frankel classification, notable distinctions were observed between surgically treated patients and those managed conservatively. Prior research has established that timely surgical intervention is highly effective in promptly relieving spinal cord compression, resulting in a decrease in the occurrence of neurological symptoms and complications [24] . Multiple surgical techniques can be employed for the treatment of CCSWOFD, including the anterior approach, posterior approach, or their combination. In cases where canal stenosis coexists with CCSWOFD, two commonly utilized surgical interventions involve performing an anterior cervical discectomy and fusion (ACDF) or an anterior cervical corpectomy and fusion (ACCF). These procedures directly address the compression tissue located anterior to the cervical cord, restoring natural alignment and function while ensuring stability within the cervical spine. The previous research has revealed potential complications and intricate procedures linked to anterior approaches [25] . As a result, ACDF and ACCF are typically recommended for treating CCSWOFD affecting fewer than three levels. These surgical procedures have been widely accepted as effective treatment options for patients suffering from this specific condition. conversely, posterior approaches such as laminectomy fusion and fixation or single/double-door laminoplasty are often preferred for multi-level cases. The single open-door laminoplasty involves repositioning the lamina to enlarge the cervical canal, resulting in dorsal displacement of the spinal cord for effective decompression. In traditional open-door laminoplasty, both sides undergo dissection of the paravertebral muscles. On one side, a unilateral laminotomy is performed followed by a cortical incision on the other side to thin out and reduce thickness of the lamina. The elevated lamina is then stabilized using mini-plates and screws to create additional space for posterior displacement of the spinal cord. Laminectomy fusion and fixation is another commonly employed posterior surgical technique that offers advantages such as extensive indirect decompression of the spinal cord and restoration of lordotic physiological curvature. However, due to the potential for postoperative instability associated with laminectomy alone, it is commonly combined with lateral mass screw fixation or fusion at present. This combination approach effectively mitigates risks related to kyphosis, post-surgical segmental instability , progression of ossification of the posterior longitudinal ligament (OPLL), and neurological deterioration [26] . Nevertheless, an ongoing debate persists regarding whether laminectomy or laminoplasty should be utilized for multi-segmental canal stenosis combined with CCSWOFD. Our research findings suggest that both laminectomy and laminoplasty are effective in improving neurological symptoms, reducing pain, enhancing motor ability and employability, as well as relieving edema or hemorrhage of the cervical cord. The final JOA scores and VAS scores for both groups demonstrated significant improvement compared to pre-operation levels, indicating a clear enhancement in neurological function and pain relief. Furthermore, the LF group exhibited superior JOA scores and a higher rate of neurological recovery during follow-up (P<0.05). The underlying cause for this phenomenon lies in the presence of multi-level cervical canal stenosis, which can result in spinal cord compression due to multiple protruding cervical intervertebral discs or OPLL at various locations, as well as varying degrees of relative displacement or angle between vertebral bodies during hyperextension or flexion of the cervical spine. As a result, there is an increased instantaneous pressure exerted on the spinal cord, leading to more severe injury. However, laminectomy decompression and fusion with a lateral mass fixation system help maintain the normal lordotic physiological curvature of the cervical spine while controlling intervertebral movement of ossified segments. This prevents late kyphosis and enables better posterior shift as well as adequate decompression of the cervical cord. By implementing these measures, healthcare professionals aim to enhance overall patient outcomes and quality of life. The prevention of late kyphosis not only promotes better posture but also alleviates discomfort and pain associated with spinal abnormalities. Moreover, facilitating a posterior shift and ensuring adequate decompression can effectively mitigate the risk of further neurological complications arising from compression on the cervical cord, thereby elucidating why posterior laminectomy surpasses laminoplasty in terms of long-term improvement in neurological function. The assessment of the natural curvature of the cervical spine usually includes determining values such as C2-7 sagittal vertical axis (C2-7SVA) and measuring the angle between vertebrae C2 and C7, known as the Cobb angle [27] . Dynamic X-ray films are utilized to assess cervical range of motion (ROM) by quantifying flexion and hyperextension angles at the level spanning from vertebrae C2 to C7. The cumulative value obtained from these measurements reflects the comprehensive extent of movement within this region. The previous investigations conducted by Kim et al. [28] have demonstrated that an increase in cervical lordosis is associated with decreased values for C2-7SVA, while a decrease in lordotic curvature or an increase in kyphosis corresponds to elevated levels of this parameter. In our study, patients who underwent laminoplasty demonstrated a significant increase in their respective C2-7SVA values; however, there was a simultaneous decrease observed in both ROM and the Cobb angle encompassing vertebrae C3 through C7. In contrast, patients who underwent laminectomy with fusion (LF) exhibited a notable elevation in the C2-7 Cobb angle but experienced a reduction in range of motion and C2-7SVA at the final follow-up. The maintenance of lordotic physiological curvature through rigid fixation in the LF group, as well as unintended autofusion along the lateral margin of laminar, can be attributed to this phenomenon. However, inadequate rigid fixation and paravertebral muscle dissection during LP led to the development of sagittal imbalance within the cervical spine over time, resulting in a decrease in the C2-C7 Cobb angle. The scores of intrinsic hand muscle strength showed significant improvements (P< 0.05) in both groups, indicating a substantial enhancement in the patients' physical activity capacity following either lamnectomy or laminoplasty. However, the LF group demonstrated superior performance compared to the LP group by achieving significantly higher final scores .The proposal by Aarabi et al [29] suggested that the ASI motor score upon admission could serve as a prognostic indicator for CCS patients. However, it is important to note that this composite score includes both upper and lower extremity components. Nevertheless, CCS primarily manifests with severe symptoms that mainly affect the upper limbs rather than the lower limbs, thus highlighting its predominant impact on dysfunction in the upper extremities. Therefore, relying solely on the ASI motor score may not accurately predict patient prognosis. The underlying pathology of CCS lies in the anatomical distribution of corticospinal tract fibers, with those supplying the upper limb being located more centrally within the spinal cord. Consequently, the functionality of the upper limbs can be significantly affected by central spinal cord contusion or hematoma [30] . The study conducted by Levi et al [31] proposed that intact corticospinal tracts play a critical role in hand function in primates. Additionally, neurophysiological investigations carried out by Curt et al [32] have revealed that axons controlling hand movement are more vulnerable to damage compared to those controlling lower limb movement in cases of central cord syndrome (CCS). At the final follow-up, both groups exhibited significant improvement in BASIC scores (P<0.05), indicating the effective reduction of intramedullary edema and hemorrhage symptoms through both surgical procedures. Moreover, the LF group demonstrated superior overall BASIC scores compared to the LP group (P<0.05). However, the reasons behind the superior performance observed in the LF group compared to the LP group during last follow-up remain unclear. This disparity can be attributed to the laminectomy technique, which removes the lamina with rigid fixation, thereby preventing long-term instability. The preservation of a buffer space for spinal cord movement and the facilitation of expedited recovery from intramedullary edema and hemorrhage are achieved as a result. This buffer space allows for enhanced flexibility and mobility within the spinal cord, ultimately contributing to expedited recovery from intramedullary edema and hemorrhage. The absence of rigid structures such as the lamina reduces compression on the spinal cord, allowing it to heal more efficiently. The BASIC score is a reliable classification system proposed by Talbott JF et al [18] to assess acute blunt traumatic spinal cord injuries (SCIs) based on observed T2 signal abnormality patterns in axial plane imaging at the injury epicenter. It has demonstrated excellent prognostic potential across all severities of SCI. This classification system builds upon existing literature and provides valuable prognostic stratification for patients with SCIs by identifying functionally and anatomically significant patterns of T2 hyperintensity in axial plane images, irrespective of arbitrary measures of longitudinal signal abnormality. The K-line, initially proposed by Fujiyoshi and colleagues [33] , functions as a prognostic tool for evaluating the clinical effectiveness of posterior cervical decompression in patients with OPLL. It is defined as a linear connection between the midpoints of the cervical canal from C2 to C7 on a standard lateral cervical X-ray image. The classification of patients as K-line positive occurs when their OPLL does not extend beyond this line, while they are classified as K-line negative when it does. To enhance the understanding of the correlation between cervical physiological curvature and clinical results, patients diagnosed with multi-segmental OPLL were classified into subgroups according to the pivotal K-line index, which is linked to cervical physiological curvature [34] .Our study findings demonstrate that in cases where the K-line is positive, the LF group exhibits a significantly superior recovery rate (RR) compared to the LP group. Conversely, when the K-line is negative, we observed significantly higher final JOA scores, IHMS scores, and RR in the LF group as opposed to the LP group. We proposed that the observed enhanced outcomes in the LF group may be attributed to rigid fixation, which maintains a larger postoperative C2-C7 Cobb angle and consequently creates increased buffer space for posterior movement of the cervical cord. The maintenance of a larger postoperative C2-C7 Cobb angle allows for improved spinal alignment, reducing stress on the surrounding structures and potentially preventing further degeneration or complications. In addition to reducing stress and preventing degeneration, an optimal Cobb angle also contributes to better posture. Good posture not only enhances physical appearance but also promotes efficient body mechanics while performing daily activities. It ensures that all body parts are properly aligned, allowing for smooth movements without unnecessary strain on any particular area. In terms of postoperative complications, there were no significant disparities observed between the two groups. However, both groups exhibited a relatively high incidence of C5 nerve root palsy and axial pain. C5 nerve root palsy is more frequently observed in males and typically manifests as deltoid and biceps brachii muscle weakness, accompanied by reduced or absent sensation in the shoulder and lateral arm. Additionally, there may be diminished or absent biceps tendon reflex. These symptoms can manifest within a few days or weeks following surgery but are generally transient, leading to the adoption of conservative treatment approaches. The main pathological mechanism responsible for the development of C5 nerve root palsy is thought to be the entrapment effect exerted on the nerve root [35] . Imagama et al [36] reported that approximately 67% of patients who underwent laminoplasty and experienced postoperative C5 nerve root palsy recovered without requiring surgical intervention during an average follow-up period of 4.1 months. Postoperative C5 nerve root palsy is also a common and challenging complication following posterior laminectomy, with an overall incidence rate of 11.3%. Preexisting risk factors include intervertebral foraminal stenosis, ossification of the posterior longitudinal ligament, herniation of multi-level cervical disc, and male gender [37] . Generally speaking, resolution of C5 nerve root palsy tends to occur within several months without specific management; However, it necessitates rehabilitation that emphasizes on enhancing muscular strength and performing exercises to improve the range of motion [38] . Currently, there remains a limited understanding regarding the precise factors underlying axial pain. It is believed that variables such as cervical curvature, extent of paravertebral muscle dissection during surgical procedures, rate of preoperative spinal cord compression, and subsequent postoperative displacement are associated with this type of pain. Moreover, a shift in the position of the spinal cord after surgery is considered a potential risk factor for developing axial pain. The occurrence thereof can potentially be attributed to dura mater bulging or excessive deformation affecting the cervical spinal cord; alternatively, it may result from injury