人工颈椎间盘置换的近期临床疗效和影像学分析

目的分析人工颈椎间盘置换治疗神经根型