or necrosis impacting blood vessels responsible for innervating autonomic nerves. The study conducted by Hosono et al [39] revealed a significantly higher prevalence of axial pain in patients who underwent laminoplasty compared to those who underwent anterior fusion (60% vs 19%, respectively). Among the patients who underwent laminoplasty, 26% experienced postoperative neck pain with an average duration of 5.5 months; however, this condition improved within 1 to 1.5 years after surgery. The study conducted by Nurboja et al [40] demonstrated that patients who underwent cervical laminectomy experienced significant relief from axial pain compared to those who underwent laminoplasty, particularly when decompression was performed over more than three vertebral levels. Preserving the semispinalis cervicis muscle may play a crucial role in reducing the incidence of axial neck pain. The higher occurrence rate of axial symptoms observed in our study could potentially be attributed to extensive dissection performed on paravertebral muscles. The present study has several limitations. First and foremost, it is crucial to acknowledge that this retrospective study was conducted solely at one institution. Secondly, the sample size utilized in this research was relatively small. Lastly, the duration of follow-up employed in this investigation was comparatively short-lived. Henceforth, future studies should contemplate conducting a prospective randomized controlled trial encompassing multiple institutions with an enlarged sample size and an extended follow-up period. In conclusion, both laminectomy fusion fixation and single open-door laminoplasty have demonstrated efficacy as surgical options for restoring neurological function, alleviating pain, enhancing motor ability, and reducing spinal cord edema. However, when considering the achievement of better final C2-7 SVA, C2-C7 Cobb angle, JOA score, IHMS score, RR and BASIC score; laminectomy fusion fixation excels single open-door laminoplasty. Despite the shorter surgical duration and preserved range of motion associated with laminoplasty, laminectomy fusion fixation is considered the optimal primary treatment for canal stenosis combined with CCSWOFD, particularly in cases involving multi-segmental OPLL with K-line (-). Abbreviations central cord syndrome without fracture or dislocation (CCSWOFD);laminectomy and fusion (LF); laminoplsty(LP);ossification of the posterior longitudinal ligament (OPLL); Japanese Orthopaedic Association (JOA); Visual Analogue Scale (VAS);IHMS(intrinsic hand muscle strength); Indian modification of Nurick( imNurick );RR(recovery rate);range of motion (ROM); sagittal vertical axis(SVA);anterior cervical discectomy decompression and fusion (ACDF);anterior cervical corpectomy decompression and fusion (ACCF);magnetic resonance imaging (MRI); cerebrospinal fluid (CSF);surgical site infection(SSI); spinal epidural hematoma(SEH) Declarations Ethics approval and consent to participate This study was approved by the ethics committee of Lanxi People's Hospital. All methods were performed in accordance with the relevant guidelines and regulations. Each patient gave the written informed consent on this study. Disclosure Qian Zhang, Jun Wang, Rudan Guo should be considered the joint first authors Consent for publication Not applicable Availability of data and materials All data generated or analysed during this study are included in this published article Competing interests The authors declare that they have no competing interests Funding None Authors' contributions Qian Zhang,Jun Wang,Rudan Guo: literature research; manuscript preparation; manuscript editing; data analysis Xiaoling Yang: study design; clinical studies; manuscript review Yuefen Wu: data acquisition; statistical analysis Shunyi Tong: guarantor of integrity of the entire study; experimental studies Chao Miao: study concepts; definition of intellectual content All authors read and approved the final manuscript Acknowledgements None References Nakajima H, Honjoh K, Watanabe S, e al. Management of Cervical Spinal Cord Injury without Major Bone Injury in Adults. J Clin Med. 2023 Oct 27;12(21):6795. doi: 10.3390/jcm12216795. PMID: 37959260; PMCID: PMC10650636. Lee S, Kim C, Ha JK, et al. Comparison of Early Surgical Treatment With Conservative Treatment of Incomplete Cervical Spinal Cord Injury Without Major Fracture or Dislocation in Patients With Pre-existing Cervical Spinal Stenosis. Clin Spine Surg. 2021 Apr 1;34(3):E141-E146. doi: 10.1097/BSD.0000000000001065. PMID: 32925187. Takao T, Morishita Y, Okada S, et al. Clinical relationship between cervical spinal canal stenosis and traumatic cervical spinal cord injury without major fracture or dislocation. Eur Spine J. 2013 Oct;22(10):2228-31. doi: 10.1007/s00586-013-2865-7. Epub 2013 Jun 23. PMID: 23793521; PMCID: PMC3804697. Kumar AA, Wong JYH, Pillay R, et al. Treatment of acute traumatic central cord syndrome: a score-based approach based on the literature. Eur Spine J. 2023 May;32(5):1575-1583. doi: 10.1007/s00586-023-07626-3. Epub 2023 Mar 13. Erratum in: Eur Spine J. 2023 May 4;: PMID: 36912986. Asemota AO, Ahmed AK, Purvis TE, et al. Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database: Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges. World Neurosurg. 2018 Dec;120:e114-e130. doi: 10.1016/j.wneu.2018.07.228. Epub 2018 Aug 2. PMID: 30077751. Takao T, Okada S, Morishita Y, et al. Clinical Influence of Cervical Spinal Canal Stenosis on Neurological Outcome after Traumatic Cervical Spinal Cord Injury without Major Fracture or Dislocation. Asian Spine J. 2016 Jun;10(3):536-42. doi: 10.4184/asj.2016.10.3.536. Epub 2016 Jun 16. PMID: 27340535; PMCID: PMC4917774. Engel-Haber E, Snider B, Kirshblum S. Central cord syndrome definitions, variations and limitations. Spinal Cord. 2023 Apr 5. doi: 10.1038/s41393-023-00894-2. Epub ahead of print. PMID: 37015975. Thompson C, Gonsalves JF, Welsh D. Hyperextension injury of the cervical spine with central cord syndrome. Eur Spine J. 2015 Jan;24(1):195-202. doi: 10.1007/s00586-014-3432-6. Epub 2014 Jul 31. PMID: 25077941. Aarabi B, Koltz M, Ibrahimi D. Hyperextension cervical spine injuries and traumatic central cord syndrome. Neurosurg Focus. 2008;25(5):E9. doi: 10.3171/FOC.2008.25.11.E9. PMID: 18980483. Hashmi SZ, Marra A, Jenis LG, et al. Current Concepts: Central Cord Syndrome. Clin Spine Surg. 2018 Dec;31(10):407-412. doi: 10.1097/BSD.0000000000000731. PMID: 30346310. Jia Y, Zuo X, Zhang Y, et al. Effectiveness of different surgical methods in the treatment of acute central cord syndrome without fractures and dislocations of the cervical spine. J Back Musculoskelet Rehabil. 2023;36(1):71-77. doi: 10.3233/BMR-210377. PMID: 35988214; PMCID: PMC9912723. Oshima Y, Takeshita K, Taniguchi Y, et al. Effect of Preoperative Sagittal Balance on Cervical Laminoplasty Outcomes. Spine (Phila Pa 1976). 2016 Nov 1;41(21):E1265-E1270. doi: 10.1097/BRS.0000000000001615. PMID: 27054450. Ishibashi Y, Adachi N, Koga H, et al. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci. 2020 Jan;25(1):6-45. doi: 10.1016/j.jos.2019.10.009. Epub 2019 Dec 13. Erratum in: J Orthop Sci. 2022 Jan;27(1):296. PMID: 31843222. Yamazaki T, Yanaka K, Fujita K, et al. Traumatic central cord syndrome: analysis of factors affecting the outcome. Surg Neurol. 2005 Feb;63(2):95-9; discussion 99-100. doi: 10.1016/j.surneu.2004.03.020. PMID: 15680638. Myles PS, Myles DB, Galagher W, et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017 Mar 1;118(3):424-429. doi: 10.1093/bja/aew466. PMID: 28186223 Roberts TT, Leonard GR, Cepela DJ. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res. 2017 May;475(5):1499-1504. doi: 10.1007/s11999-016-5133-4. Epub 2016 Nov 4. PMID: 27815685; PMCID: PMC5384910. van Middendorp JJ, Goss B, Urquhart S, et al. Diagnosis and prognosis of traumatic spinal cord injury. Global Spine J. 2011 Dec;1(1):1-8. doi: 10.1055/s-0031-1296049. PMID: 24353930; PMCID: PMC3864437. Talbott JF, Whetstone WD, Readdy WJ, et al. The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings. J Neurosurg Spine. 2015 Oct;23(4):495-504. doi: 10.3171/2015.1.SPINE141033. Epub 2015 Jul 10. PMID: 26161519. Revanappa KK, Moorthy RK, Jeyaseelan V, et al. Modification of Nurick scale and Japanese Orthopedic Association score for Indian population with cervical spondylotic myelopathy. Neurol India. 2015 Jan-Feb;63(1):24-9. doi: 10.4103/0028-3886.152627. PMID: 25751465. Lenehan B, Fisher CG, Vaccaro A, et al. The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine (Phila Pa 1976). 2010 Oct 1;35(21 Suppl):S180-6. doi: 10.1097/BRS.0b013e3181f32a44. PMID: 20881460. Brooks NP. Central Cord Syndrome. Neurosurg Clin N Am. 2017 Jan;28(1):41-47. doi: 10.1016/j.nec.2016.08.002. Epub 2016 Nov 1. PMID: 27886881. Jin W, Sun X, Shen K, et al. Recurrent Neurological Deterioration after Conservative Treatment for Acute Traumatic Central Cord Syndrome without Bony Injury: Seventeen Operative Case Reports. J Neurotrauma. 2017 Nov 1;34(21):3051-3057. doi: 10.1089/neu.2016.4706. Epub 2017 Jul 20. PMID: 27842476. Wang J, Li J, Cai L. Effects of Treatment of Cervical Spinal Cord Injury without Fracture and Dislocation in A Medium-to Long-Term Follow-Up Study. World Neurosurg. 2018 May;113:e515-e520. doi: 10.1016/j.wneu.2018.02.071. Epub 2018 Feb 21. PMID: 29477003. Aarabi B, Akhtar-Danesh N, Simard JM,et al. Efficacy of Early (≤ 24 Hours), Late (25-72 Hours), and Delayed (>72 Hours) Surgery with Magnetic Resonance Imaging-Confirmed Decompression in American Spinal Injury Association Impairment Scale Grades C and D Acute Traumatic Central Cord Syndrome Caused by Spinal Stenosis. J Neurotrauma. 2021 Aug 1;38(15):2073-2083. doi: 10.1089/neu.2021.0040. Epub 2021 Apr 6. PMID: 33726507; PMCID: PMC8309437. Shi H, Chen L, Zhu L, et al. Instrumented fusion versus instrumented non-fusion following expansive open-door laminoplasty for multilevel cervical ossification of the posterior longitudinal ligament. Arch Orthop Trauma Surg. 2023 Jun;143(6):2919-2927. doi: 10.1007/s00402-022-04498-y. Epub 2022 Jun 9. PMID: 35678891. Blizzard DJ, Caputo AM, Sheets CZ, et al. Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up. Eur Spine J. 2017 Jan;26(1):85-93. doi: 10.1007/s00586-016-4746-3. Epub 2016 Aug 23. PMID: 27554354. Xu C, Zhang Y, Dong M, et al. The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients. Spine J. 2020 Sep;20(9):1422-1429. doi: 10.1016/j.spinee.2020.05.542. Epub 2020 May 28. PMID: 32474225. Kim B, Yoon DH, Ha Y, et al. Relationship between T1 slope and loss of lordosis after laminoplasty in patients with cervical ossification of the posterior longitudinal ligament. Spine J. 2016 Feb;16(2):219-25. doi: 10.1016/j.spinee.2015.10.042. Epub 2015 Oct 30. PMID: 26523967. Aarabi B, Alexander M, Mirvis SE,et al. Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis. J Neurosurg Spine. 2011 Jan;14(1):122-30. doi: 10.3171/2010.9.SPINE09922. Epub 2010 Dec 17. PMID: 21166485. Bosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia. A ten-year review. JAMA. 1971 Apr 19;216(3):473-8. PMID: 5107929. Levi AD, Tator CH, Bunge RP. Clinical syndromes associated with disproportionate weakness of the upper versus the lower extremities after cervical spinal cord injury. Neurosurgery. 1996 Jan;38(1):179-83; discussion 183-5. doi: 10.1097/00006123-199601000-00039. PMID: 8747967. Curt A, Ellaway PH. Clinical neurophysiology in the prognosis and monitoring of traumatic spinal cord injury. Handb Clin Neurol. 2012;109:63-75. doi: 10.1016/B978-0-444-52137-8.00004-8. PMID: 23098706. Fujiyoshi T, Yamazaki M, Kawabe J,et al. A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line. Spine (Phila Pa 1976). 2008;33(26):E990-3 Tang Z, Chen T, Tan J, et al. Impact of the K-line in patients with ossification of the posterior longitudinal ligament: Analysis of sagittal cervical curvature changes and surgical outcomes. Front Surg. 2023 Feb 15;10:1095391. doi: 10.3389/fsurg.2023.1095391. PMID: 36874452; PMCID: PMC9975339. Molliqaj G, Payer M, Schaller K, et al. Acute traumatic central cord syndrome: a comprehensive review. Neurochirurgie. 2014 Feb-Apr;60(1-2):5-11. doi: 10.1016/j.neuchi.2013.12.002. Epub 2014 Mar 7. PMID: 24613283. Imagama S, Matsuyama Y, Yukawa Y, Kawakami N, Kamiya M, Kanemura T, Ishiguro N; Nagoya Spine Group. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg Br. 2010 Mar;92(3):393-400. doi: 10.1302/0301-620X.92B3.22786. PMID: 20190311. Mayer M, Meier O, Auffarth A, Koller H. Cervical laminectomy and instrumented lateral mass fusion: techniques, pearls and pitfalls. Eur Spine J. 2015 Apr;24 Suppl 2:168-85. doi: 10.1007/s00586-013-2838-x. Epub 2013 May 29. PMID: 23715892. Komotar RJ, Mocco J, Kaiser MG. Surgical management of cervical myelopathy: indications and techniques for laminectomy and fusion. Spine J. 2006 Nov-Dec;6(6 Suppl):252S-267S. doi: 10.1016/j.spinee.2006.04.029. PMID: 17097545. Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976). 1996 Sep 1;21(17):1969-73. doi: 10.1097/00007632-199609010-00005. PMID: 8883196. Nurboja B, Kachramanoglou C, Choi D. Cervical laminectomy vs laminoplasty: is there a difference in outcome and postoperative pain? Neurosurgery. 2012 Apr;70(4):965-70; discussion 970. doi: 10.1227/NEU.0b013e31823cf16b. PMID: 22015812. Tables Table 1 Comparison of preoperative general data of patients between two groups parameters LF group LP group P value Age(years) 57.75±18.72 58.77±19.45 0.365 Gender (male/female) 31/28 27/26 0.826 Smoking status (yes/no) 11/48 9/44 0.728 Diabetes mellitus(n,%) 5（8.5%） 4（7.6%） 0.175 Hypertension(n,%) 8（13.6%） 6（11.4%） 0.261 Number of disc herniation(n) 3.79±0.58 3.68.±0.46 0.185 Intramedullary high-signal lesion(n) 1.98±0.76 1.87.±0.65 0.126 Number of ossifed vertebra 3.93±0.42 3.87.±0.56 0.205 OPLL type according to K-line (n, %) K-line (+) K-line (-) (26，44.1%） (23，38.9%） (23，43.4%） (18，33.7%） Table 2 Comparison of perioperative parameters between two groups. Parameters LF group LP group P value Operation duration(min) 188.3± 36.28 153.79±22.37 0.03 Total blood loss(ml) 498.76±315.69 423.56±265.15 0.526 Length of hospital stay (day) 14.56 ± 3.76 13.85 ± 4.05 0.428 Number of opened lamina(n) 4.82 ± 0.98 4.38 ± 0.45 0.285 Table 3 Comparison of clinical outcomes at last follow up. Parameters Point-in-time LP group LF group P value JOA score Pre-operation 6.35 ± 1.12 6.98 ± 0.89 0.653 Last follow-up 10.68 ± 1.13 12.98 ± 1.25 0.015 P value P <0.0 01 P <0. 001 VAS score Pre-operation 6.75 ± 1.23 7.03 ± 1.45 0.682 Last follow-up 2.33 ± 0.63 2.07 ± 0.52 0.857 P value P <0. 001 P <0.001 IHMS score Pre-operation 59.75 ±21.23 61.03 ± 20.45 0.849 Last follow-up 99.33 ± 19.63 107.07 ± 18.52 0.018 P value P <0. 001 P <0. 001 BASIC score Pre-operation 2.1 ± 0.6 2.2 ±0.5 0.568 Last follow-up 0.8 ± 0.3 0.4± 0.2 0.032 P value 0.035 0.041 imNurick scale score Pre-operation 2.69 ± 0.31 2.35 ±0.32 0.668 Last follow-up 1.52 ± 0.23 1.27± 0.19 0.462 P value 0.015 0.021 RR(%) Last follow-up 52.22 ± 11.67 68.23± 13.21 P <0. 001 JOA Japanese Orthopaedic Association VAS Visual Analogue Scale IHMS intrinsic hand muscle strength BASIC Brain and Spinal Injury Center imNurick Indian modification of Nurick RR recovery rate Table 4 Comparison of radiological outcomes between two groups. Parameters Point-in-time LF group LP group P value C2-7 Cobb angle (°) Pre-operation 11.73 ± 1.72 12.65 ± 1.57 0.489 Last follow-up 17.32 ± 1.78 10.18± 1.45 P < 0. 001 P value P < 0. 001 0.018 C2-7 SVA Pre-operation 20.93 ± 4.20 21.32 ± 3.18 0.567 Last follow-up 18.05 ± 3.82 23.41 ± 2.78 0.008 P value 0.032 0.037 ROM(°) Pre-operation 26.58 ± 3.50 27.06 ± 3.72 0.725 Last follow-up 14.32 ± 3.78 24.79 ± 2.86 P <0. 001 P value P < 0. 001 0.023 SVA sagittal vertical axis ROM range of motion Table 5 Comparison of clinical outcomes between two groups according to K-line Preoperative JOA (score) Final JOA (score) Preoperative VAS (score) Final VAS (score) Preoperative IHMS (score) Final IHMS (score) RR K-line(+) (inter.P value) 0.516 0.125 0.425 0.137 0.482 0.327 0.031 LFG=26 7.75 ± 1.16 11.82 ± 1.05 6.85 ± 1.37 2.91 ± 0.85 51.15 ± 21.12 107.25 ± 21.12 57.35 ± 1.97 LPG=23 7.98 ± 1.22 12.05 ± 0.92 6.92 ± 1.41 3.07 ± 1.12 49.35 ± 17.12 102.13 ± 19.12 36.35 ± 0.12 K-line(-) (inter.P value) 0.852 0.016 0.726 0.132 0.728 0.019 0.018 LFG=23 8.35 ± 1.03 12.39 ± 0.92 6.72 ± 1.07 3.09 ± 0.72 46.17 ± 1.18 100.28 ± 20.49 37.21 ± 1.12 LPG=18 8.16± 0.79 9.76 ± 1.17 6.82 ± 1.12 3.15 ± 1.03 47.36± 1.07 77.42 ± 11.73 19.45 ± 1.12 LFG laminectomy fusion fixation group LPG laminoplasty group Table 6 Comparison of postoperative complications between two groups Complications LF group LP group χ2 value P value SSI 1 1 0.008 1.000 CSF leakage 3 2 4.119 0.248 Axial symptoms 4 3 5.829 0.418 C5 palsy 5 4 7.374 0.612 Symptomatic SEH 1 1 0.008 1.000 Total 16 14 0.347 0.083 CSF cerebrospinal fluid , SSI surgical site infection, SEH spinal epidural hematoma Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4474933","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":309660152,"identity":"73a1d271-a714-4e73-b26c-e440f640ba02","order_by":0,"name":"Qian Zhang","email":"","orcid":"","institution":"Lanxi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qian","middleName":"","lastName":"Zhang","suffix":""},{"id":309660153,"identity":"410cbecf-9bcd-458b-afdd-6d14a8c33c56","order_by":1,"name":"Jun Wang","email":"","orcid":"","institution":"Lanxi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Wang","suffix":""},{"id":309660154,"identity":"bf1f01c2-3851-4200-bbe3-89e962a41dfd","order_by":2,"name":"Rudan Guo","email":"","orcid":"","institution":"Lanxi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rudan","middleName":"","lastName":"Guo","suffix":""},{"id":309660155,"identity":"8ac76bdc-9dde-4221-b3c4-db94873023e7","order_by":3,"name":"Xiaoling Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBACNv7m4x8+VNjY2bc3Nj5IqKghrIVP4lga44wzackGPIebDR6cOUZYixxDjhkzb9thxg0S7m2SD1uYiXAYw7G0hzPbDjObSzC2VSQ2sDHwt3cn4NfC3Hzc4MO5dD7L2Y1tNxJ3yDBInDm7gZAtCZIzyqyZGe4cBGo5w8ZgIJFLSEuOgTQPGzNjw43EtoLENmaitJhJ87Q5M24AamEgTovEsWRDUCBL9hxslkg4c4yHoF/k+5sPPgBFJT97+8OPPypq5Pjbe/FrwQA8pCkfBaNgFIyCUYAVAABkrFAMhUutbwAAAABJRU5ErkJggg==","orcid":"","institution":"Lanxi People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xiaoling","middleName":"","lastName":"Yang","suffix":""},{"id":309660156,"identity":"e31095b5-68c1-4b95-a16d-ded58a6b9025","order_by":4,"name":"Yuefen Wu","email":"","orcid":"","institution":"Lanxi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuefen","middleName":"","lastName":"Wu","suffix":""},{"id":309660157,"identity":"7f0eee38-aea8-44cd-a370-7cc22c2d7d80","order_by":5,"name":"Shunyi Tong","email":"","orcid":"","institution":"Lanxi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shunyi","middleName":"","lastName":"Tong","suffix":""},{"id":309660158,"identity":"72568c0c-c737-405a-a79a-635e998c0b10","order_by":6,"name":"Chao Miao","email":"","orcid":"","institution":"Lanxi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chao","middleName":"","lastName":"Miao","suffix":""}],"badges":[],"createdAt":"2024-05-25 03:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4474933/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4474933/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58154391,"identity":"2815e2a8-64d8-4e79-a2a5-1e3abdd53459","added_by":"auto","created_at":"2024-06-11 20:39:22","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":509678,"visible":true,"origin":"","legend":"\u003cp\u003eA.The schematic representation of Cervical Sagittal Balance Index (C2-7 SVA) and C2-C7 Cobb Angle is depicted, where C2-7 SVA refers to the distance between the posterosuperior corner of C7 and a plumb line dropped from the center of C2 vertebral body, while C2-C7 Cobb angle is measured between the lower endplates of C2 and C7 on a standard cervical lateral X-ray.\u003c/p\u003e\n\u003cp\u003eMoving on to Pictures B and C, these diagrams depict the Range of Motion (ROM) in the cervical spine. The flexion angle, denoted as α, assumes a negative value when there is a reverse curvature observed. Conversely, the hyperextension angle, labeled as β, represents the calculated ROM as β - α.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4474933/v1/02e73f82614d25ca90b4f460.jpeg"},{"id":58154392,"identity":"f2ce7972-855f-4604-b94c-6585a8633c53","added_by":"auto","created_at":"2024-06-11 20:39:22","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":747196,"visible":true,"origin":"","legend":"\u003cp\u003eThe patient, a 61-year-old male, presented with cervical pain and experienced bilateral upper limb numbness and weakness following an injury that occurred 3 hours prior to admission. The diagnosis revealed multilevel cervical stenosis accompanied by central canal syndrome. To address this condition, the patient underwent a posterior laminectomy fusion fixation procedure. A1 and B1 demonstrate the presence of normal cervical lordosis without any significant narrowing observed in the intervertebral spaces. C1 displays multilevel cervical stenosis along with high signal intensity detected in the C3/4 segment of the cord on preoperative cervical MRI scans. D1 and E1 exhibit postoperative lateral and anterior-posterior X-Rays of the cervical spine, indicating satisfactory positioning of internal fixation devices. F1 represents a postoperative cervical MRI scan which reveals noticeable posterior displacement of the cord but no substantial compression is evident.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4474933/v1/32c698cebe96224459d23380.jpeg"},{"id":58154393,"identity":"795aa0b5-e7de-499f-a166-33fb089ccb70","added_by":"auto","created_at":"2024-06-11 20:39:23","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":843422,"visible":true,"origin":"","legend":"\u003cp\u003eThe patient, a 57-year-old male, presented to the hospital with acute pain and weakness in both upper extremities following trauma three hours prior to admission. He had a history of cervical spinal stenosis resulting in central canal syndrome at multiple levels. A posterior single-door laminectomy was performed, and radiographs (A2 and B2 films) demonstrated normal cervical lordosis without significant intervertebral space narrowing. Preoperative cervical MRI (C2) revealed multiple instances of cervical spinal stenosis accompanied by high signal changes in the C3-5 spinal cord region. Postoperatively, radiographs (D2 and E2 films) showed satisfactory positioning of internal fixation devices, while postoperative cervical MRI (F2 film) revealed noticeable posterior displacement of the spinal cord without notable compression.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4474933/v1/a915d28b7bdcd480497ea3a7.jpeg"},{"id":63406761,"identity":"bf5fb711-7ab5-4311-b218-443f7bccebf8","added_by":"auto","created_at":"2024-08-27 21:45:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2939935,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4474933/v1/0e1ec0fa-6d3c-4651-b1e5-35b12de208dd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Laminectomy versus laminoplasty for treating multi-segmental cervical canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD):a retrospective study with a minimum follow-up period of two years","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCentral cord syndrome without fracture or dislocation (CCSWOFD) is commonly characterized by normal radiographs \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e or the absence of traumatic evidence on imaging studies \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. These injuries predominantly affect older populations with degenerative changes in their cervical spine and primarily occur due to excessive extension, resulting in compression within the narrowed spinal canal \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. In the United States, approximately 8.7% of individuals aged 60 and above experience CCSWOFD \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, while it constitutes around 47% of all cases involving cervical spinal cord damage in Japan \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Moreover, there has been a noticeable increase in the incidence rate of this type of partial injury to the cervical spinal cord within China's aging population.\u003c/p\u003e \u003cp\u003eCentral cord syndrome is a commonly observed incomplete injury to the cervical spinal cord, frequently occurring in the absence of fractures or dislocations. The clinical definition of central cord syndrome was initially proposed by Schneider et al. in 1954 \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Despite the lack of visible fractures or dislocations in the cervical region, a majority of patients present with pre-existing degenerative conditions like herniated discs, ossification of the posterior longitudinal ligament (OPLL), and hypertrophy of the ligamentum flavum \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.The clinical presentation entails varying degrees of paralysis in both the upper and lower extremities, with a predilection for greater severity observed in the upper extremities. Additionally, patients may demonstrate diverse levels of sphincter control dysfunction and sensory impairment. When an external force is applied to the patient's neck region, two significant factors that contribute to narrowing of the spinal canal and subsequent development of central cord syndrome are cervical disc herniation with or without osteophyte formation and ossification of the posterior longitudinal ligament (OPLL).\u003c/p\u003e \u003cp\u003ePatients presenting with central cord syndrome and neurological symptoms typically require surgical intervention rather than conservative therapy\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Currently, there is an ongoing debate regarding the indications, timing, approach, and prognostic factors for surgical treatment \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Depending on the extent of spinal cord injury and canal stenosis, either anterior or posterior cervical surgery may be performed. Anterior procedures such as anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are commonly employed; however, they are more suitable for patients with involvement in fewer than three segments. One advantage of these anterior procedures is that they provide direct access to the affected area without having to manipulate or retract important structures such as nerves or blood vessels located at the back of the spine. This approach allows for better visualization and easier removal of discs or bone fragments. Conversely, posterior approaches are commonly regarded as more favorable for managing multi-segmental cervical canal stenosis due to their reduced incidence of complications, this may be attributed to factors such as reduced manipulation of vital structures like blood vessels and esophagus during surgery. Minimizing these risks can play a role in enhancing patient results and expediting the recovery process\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. The techniques of laminectomy fusion fixation and single open-door laminoplasty are widely employed among the posterior surgical options for cases of CCSWOFD. However, there is currently a lack of comprehensive statistical analysis comparing these two surgical procedures to ascertain their relative superiority.\u003c/p\u003e \u003cp\u003eTherefore, this retrospective study was undertaken to examine the clinical outcomes associated with laminectomy fusion fixation and single open-door laminoplasty for treating multi-segmental spinal cord stenosis combined with CCSWOFD. The aim is to assess their comparative efficacy and offer insights for surgical decision-making in subsequent clinical settings.\u003c/p\u003e"},{"header":"1. Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 General Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom January 2012 to December 2021, a total of 112 patients diagnosed with central cord syndrome but without fracture or dislocation were selected for this study. The patients underwent either posterior laminectomy fusion or single open-door laminoplasty at our department. Prior to the surgery, preoperative anteroposterior and lateral X-ray films, CT scans, and magnetic resonance imaging (MRI) of the cervical spine were obtained to evaluate the extent of spinal cord compression and injury. Inclusion criteria for patient selection included: (1) presence of multi-segment cervical canal stenosis involving three or more segments, as evidenced by a spinal canal anteroposterior diameter less than 12 mm on imaging; (2) absence of significant cervical kyphosis; (3) manifestation of symptoms related to central cord injury; (4) availability of complete preoperative and postoperative data with a minimum follow-up period lasting at least 24 months. Patients with spinal canal stenosis affecting only one or two segments, as well as those presenting evident cervical kyphosis unsuitable for posterior surgeries, were excluded from the study. Additionally, patients with a history of surgery on the corresponding segment, combined spinal deformity, tumor or infection were also excluded. Individuals with concurrent diseases that may impact neurological function assessment such as motor neuron disease, Parkinson\u0026apos;s disease, cerebral palsy and cerebral infarction were likewise excluded from the study. Finally, cases where postoperative follow-up data was incomplete or had a follow-up time less than two years were not considered in our analysis.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e1.2 Surgical methods\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe patients underwent the administration of general anesthesia and were positioned in a prone posture. The head was placed facing downwards on the head frame, while the abdomen was elevated. No pressure was applied to the eyes, and standard sterilization procedures were followed to prepare the surgical area. A posterior median incision was performed.\u003c/p\u003e\n\u003cp\u003eIn the LP group, a 12 cm incision was made from the lower edge of the C2 spinous process to the upper edge of the C7 spinous process. Sequentially, an incision was performed on the skin, subcutaneous tissue, and fascial layers. The paravertebral muscles on both sides were dissected along the spinous process. Medially exposed were bilateral laminae of C3-C6 up to the facet joint. Following confirmation of decompression segments through C-arm X-ray fluoroscopy, bone grafting was conducted by removing the spinous processes of C3-C6. A groove was created at the inner edge of each facet joint on both sides (C3-C6) for careful grinding with a drill that selectively removed only the outer cortical bone while preserving the integrity of the inner cortical bone. Access to open and expose laminae from C3-C6 on one side was gained using a 45\u0026deg;angled nerve hook. Subsequently, steel plates measuring 8-12 mm in length were individually placed at levels corresponding to C3-C6 and secured with screws for internal fixation.\u0026nbsp;Intraoperative fluoroscopy confirmed the accurate positioning of internal fixation devices. The surgical site was thoroughly irrigated with copious amounts of normal saline solution for effective cleansing and bleeding control purposes. Once active bleeding ceased observationally, strips cut from spinous process bones were implanted alongside portal shafts .\u003c/p\u003e\n\u003cp\u003eIn the LF group, a 15 cm longitudinal incision was made along the spinous process. The skin, subcutaneous tissue, and posterior cervical fascia were incised, and the paravertebral muscle tissue was dissected layer by layer. Fluoroscopy verified accurate positioning of the screws. The connecting rod of appropriate length was pre-bent and positioned at the tail of each screw to match the physiological curvature. The cervical spine\u0026apos;s physiological lordosis was restored by extending the neck backwards.. The bilateral lamina edges were gradually polished using grinding drills until reaching the inner cortical bone. Residual connective bone tissue and ligamentum flavum tissue on the polished side of laminae were meticulously removed with forceps in an \u0026quot;uncapping\u0026quot; manner. Subsequently, the C3-C6 laminae were fully exposed while completely eliminating any pressure factors during surgery. Exploration revealed an intact dura mater with noticeable bulging and normal pulsation. Thorough polishing was performed on the bilateral lateral masses of C3-C6, and the removed lamina bone tissue was prepared into 2-3 mm granular bone grafts for fusion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Postoperative Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient\u0026apos;s postoperative vital signs were closely monitored, while a 3-day course of methylprednisolone and antibiotics was administered and continued. The timely removal of drainage tubes was determined based on an evaluation of the color and volume of wound discharge. In order to promote optimal healing, cervical braces were provided to patients for a duration of 4 weeks, during which gradual introduction of gentle movements such as nodding and turning the head followed the removal of drainage tubes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Observation Indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(1) Surgical Complications\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients were monitored for a minimum duration of 24 months in order to observe any incidences of surgical site infection, cerebrospinal fluid leakage, symptoms associated with the axial region, fifth cervical nerve root paralysis, spinal epidural hematoma, and other potential complications.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(2)Assessment of neurological function \u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNeurological function assessment of patients was performed using the Japanese Orthopaedic Association (JOA) score both preoperatively and during their final follow-up. To calculate the rate of neurological recovery (RR), it was determined by: (final JOA score - preoperative JOA score)/(17 (maximum score) - preoperative JOA score)\u0026nbsp;\u0026times;\u0026nbsp;100%\u003csup\u003e[13]\u003c/sup\u003e. Following Yamazaki et al\u0026apos;s methodology, a favorable prognosis was defined as a JOA score improvement rate \u0026gt;50%, while an unfavorable prognosis was defined as a JOA score improvement rate\u0026nbsp;\u0026le;50%\u003csup\u003e[14]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(3) Assessment of Pain \u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe assessment for neck and upper limb pain was performed before surgery and during the final follow-up using the Visual Analogue Scale (VAS) score. Pain intensity was evaluated on a numerical scale ranging from 0 to 10, with higher scores indicating more severe pain \u003csup\u003e[15]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(4)Assessment of motor function\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe ASI motor score, which is a component of the American Spinal Injury Association Impairment Scale, serves as a standardized assessment method utilized to evaluate motor strength through the examination of myotomes \u003csup\u003e[16]\u003c/sup\u003e. Given its predominant impact on upper limb functionality\u003csup\u003e[17]\u003c/sup\u003e, we employed scores for intrinsic hand muscle strength to assess hand mobility, including bilateral digital flexor muscle strength and little finger abductor muscle strength. The evaluation utilizes a universally recognized six-point scale (ranging from 0 to 5) to assess the bilateral motor strength of each muscle group, with higher scores indicating improved hand strength.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(5)Assessment of intraparenchymal cord injury\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Brain and Spinal Injury Center (BASIC) score was used to assess the extent of intramedullary high-signal and intraparenchymal cord injury. In brief, a spinal cord injury (SCI) with a BASIC score of 0 indicated normal T2 relaxivity of the spinal cord without any discernible pathological intramedullary signal. A BASIC score of 1 represented cases where there was confined pathological T2 hyperintensity primarily in the gray matter of the spinal cord. If the pathological intramedullary T2 hyperintensity extended beyond the margins of central gray matter and obscured the boundaries between gray and white matter, it would be assigned a BASIC score of 2.Conversely, if the entire transverse extent of the spinal cord is affected by pathological T2 hyperintensity without any remaining normal-appearing white matter, it would receive a BASIC score of 3. Lastly, an SCI with a BASIC score of 4 refers to an injury classified as BASIC Score 3 but also exhibits additional distinct areas of macroscopic intramedullary hemorrhage resulting in hypointense signals on T2 imaging\u003csup\u003e[18]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e(6)\u0026nbsp;\u003cstrong\u003e\u003cem\u003eAssessment of employability\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe assessment of daily functional recovery and employability level was conducted using the Indian modifications of the (imNurick) scale, which is a standardized six-point grading system (ranging from 0 to 5).Grade 0 indicates absence of signs or symptoms related to root involvement, without any evidence of spinal cord disease. Grade 1 signifies the presence of spinal cord disease but no ambulatory difficulties. Grade 2 represents mild challenges in ambulation, yet the individual can independently rise from squatting or sitting on the ground without requiring external support. Grade 3 reflects moderate difficulty in walking and necessitates external support when transitioning from squatting or sitting positions. Grade 4 denotes dependence on assistance from another person or assistive device for ambulation. Lastly, grade 5 corresponds to being confined to a wheelchair or bedridden\u003csup\u003e[19]\u003c/sup\u003e. A higher grade implies poorer employability and daily functional outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(7) Imaging Assessment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;Cervical Sagittal Balance Index (C2-7 SVA):\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThis index provides valuable insights into the sagittal balance and degree of anteversion in the cervical spine. To quantify this\u0026nbsp;index, we precisely measure the vertical distance between the posterior-superior edge of C7 vertebra and a vertically aligned line passing through the center of second cervical vertebra on a lateral X-ray image (\u003cstrong\u003eFig.A\u003c/strong\u003e). The presence of a higher C2-7 SVA value indicates a potential compromise in the sagittal balance of the cervical spine\u0026nbsp;\u003csup\u003e[12]\u003c/sup\u003e.\u0026nbsp;\u003cstrong\u003e\u003cem\u003eRange of Motion (ROM)\u003c/em\u003e\u003c/strong\u003e: Cervical range of motion (ROM) was evaluated through dynamic X-ray imaging during neck flexion and hyperextension, with specific focus on measuring the C2-7 Cobb Angle. The angle\u0026nbsp;\u0026beta;\u0026nbsp;represents flexion, where a negative value indicates reverse motion in the cervical spine (CS). Conversely,\u0026nbsp;\u0026alpha;\u0026nbsp;denotes hyperextension, allowing ROM to be calculated as\u0026nbsp;\u0026alpha;+\u0026beta;. By subtracting postoperative ROM from preoperative ROM, an angle reflecting loss can be obtained (\u003cstrong\u003eFig.B.C\u003c/strong\u003e).\u003cstrong\u003e\u003cem\u003eC2\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026ndash;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eC7 Cobb angle\u003c/em\u003e\u003c/strong\u003e: This measurement involves determining an angle between lower endplates of C2 and C7 on a standard lateral X-ray film (\u003cstrong\u003eFig.A\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.5 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVersion 22.0 of the SPSS software was used for statistical analysis purposes. The measurement data were presented as mean\u0026plusmn;standard deviation (x̄\u0026plusmn;s) and analyzed using t-tests, while count data were expressed in percentages and analyzed using\u0026nbsp;\u0026chi;\u003csup\u003e2\u003c/sup\u003e tests. Statistical significance was considered when the p-value \u0026lt; 0.05.\u003c/p\u003e"},{"header":"2. Results","content":"\u003cp\u003eThe age range of the patients was between 33 and 62 years. The LF group comprised 59 cases, including 31 males and 28 females, with ages ranging from 39 to 75 (with an average age of 57.75\u0026plusmn;18.72) years. Within this group, there were ten cases of multi-segmental cervical disc herniation, twenty-three cases of OPLL with K-line(-), and twenty-six cases of OPLL with K-line(+). Additionally, diabetes occurred in five cases and hypertension in eight cases among these individuals. The LP group consisted of fifty-three cases, including twenty-seven males and twenty-six females aged between thirty-eight and seventy-seven years (with a mean age of 58.77\u0026plusmn;19.45). Among them, twelve had multi-segmental cervical disc herniation while eighteen had OPLL with K-line(-) and twenty-three had OPLL with K-line(+). Moreover, four individuals had diabetes while six suffered from hypertension.\u003c/p\u003e\n\u003cp\u003eThe demographic characteristics of the two cohorts are presented in \u003cstrong\u003eTable 1\u003c/strong\u003e. No significant differences were observed between the two groups in terms of gender, age, smoking status, diabetes, hypertension, number of disc herniation, number of ossified vertebral or intramedullary high-signal lesion (P\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eThe duration of surgical procedures, overall blood loss, length of hospital stay, and number of lamina opened in both groups are presented in \u003cstrong\u003eTable 2\u003c/strong\u003e. The two groups did not exhibit any statistically significant disparities in terms of overall blood loss (P=0.526), duration of hospitalization (P=0.428), and quantity of laminae opened (P=0.285).However, it is noteworthy that the LP group exhibited a comparatively shorter surgical duration than the LF group (P = 0.03).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e presents the clinical outcomes and recovery of intraparenchymal cord injury in patients. No significant disparities were observed in preoperative JOA score, VAS score, IHMS score, BASIC score, and RR between the two groups(P\u0026gt;0.05). However, both groups exhibited statistically significant improvement in all parameters after surgery (P \u0026lt; 0.05). It is worth mentioning that the LF group demonstrated significantly superior JOA scores, IHMS score, BASIC score and RR compared to the LP group (P \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eThe C2-7 sagittal vertical axis (SVA) and range of motion (ROM) between the LF group and LP group were compared preoperatively and at the last follow-up, as shown in \u003cstrong\u003eTable 4\u003c/strong\u003e. The preoperative C2-7 SVA was found to be comparable between the two groups with no significant difference observed (P \u0026gt; 0.05). However, at the last follow-up, a significant increase in C2-7 SVA was observed in the LP group while a decrease was noted in the LF group, indicating a statistically significant difference between these outcomes (P \u0026lt; 0.05). Regarding the preoperative ROM, there was no significant difference observed between the LF and LP groups prior to surgery (P \u0026gt; 0.05). However, at the final follow-up, both groups exhibited a decrease in range of motion; furthermore, there was a statistically significant difference detected between these two groups\u0026apos; outcomes (P \u0026lt; 0.05). Similarly, there were no notable differences found in terms of preoperative C2-7 Cobb angle between the LF and LP groups before surgery (P \u0026gt; 0.05). Nevertheless, at final follow-up evaluation, it was observed that this angle had increased to some extent in the LF group while decreasing slightly in the LP group; once again highlighting a statistically significant distinction between these outcomes(P \u0026lt;0 .05).\u003c/p\u003e\n\u003cp\u003eThe surgical indications for LF and LP were investigated in our study, where patients with OPLL were classified into subgroups based on their K-line status (\u003cstrong\u003eTable 5\u003c/strong\u003e).\u0026nbsp;Our results indicate that when a positive K-line was present, there were no significant differences observed between the two groups in terms of the final JOA score and IHMS score (P=0.125 and P=0.327 respectively).However, it is worth noting that the LF group exhibited significantly superior outcomes in terms of RR compared to the LP group (P=0.029). Conversely, when a negative K-line was observed, we discovered significantly higher final JOA scores, IHMS scores, and RR favoring the LF group over those observed in the LP group (P = 0 .016,P = 0 .019 and P = 0 .018 respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e\u0026nbsp; The occurrence of postoperative complications was compared between the two groups, revealing similar rates of incision infection, cerebrospinal fluid leakage, axial symptoms, C5 nerve root palsy, and symptomatic spinal epidural hematoma (SEH) (P\u0026gt;0.05). Furthermore, there were no significant differences observed in the overall complication rates (P\u0026gt;0.05).\u003c/p\u003e"},{"header":"3 Discussion","content":"\u003cp\u003emulti-segmental cervical canal stenosis refers to a specific anatomical configuration of the cervical canal, characterized by a consistent sagittal diameter-to-segment ratio below 0.75 for more than three consecutive segments. This condition predisposes individuals to compression or injury of the cervical spinal cord.\u0026nbsp;The classification of spinal stenosis is determined by the underlying pathological conditions, primarily associated with intervertebral disc herniation and ossification of the posterior longitudinal ligament (OPLL) \u003csup\u003e[20]\u003c/sup\u003e. Central cord syndrome is a prevalent form of incomplete cervical cord injury frequently resulting from high-speed accidents, often coexisting with degenerative diseases in the cervical spine that contribute to varying degrees of spinal stenosis. The presence of spinal cord compression may initially manifest without apparent symptoms. However, as degenerative changes in the spine progressively diminish the protective space surrounding the spinal cord, trauma can lead to compression injuries at affected sites impacted by OPLL or intervertebral disc protrusion. The occurrence of canal stenosis in adults who experience external forces, such as accidents or injuries involving sudden excessive flexion and extension, is significantly influenced by the presence of cervical disc herniation and OPLL. These conditions act as inherent risk factors for the development of CCSWOFD\u0026nbsp;\u003csup\u003e[21]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCurrently, there are two treatment options available for multi-level cervical canal stenosis combined with CCSWOFD: conservative therapy or early surgical intervention.\u0026nbsp;A research conducted by Jin et al \u003csup\u003e[22]\u003c/sup\u003e discovered that a total of 17 patients were treated non-surgically; however, after 6 weeks, it was observed that 8 patients experienced varying degrees of neurological deterioration and recurrence. The current consensus recognizes the significant benefits of early surgical intervention in alleviating motor neuron dysfunction at both the injury site and distal spinal cord, as well as mitigating the loss of secondary motor neurons associated with CCSWOFD. In the mid- to long-term follow-up for all patients, Wang et al \u003csup\u003e[23]\u003c/sup\u003e reported no significant difference in JOA score between anterior and posterior approaches. However, when considering the Frankel classification, notable distinctions were observed between surgically treated patients and those managed conservatively. Prior research has established that timely surgical intervention is highly effective in promptly relieving spinal cord compression, resulting in a decrease in the occurrence of neurological symptoms and complications \u003csup\u003e[24]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eMultiple surgical techniques can be employed for the treatment of CCSWOFD, including the anterior approach, posterior approach, or their combination. In cases where canal stenosis coexists with CCSWOFD, two commonly utilized surgical interventions involve performing an anterior cervical discectomy and fusion (ACDF) or an anterior cervical corpectomy and fusion (ACCF). These procedures directly address the compression tissue located anterior to the cervical cord, restoring natural alignment and function while ensuring stability within the cervical spine. The previous research has revealed potential complications and intricate procedures linked to anterior approaches \u003csup\u003e[25]\u003c/sup\u003e. As a result, ACDF and ACCF are typically recommended for treating CCSWOFD affecting fewer than three levels. These surgical procedures have been widely accepted as effective treatment options for patients suffering from this specific condition. conversely, posterior approaches such as laminectomy fusion and fixation or single/double-door laminoplasty are often preferred for multi-level cases.\u003c/p\u003e\n\u003cp\u003eThe single open-door laminoplasty involves repositioning the lamina to enlarge the cervical canal, resulting in dorsal displacement of the spinal cord for effective decompression. In traditional open-door laminoplasty, both sides undergo dissection of the paravertebral muscles.\u0026nbsp;On one side, a unilateral laminotomy is performed followed by a cortical incision on the other side to thin out and reduce thickness of the lamina. The elevated lamina is then stabilized using mini-plates and screws to create additional space for posterior displacement of the spinal cord. Laminectomy fusion and fixation is another commonly employed posterior surgical technique that offers advantages such as extensive indirect decompression of the spinal cord and restoration of lordotic physiological curvature. However, due to the potential for postoperative instability associated with laminectomy alone, it is commonly combined with lateral mass screw fixation or fusion at present. This combination approach effectively mitigates risks related to kyphosis, post-surgical segmental instability , progression of ossification of the posterior longitudinal ligament (OPLL), and neurological deterioration\u003csup\u003e[26]\u003c/sup\u003e. Nevertheless, an ongoing debate persists regarding whether laminectomy or laminoplasty should be utilized for multi-segmental canal stenosis combined with CCSWOFD.\u003c/p\u003e\n\u003cp\u003eOur research findings suggest that both laminectomy and laminoplasty are effective in improving neurological symptoms, reducing pain, enhancing motor ability and employability, as well as relieving edema or hemorrhage of the cervical cord. The final JOA scores and VAS scores for both groups demonstrated significant improvement compared to pre-operation levels, indicating a clear enhancement in neurological function and pain relief. Furthermore, the LF group exhibited superior JOA scores and a higher rate of neurological recovery during follow-up (P\u0026lt;0.05). The underlying cause for this phenomenon lies in the presence of multi-level cervical canal stenosis, which can result in spinal cord compression due to multiple protruding cervical intervertebral discs or OPLL at various locations, as well as varying degrees of relative displacement or angle between vertebral bodies during hyperextension or flexion of the cervical spine. As a result, there is an increased instantaneous pressure exerted on the spinal cord, leading to more severe injury. However, laminectomy decompression and fusion with a lateral mass fixation system help maintain the normal lordotic physiological curvature of the cervical spine while controlling intervertebral movement of ossified segments. This prevents late kyphosis and enables better posterior shift as well as adequate decompression of the cervical cord. By implementing these measures, healthcare professionals aim to enhance overall patient outcomes and quality of life. The prevention of late kyphosis not only promotes better posture but also alleviates discomfort and pain associated with spinal abnormalities. Moreover, facilitating a posterior shift and ensuring adequate decompression can effectively mitigate the risk of further neurological complications arising from compression on the cervical cord, thereby elucidating why posterior laminectomy surpasses laminoplasty in terms of long-term improvement in neurological function.\u003c/p\u003e\n\u003cp\u003eThe assessment of the natural curvature of the cervical spine usually includes determining values such as C2-7 sagittal vertical axis (C2-7SVA) and measuring the angle between vertebrae C2 and C7, known as the Cobb angle \u003csup\u003e[27]\u003c/sup\u003e. Dynamic X-ray films are utilized to assess cervical range of motion (ROM) by quantifying flexion and hyperextension angles at the level spanning from vertebrae C2 to C7. The cumulative value obtained from these measurements reflects the comprehensive extent of movement within this region. The previous investigations conducted by Kim et al. \u003csup\u003e[28]\u003c/sup\u003e have demonstrated that an increase in cervical lordosis is associated with decreased values for C2-7SVA, while a decrease in lordotic curvature or an increase in kyphosis corresponds to elevated levels of this parameter. In our study, patients who underwent laminoplasty demonstrated a significant increase in their respective C2-7SVA values; however, there was a simultaneous decrease observed in both ROM and the Cobb angle encompassing vertebrae C3 through C7. In contrast, patients who underwent laminectomy with fusion (LF) exhibited a notable elevation in the C2-7 Cobb angle but experienced a reduction in range of motion and C2-7SVA at the final follow-up. The maintenance of lordotic physiological curvature through rigid fixation in the LF group, as well as unintended autofusion along the lateral margin of laminar, can be attributed to this phenomenon. However, inadequate rigid fixation and paravertebral muscle dissection during LP led to the development of sagittal imbalance within the cervical spine over time, resulting in a decrease in the C2-C7 Cobb angle.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe scores of intrinsic hand muscle strength showed significant improvements (P\u0026lt; 0.05) in both groups, indicating a substantial enhancement in the patients\u0026apos; physical activity capacity following either lamnectomy or laminoplasty. However, the LF group demonstrated superior performance compared to the LP group by achieving significantly higher final scores .The proposal by Aarabi et al\u003csup\u003e[29]\u0026nbsp;\u003c/sup\u003esuggested that the ASI motor score upon admission could serve as a prognostic indicator for CCS patients. However, it is important to note that this composite score includes both upper and lower extremity components. Nevertheless, CCS primarily manifests with severe symptoms that mainly affect the upper limbs rather than the lower limbs, thus highlighting its predominant impact on dysfunction in the upper extremities. Therefore, relying solely on the ASI motor score may not accurately predict patient prognosis. The underlying pathology of CCS lies in the anatomical distribution of corticospinal tract fibers, with those supplying the upper limb being located more centrally within the spinal cord. Consequently, the functionality of the upper limbs can be significantly affected by central spinal cord contusion or hematoma\u003csup\u003e[30]\u003c/sup\u003e.\u0026nbsp;The study conducted by Levi et al\u003csup\u003e\u0026nbsp;[31]\u003c/sup\u003e proposed that intact corticospinal tracts play a critical role in hand function in primates. Additionally, neurophysiological investigations carried out by Curt et al\u003csup\u003e[32]\u003c/sup\u003e have revealed that axons controlling hand movement are more vulnerable to damage compared to those controlling lower limb movement in cases of central cord syndrome (CCS).\u0026nbsp;At the final follow-up, both groups exhibited significant improvement in BASIC scores (P\u0026lt;0.05), indicating the effective reduction of intramedullary edema and hemorrhage symptoms through both surgical procedures. Moreover, the LF group demonstrated superior overall BASIC scores compared to the LP group (P\u0026lt;0.05). However, the reasons behind the superior performance observed in the LF group compared to the LP group during last follow-up remain unclear. This disparity can be attributed to the laminectomy technique, which removes the lamina with rigid fixation, thereby preventing long-term instability. The preservation of a buffer space for spinal cord movement and the facilitation of expedited recovery from intramedullary edema and hemorrhage are achieved as a result. This buffer space allows for enhanced flexibility and mobility within the spinal cord, ultimately contributing to expedited recovery from intramedullary edema and hemorrhage. The absence of rigid structures such as the lamina reduces compression on the spinal cord, allowing it to heal more efficiently. The BASIC score is a reliable classification system proposed by Talbott JF et al \u003csup\u003e[18]\u003c/sup\u003e to assess acute blunt traumatic spinal cord injuries (SCIs) based on observed T2 signal abnormality patterns in axial plane imaging at the injury epicenter. It has demonstrated excellent prognostic potential across all severities of SCI. This classification system builds upon existing literature and provides valuable prognostic stratification for patients with SCIs by identifying functionally and anatomically significant patterns of T2 hyperintensity in axial plane images, irrespective of arbitrary measures of longitudinal signal abnormality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe K-line, initially proposed by Fujiyoshi and colleagues\u003csup\u003e[33]\u003c/sup\u003e, functions as a prognostic tool for evaluating the clinical effectiveness of posterior cervical decompression in patients with OPLL. It is defined as a linear connection between the midpoints of the cervical canal from C2 to C7 on a standard lateral cervical X-ray image. The classification of patients as K-line positive occurs when their OPLL does not extend beyond this line, while they are classified as K-line negative when it does.\u0026nbsp;To enhance the understanding of the correlation between cervical physiological curvature and clinical results, patients diagnosed with multi-segmental OPLL were classified into subgroups according to the pivotal K-line index, which is linked to cervical physiological curvature \u003csup\u003e[34]\u003c/sup\u003e.Our study findings demonstrate that in cases where the K-line is positive, the LF group exhibits a significantly superior recovery rate (RR) compared to the LP group. Conversely, when the K-line is negative, we observed significantly higher final JOA scores, IHMS scores, and RR in the LF group as opposed to the LP group. We proposed that the observed enhanced outcomes in the LF group may be attributed to rigid fixation, which maintains a larger postoperative C2-C7 Cobb angle and consequently creates increased buffer space for posterior movement of the cervical cord. The maintenance of a larger postoperative C2-C7 Cobb angle allows for improved spinal alignment, reducing stress on the surrounding structures and potentially preventing further degeneration or complications. In addition to reducing stress and preventing degeneration, an optimal Cobb angle also contributes to better posture. Good posture not only enhances physical appearance but also promotes efficient body mechanics while performing daily activities. It ensures that all body parts are properly aligned, allowing for smooth movements without unnecessary strain on any particular area.\u003c/p\u003e\n\u003cp\u003eIn terms of postoperative complications, there were no significant disparities observed between the two groups.\u0026nbsp;However, both groups exhibited a relatively high incidence of C5 nerve root palsy and axial pain. C5 nerve root palsy is more frequently observed in males and typically manifests as deltoid and biceps brachii muscle weakness, accompanied by reduced or absent sensation in the shoulder and lateral arm. Additionally, there may be diminished or absent biceps tendon reflex. These symptoms can manifest within a few days or weeks following surgery but are generally transient, leading to the adoption of conservative treatment approaches. The main pathological mechanism responsible for the development of C5 nerve root palsy is thought to be the entrapment effect exerted on the nerve root \u003csup\u003e[35]\u003c/sup\u003e. Imagama et al\u003csup\u003e[36]\u003c/sup\u003e reported that approximately 67% of patients who underwent laminoplasty and experienced postoperative C5 nerve root palsy recovered without requiring surgical intervention during an average follow-up period of 4.1 months. Postoperative C5 nerve root palsy is also a common and challenging complication following posterior laminectomy, with an overall incidence rate of 11.3%. Preexisting risk factors include intervertebral foraminal stenosis, ossification of the posterior longitudinal ligament, herniation of multi-level cervical disc, and male gender\u003csup\u003e[37]\u003c/sup\u003e. Generally speaking, resolution of C5 nerve root palsy tends to occur within several months without specific management; However, it necessitates rehabilitation that emphasizes on enhancing muscular strength and performing exercises to improve the range of motion\u003csup\u003e[38]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCurrently, there remains a limited understanding regarding the precise factors underlying axial pain. It is believed that variables such as cervical curvature, extent of paravertebral muscle dissection during surgical procedures, rate of preoperative spinal cord compression, and subsequent postoperative displacement are associated with this type of pain. Moreover, a shift in the position of the spinal cord after surgery is considered a potential risk factor for developing axial pain. The occurrence thereof can potentially be attributed to dura mater bulging or excessive deformation affecting the cervical spinal cord;\u0026nbsp;alternatively, it may result from injury or necrosis impacting blood vessels responsible for innervating autonomic nerves.\u0026nbsp;The study conducted by Hosono et al\u003csup\u003e[39]\u003c/sup\u003e revealed a significantly higher prevalence of axial pain in patients who underwent laminoplasty compared to those who underwent anterior fusion (60% vs 19%, respectively). Among the patients who underwent laminoplasty, 26% experienced postoperative neck pain with an average duration of 5.5 months; however, this condition improved within 1 to 1.5 years after surgery. The study conducted by Nurboja et al\u003csup\u003e[40]\u003c/sup\u003e demonstrated that patients who underwent cervical laminectomy experienced significant relief from axial pain compared to those who underwent laminoplasty, particularly when decompression was performed over more than three vertebral levels. Preserving the semispinalis cervicis muscle may play a crucial role in reducing the incidence of axial neck pain. The higher occurrence rate of axial symptoms observed in our study could potentially be attributed to extensive dissection performed on paravertebral muscles.\u003c/p\u003e\n\u003cp\u003eThe present study has several limitations. First and foremost, it is crucial to acknowledge that this retrospective study was conducted solely at one institution. Secondly, the sample size utilized in this research was relatively small. Lastly, the duration of follow-up employed in this investigation was comparatively short-lived. Henceforth, future studies should contemplate conducting a prospective randomized controlled trial encompassing multiple institutions with an enlarged sample size and an extended follow-up period.\u003c/p\u003e\n\u003cp\u003eIn conclusion, both laminectomy fusion fixation and single open-door laminoplasty have demonstrated efficacy as surgical options for restoring neurological function, alleviating pain, enhancing motor ability, and reducing spinal cord edema. However, when considering the achievement of better final C2-7 SVA, C2-C7 Cobb angle, JOA score, IHMS score, RR and BASIC score; laminectomy fusion fixation excels single open-door laminoplasty. Despite the shorter surgical duration and preserved range of motion associated with laminoplasty, laminectomy fusion fixation is considered the optimal primary treatment for canal stenosis combined with CCSWOFD, particularly in cases involving multi-segmental OPLL with K-line (-).\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ecentral cord syndrome without fracture or dislocation (CCSWOFD);laminectomy and fusion (LF); laminoplsty(LP);ossification of the posterior longitudinal ligament (OPLL); Japanese Orthopaedic Association (JOA); Visual Analogue Scale (VAS);IHMS(intrinsic hand muscle strength); Indian modification of Nurick( imNurick );RR(recovery rate);range of motion (ROM); sagittal vertical axis(SVA);anterior cervical discectomy decompression and fusion (ACDF);anterior cervical corpectomy decompression and fusion (ACCF);magnetic resonance imaging (MRI); cerebrospinal fluid (CSF);surgical site infection(SSI); spinal epidural hematoma(SEH)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of\u0026nbsp;Lanxi People\u0026apos;s Hospital. All methods were performed in accordance with the relevant guidelines and regulations. Each patient gave the written informed consent on this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQian Zhang, Jun Wang, Rudan Guo\u0026nbsp;should be considered the joint first authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQian Zhang,Jun Wang,Rudan Guo: literature research; manuscript preparation; manuscript editing; data analysis\u003c/p\u003e\n\u003cp\u003eXiaoling Yang: study design; clinical studies; manuscript review\u003c/p\u003e\n\u003cp\u003eYuefen Wu: data acquisition; statistical analysis\u003c/p\u003e\n\u003cp\u003eShunyi Tong: guarantor of integrity of the entire study; experimental studies\u003c/p\u003e\n\u003cp\u003eChao Miao: study concepts; definition of intellectual content\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNakajima H, Honjoh K, Watanabe S, e al. Management of Cervical Spinal Cord Injury without Major Bone Injury in Adults. J Clin Med. 2023 Oct 27;12(21):6795. doi: 10.3390/jcm12216795. PMID: 37959260; PMCID: PMC10650636.\u003c/li\u003e\n\u003cli\u003eLee S, Kim C, Ha JK, et al. Comparison of Early Surgical Treatment With Conservative Treatment of Incomplete Cervical Spinal Cord Injury Without Major Fracture or Dislocation in Patients With Pre-existing Cervical Spinal Stenosis. Clin Spine Surg. 2021 Apr 1;34(3):E141-E146. doi: 10.1097/BSD.0000000000001065. PMID: 32925187.\u003c/li\u003e\n\u003cli\u003eTakao T, Morishita Y, Okada S, et al. Clinical relationship between cervical spinal canal stenosis and traumatic cervical spinal cord injury without major fracture or dislocation. Eur Spine J. 2013 Oct;22(10):2228-31. doi: 10.1007/s00586-013-2865-7. Epub 2013 Jun 23. PMID: 23793521; PMCID: PMC3804697.\u003c/li\u003e\n\u003cli\u003eKumar AA, Wong JYH, Pillay R, et al. Treatment of acute traumatic central cord syndrome: a score-based approach based on the literature. Eur Spine J. 2023 May;32(5):1575-1583. doi: 10.1007/s00586-023-07626-3. Epub 2023 Mar 13. Erratum in: Eur Spine J. 2023 May 4;: PMID: 36912986.\u003c/li\u003e\n\u003cli\u003eAsemota AO, Ahmed AK, Purvis TE, et al. Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database: Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges. World Neurosurg. 2018 Dec;120:e114-e130. doi: 10.1016/j.wneu.2018.07.228. Epub 2018 Aug 2. PMID: 30077751.\u003c/li\u003e\n\u003cli\u003eTakao T, Okada S, Morishita Y, et al. Clinical Influence of Cervical Spinal Canal Stenosis on Neurological Outcome after Traumatic Cervical Spinal Cord Injury without Major Fracture or Dislocation. Asian Spine J. 2016 Jun;10(3):536-42. doi: 10.4184/asj.2016.10.3.536. Epub 2016 Jun 16. PMID: 27340535; PMCID: PMC4917774.\u003c/li\u003e\n\u003cli\u003eEngel-Haber E, Snider B, Kirshblum S. Central cord syndrome definitions, variations and limitations. Spinal Cord. 2023 Apr 5. doi: 10.1038/s41393-023-00894-2. Epub ahead of print. PMID: 37015975.\u003c/li\u003e\n\u003cli\u003eThompson C, Gonsalves JF, Welsh D. Hyperextension injury of the cervical spine with central cord syndrome. Eur Spine J. 2015 Jan;24(1):195-202. doi: 10.1007/s00586-014-3432-6. Epub 2014 Jul 31. PMID: 25077941.\u003c/li\u003e\n\u003cli\u003eAarabi B, Koltz M, Ibrahimi D. Hyperextension cervical spine injuries and traumatic central cord syndrome. Neurosurg Focus. 2008;25(5):E9. doi: 10.3171/FOC.2008.25.11.E9. PMID: 18980483.\u003c/li\u003e\n\u003cli\u003eHashmi SZ, Marra A, Jenis LG, et al. Current Concepts: Central Cord Syndrome. Clin Spine Surg. 2018 Dec;31(10):407-412. doi: 10.1097/BSD.0000000000000731. PMID: 30346310.\u003c/li\u003e\n\u003cli\u003eJia Y, Zuo X, Zhang Y, et al. Effectiveness of different surgical methods in the treatment of acute central cord syndrome without fractures and dislocations of the cervical spine. J Back Musculoskelet Rehabil. 2023;36(1):71-77. doi: 10.3233/BMR-210377. PMID: 35988214; PMCID: PMC9912723.\u003c/li\u003e\n\u003cli\u003eOshima Y, Takeshita K, Taniguchi Y, et al. Effect of Preoperative Sagittal Balance on Cervical Laminoplasty Outcomes. Spine (Phila Pa 1976). 2016 Nov 1;41(21):E1265-E1270. doi: 10.1097/BRS.0000000000001615. PMID: 27054450.\u003c/li\u003e\n\u003cli\u003eIshibashi Y, Adachi N, Koga H, et al. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci. 2020 Jan;25(1):6-45. doi: 10.1016/j.jos.2019.10.009. Epub 2019 Dec 13. Erratum in: J Orthop Sci. 2022 Jan;27(1):296. PMID: 31843222.\u003c/li\u003e\n\u003cli\u003eYamazaki T, Yanaka K, Fujita K, et al. Traumatic central cord syndrome: analysis of factors affecting the outcome. Surg Neurol. 2005 Feb;63(2):95-9; discussion 99-100. doi: 10.1016/j.surneu.2004.03.020. PMID: 15680638.\u003c/li\u003e\n\u003cli\u003eMyles PS, Myles DB, Galagher W, et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017 Mar 1;118(3):424-429. doi: 10.1093/bja/aew466. PMID: 28186223\u003c/li\u003e\n\u003cli\u003eRoberts TT, Leonard GR, Cepela DJ. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res. 2017 May;475(5):1499-1504. doi: 10.1007/s11999-016-5133-4. Epub 2016 Nov 4. PMID: 27815685; PMCID: PMC5384910.\u003c/li\u003e\n\u003cli\u003evan Middendorp JJ, Goss B, Urquhart S, et al. Diagnosis and prognosis of traumatic spinal cord injury. Global Spine J. 2011 Dec;1(1):1-8. doi: 10.1055/s-0031-1296049. PMID: 24353930; PMCID: PMC3864437.\u003c/li\u003e\n\u003cli\u003eTalbott JF, Whetstone WD, Readdy WJ, et al. The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings. J Neurosurg Spine. 2015 Oct;23(4):495-504. doi: 10.3171/2015.1.SPINE141033. Epub 2015 Jul 10. PMID: 26161519.\u003c/li\u003e\n\u003cli\u003eRevanappa KK, Moorthy RK, Jeyaseelan V, et al. Modification of Nurick scale and Japanese Orthopedic Association score for Indian population with cervical spondylotic myelopathy. Neurol India. 2015 Jan-Feb;63(1):24-9. doi: 10.4103/0028-3886.152627. PMID: 25751465.\u003c/li\u003e\n\u003cli\u003eLenehan B, Fisher CG, Vaccaro A, et al. The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine (Phila Pa 1976). 2010 Oct 1;35(21 Suppl):S180-6. doi: 10.1097/BRS.0b013e3181f32a44. PMID: 20881460.\u003c/li\u003e\n\u003cli\u003eBrooks NP. Central Cord Syndrome. Neurosurg Clin N Am. 2017 Jan;28(1):41-47. doi: 10.1016/j.nec.2016.08.002. Epub 2016 Nov 1. PMID: 27886881.\u003c/li\u003e\n\u003cli\u003eJin W, Sun X, Shen K, et al. Recurrent Neurological Deterioration after Conservative Treatment for Acute Traumatic Central Cord Syndrome without Bony Injury: Seventeen Operative Case Reports. J Neurotrauma. 2017 Nov 1;34(21):3051-3057. doi: 10.1089/neu.2016.4706. Epub 2017 Jul 20. PMID: 27842476.\u003c/li\u003e\n\u003cli\u003eWang J, Li J, Cai L. Effects of Treatment of Cervical Spinal Cord Injury without Fracture and Dislocation in A Medium-to Long-Term Follow-Up Study. World Neurosurg. 2018 May;113:e515-e520. doi: 10.1016/j.wneu.2018.02.071. Epub 2018 Feb 21. PMID: 29477003.\u003c/li\u003e\n\u003cli\u003eAarabi B, Akhtar-Danesh N, Simard JM,et al. Efficacy of Early (\u0026le; 24 Hours), Late (25-72 Hours), and Delayed (\u0026gt;72 Hours) Surgery with Magnetic Resonance Imaging-Confirmed Decompression in American Spinal Injury Association Impairment Scale Grades C and D Acute Traumatic Central Cord Syndrome Caused by Spinal Stenosis. J Neurotrauma. 2021 Aug 1;38(15):2073-2083. doi: 10.1089/neu.2021.0040. Epub 2021 Apr 6. PMID: 33726507; PMCID: PMC8309437.\u003c/li\u003e\n\u003cli\u003eShi H, Chen L, Zhu L, et al. Instrumented fusion versus instrumented non-fusion following expansive open-door laminoplasty for multilevel cervical ossification of the posterior longitudinal ligament. Arch Orthop Trauma Surg. 2023 Jun;143(6):2919-2927. doi: 10.1007/s00402-022-04498-y. Epub 2022 Jun 9. PMID: 35678891.\u003c/li\u003e\n\u003cli\u003eBlizzard DJ, Caputo AM, Sheets CZ, et al. Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up. Eur Spine J. 2017 Jan;26(1):85-93. doi: 10.1007/s00586-016-4746-3. Epub 2016 Aug 23. PMID: 27554354.\u003c/li\u003e\n\u003cli\u003eXu C, Zhang Y, Dong M, et al. The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients. Spine J. 2020 Sep;20(9):1422-1429. doi: 10.1016/j.spinee.2020.05.542. Epub 2020 May 28. PMID: 32474225.\u003c/li\u003e\n\u003cli\u003eKim B, Yoon DH, Ha Y, et al. Relationship between T1 slope and loss of lordosis after laminoplasty in patients with cervical ossification of the posterior longitudinal ligament. Spine J. 2016 Feb;16(2):219-25. doi: 10.1016/j.spinee.2015.10.042. Epub 2015 Oct 30. PMID: 26523967.\u003c/li\u003e\n\u003cli\u003eAarabi B, Alexander M, Mirvis SE,et al. Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis. J Neurosurg Spine. 2011 Jan;14(1):122-30. doi: 10.3171/2010.9.SPINE09922. Epub 2010 Dec 17. PMID: 21166485.\u003c/li\u003e\n\u003cli\u003eBosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia. A ten-year review. JAMA. 1971 Apr 19;216(3):473-8. PMID: 5107929.\u003c/li\u003e\n\u003cli\u003eLevi AD, Tator CH, Bunge RP. Clinical syndromes associated with disproportionate weakness of the upper versus the lower extremities after cervical spinal cord injury. Neurosurgery. 1996 Jan;38(1):179-83; discussion 183-5. doi: 10.1097/00006123-199601000-00039. PMID: 8747967.\u003c/li\u003e\n\u003cli\u003eCurt A, Ellaway PH. Clinical neurophysiology in the prognosis and monitoring of traumatic spinal cord injury. Handb Clin Neurol. 2012;109:63-75. doi: 10.1016/B978-0-444-52137-8.00004-8. PMID: 23098706.\u003c/li\u003e\n\u003cli\u003eFujiyoshi T, Yamazaki M, Kawabe J,et al. A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line. Spine (Phila Pa 1976). 2008;33(26):E990-3\u003c/li\u003e\n\u003cli\u003eTang Z, Chen T, Tan J, et al. Impact of the K-line in patients with ossification of the posterior longitudinal ligament: Analysis of sagittal cervical curvature changes and surgical outcomes. Front Surg. 2023 Feb 15;10:1095391. doi: 10.3389/fsurg.2023.1095391. PMID: 36874452; PMCID: PMC9975339.\u003c/li\u003e\n\u003cli\u003eMolliqaj G, Payer M, Schaller K, et al. Acute traumatic central cord syndrome: a comprehensive review. Neurochirurgie. 2014 Feb-Apr;60(1-2):5-11. doi: 10.1016/j.neuchi.2013.12.002. Epub 2014 Mar 7. PMID: 24613283.\u003c/li\u003e\n\u003cli\u003eImagama S, Matsuyama Y, Yukawa Y, Kawakami N, Kamiya M, Kanemura T, Ishiguro N; Nagoya Spine Group. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg Br. 2010 Mar;92(3):393-400. doi: 10.1302/0301-620X.92B3.22786. PMID: 20190311.\u003c/li\u003e\n\u003cli\u003eMayer M, Meier O, Auffarth A, Koller H. Cervical laminectomy and instrumented lateral mass fusion: techniques, pearls and pitfalls. Eur Spine J. 2015 Apr;24 Suppl 2:168-85. doi: 10.1007/s00586-013-2838-x. Epub 2013 May 29. PMID: 23715892.\u003c/li\u003e\n\u003cli\u003eKomotar RJ, Mocco J, Kaiser MG. Surgical management of cervical myelopathy: indications and techniques for laminectomy and fusion. Spine J. 2006 Nov-Dec;6(6 Suppl):252S-267S. doi: 10.1016/j.spinee.2006.04.029. PMID: 17097545.\u003c/li\u003e\n\u003cli\u003eHosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976). 1996 Sep 1;21(17):1969-73. doi: 10.1097/00007632-199609010-00005. PMID: 8883196.\u003c/li\u003e\n\u003cli\u003eNurboja B, Kachramanoglou C, Choi D. Cervical laminectomy vs laminoplasty: is there a difference in outcome and postoperative pain? Neurosurgery. 2012 Apr;70(4):965-70; discussion 970. doi: 10.1227/NEU.0b013e31823cf16b. PMID: 22015812.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Comparison of\u0026nbsp;preoperative general data of patients\u0026nbsp;between two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eparameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLF group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLP group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e57.75\u0026plusmn;18.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e58.77\u0026plusmn;19.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003eGender (male/female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e31/28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e27/26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003eSmoking status (yes/no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e11/48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e9/44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus(n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e5（8.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e4（7.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension(n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e8（13.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e6（11.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of disc herniation(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e3.79\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e3.68.\u0026plusmn;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003eIntramedullary high-signal\u0026nbsp;lesion(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e1.98\u0026plusmn;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e1.87.\u0026plusmn;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of ossifed vertebra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e3.93\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e3.87.\u0026plusmn;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.08247422680412%\" valign=\"top\"\u003e\n \u003cp\u003eOPLL type according to K-line (n, %)\u003c/p\u003e\n \u003cp\u003eK-line (+)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;K-line (-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003e(26，44.1%）\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(23，38.9%）\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e(23，43.4%）\u003c/p\u003e\n \u003cp\u003e(18，33.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Comparison of\u0026nbsp;perioperative parameters\u0026nbsp;between two groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.37373737373738%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLF group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLP group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.37373737373738%\" valign=\"top\"\u003e\n \u003cp\u003eOperation duration(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e188.3\u0026plusmn;\u0026nbsp;36.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e153.79\u0026plusmn;22.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.37373737373738%\" valign=\"top\"\u003e\n \u003cp\u003eTotal blood loss(ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e498.76\u0026plusmn;315.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e423.56\u0026plusmn;265.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.37373737373738%\" valign=\"top\"\u003e\n \u003cp\u003eLength of hospital stay (day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e14.56\u0026nbsp;\u0026plusmn;\u0026nbsp;3.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e13.85\u0026nbsp;\u0026plusmn;\u0026nbsp;4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.37373737373738%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of opened lamina(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e4.82\u0026nbsp;\u0026plusmn;\u0026nbsp;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e4.38\u0026nbsp;\u0026plusmn;\u0026nbsp;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e0.285\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u0026nbsp; Comparison of clinical outcomes at last follow up.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoint-in-time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLP group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLF group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\n \u003cp\u003eJOA score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e6.35 \u0026plusmn; 1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e6.98 \u0026plusmn; 0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e0.653\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eLast follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e10.68 \u0026plusmn; 1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e12.98 \u0026plusmn; 1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.0 01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0. 001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\n \u003cp\u003eVAS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e6.75 \u0026plusmn; 1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e7.03 \u0026plusmn; 1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eLast follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e2.33 \u0026plusmn; 0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e2.07 \u0026plusmn; 0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0. 001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\n \u003cp\u003eIHMS\u0026nbsp;score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e59.75 \u0026plusmn;21.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e61.03 \u0026plusmn; 20.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eLast follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e99.33 \u0026plusmn; 19.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e107.07 \u0026plusmn; 18.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0. 001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0. 001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\n \u003cp\u003eBASIC score\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e2.1 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e2.2 \u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eLast follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.8 \u0026plusmn; 0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e0.4\u0026plusmn; 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eimNurick\u0026nbsp;scale score\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e2.69 \u0026plusmn; 0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e2.35 \u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e0.668\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.760563380281692%\" valign=\"top\"\u003e\n \u003cp\u003eLast follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.169014084507044%\" valign=\"top\"\u003e\n \u003cp\u003e1.52 \u0026plusmn; 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.760563380281692%\" valign=\"top\"\u003e\n \u003cp\u003e1.27\u0026plusmn; 0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.760563380281692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.169014084507044%\" valign=\"top\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.760563380281692%\" valign=\"top\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.804123711340207%\" valign=\"top\"\u003e\n \u003cp\u003eRR(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eLast follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e52.22\u0026nbsp;\u0026plusmn;\u0026nbsp;11.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e68.23\u0026plusmn;\u0026nbsp;13.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0. 001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eJOA\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eJapanese Orthopaedic Association\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eVAS \u0026nbsp;\u003c/em\u003e\u003c/strong\u003eVisual Analogue Scale \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIHMS\u003c/em\u003e\u003c/strong\u003eintrinsic hand muscle strength\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBASIC \u0026nbsp;\u003c/em\u003e\u003c/strong\u003eBrain and Spinal Injury Center\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eimNurick \u0026nbsp;\u003c/em\u003e\u003c/strong\u003eIndian modification of Nurick\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRR \u0026nbsp;\u003c/em\u003e\u003c/strong\u003erecovery rate\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Comparison of radiological outcomes between two groups.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoint-in-time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLF group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLP group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003eC2-7 Cobb angle (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e11.73 \u0026plusmn; 1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e12.65 \u0026plusmn; 1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eLast follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e17.32 \u0026plusmn; 1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e10.18\u0026plusmn; 1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003eP \u0026lt; 0. 001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003eP \u0026lt; 0. 001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003eC2-7 SVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e20.93 \u0026plusmn; 4.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e21.32 \u0026plusmn; 3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eLast follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e18.05 \u0026plusmn; 3.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e23.41 \u0026plusmn; 2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003eROM(\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e26.58 \u0026plusmn; 3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e27.06 \u0026plusmn; 3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e0.725\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eLast follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e14.32 \u0026plusmn; 3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e24.79 \u0026plusmn; 2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003eP \u0026lt;0. 001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003eP \u0026lt; 0. 001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSVA\u003c/em\u003e\u003c/strong\u003e\u0026nbsp; sagittal vertical axis \u0026nbsp; \u003cstrong\u003e\u003cem\u003eROM\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e range of motion\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e\u0026nbsp; Comparison of clinical outcomes between two groups according to K-line\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"136%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative JOA (score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinal JOA (score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative VAS (score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinal VAS (score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIHMS (score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIHMS (score)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eK-line(+) (inter.P value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eLFG=26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e7.75 \u0026plusmn; 1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e11.82 \u0026plusmn; 1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e6.85 \u0026plusmn; 1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e2.91 \u0026plusmn; 0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e51.15 \u0026plusmn; 21.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e107.25 \u0026plusmn; 21.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e57.35 \u0026plusmn; 1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eLPG=23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e7.98 \u0026plusmn; 1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e12.05 \u0026plusmn; 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e6.92 \u0026plusmn; 1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e3.07 \u0026plusmn; 1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e49.35 \u0026plusmn; 17.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e102.13 \u0026plusmn; 19.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e36.35 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eK-line(-) (inter.P value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eLFG=23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e8.35 \u0026plusmn; 1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e12.39 \u0026plusmn; 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e6.72 \u0026plusmn; 1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e3.09 \u0026plusmn; 0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e46.17 \u0026plusmn; 1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e100.28 \u0026plusmn; 20.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e37.21 \u0026plusmn; 1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eLPG=18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e8.16\u0026plusmn; 0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e9.76 \u0026plusmn; 1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e6.82 \u0026plusmn; 1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e3.15 \u0026plusmn; 1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e47.36\u0026plusmn; 1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e77.42 \u0026plusmn; 11.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e19.45 \u0026plusmn; 1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLFG\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e laminectomy fusion fixation group \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cstrong\u003e\u003cem\u003e\u0026nbsp; LPG\u003c/em\u003e\u003c/strong\u003e\u0026nbsp; \u0026nbsp;laminoplasty group\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e \u0026nbsp;Comparison of\u0026nbsp;postoperative complications\u0026nbsp;between two groups\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLF group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLP group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;2 value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003eSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003eCSF leakage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e4.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e0.248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003eAxial symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e5.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003eC5 palsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e7.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003eSymptomatic\u0026nbsp;SEH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCSF\u003c/em\u003e\u003c/strong\u003e cerebrospinal fluid , \u003cstrong\u003e\u003cem\u003eSSI\u003c/em\u003e\u003c/strong\u003e surgical site infection, \u003cstrong\u003e\u003cem\u003eSEH\u003c/em\u003e\u003c/strong\u003e spinal epidural hematoma\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"multi-segment, laminectomy, laminoplasty, central cord syndrome without fracture or dislocation, canal stenosis, ossification of the posterior longitudinal ligament, efficacy comparison","lastPublishedDoi":"10.21203/rs.3.rs-4474933/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4474933/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo conduct a comparative analysis on the clinical outcomes of two different posterior surgical procedures, namely laminectomy fusion fixation and single open-door laminoplasty, for the treatment of multi-segmental cervical canal stenosis accompanied by central cord syndrome without fractures or dislocations (CCSWOFD).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 112 patients were recruited from our department between January 2012 and December 2021. The patients were divided into two groups: the LF group (n\u0026thinsp;=\u0026thinsp;59), who underwent laminectomy fusion fixation, and the LP group (n\u0026thinsp;=\u0026thinsp;53), who underwent single open-door laminoplasty. Comparative analysis was conducted on clinical outcomes and relevant radiological findings observed in both cohorts.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe two groups did not show any significant differences in terms of intraoperative blood loss and length of hospital stay, with a p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05. However, the LP group exhibited a significantly reduced surgical duration compared to the LF group, with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.The final follow-up revealed significant improvements in Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, intrinsic hand muscle strength (IHMS) score, Brain and Spinal Injury Center (BASIC) score, and neurological recovery rate (RR), compared to the preoperative values for both groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The LF group demonstrated superior performance compared to the LP group in terms of final JOA score, RR, IHMS score, and BASIC score (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Conversely, although a significantly lower range of motion (ROM) was observed in the LF group compared to the LP group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), it exhibited a superior C2-7 Cobb angle. Additionally, while there was an increase in C2-7 sagittal vertical axis (SVA) after surgery in the laminoplasty (LP) group, it showed a significant decrease in the laminectomy (LF) group compared to that observed in the LP group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No statistically significant differences were found between the two groups when considering K-line positivity with respect to their final JOA scores and VAS scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, significantly better outcomes were observed for the LF group in terms of IHMS scores and RR (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In cases where K-line negativity was present, superior final JOA scores, IHMS scores, and RR were seen in the LF group compared to those observed in the LP group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Nonetheless, there were no notable discrepancies between both groups concerning complications; furthermore, a low incidence of complications was noted within each group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn terms of restoring neurological function, alleviating pain, enhancing motor ability, and reducing spinal cord edema, both laminectomy fusion fixation and single open-door laminoplasty have demonstrated efficacy as surgical options. However, when considering the achievement of better final C2-7SVA,C2-C7 Cobb angle, JOA score, IHMS score, RR and BASIC score, laminectomy fusion fixation surpasses single open-door laminoplasty. Despite the shorter surgical duration and preserved range of motion associated with single open-door laminoplasty, laminectomy fusion fixation is considered the optimal primary treatment for canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD), particularly in cases involving multi-segmental ossification of the posterior longitudinal ligament (OPLL) with K-line (-).\u003c/p\u003e","manuscriptTitle":"Laminectomy versus laminoplasty for treating multi-segmental cervical canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD):a retrospective study with a minimum follow-up period of two years","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 20:39:18","doi":"10.21203/rs.3.rs-4474933/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31cea1bd-e2b1-415c-bf0e-d1dc1529dba7","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-27T21:37:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-11 20:39:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4474933","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4474933","identity":"rs-4474933","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}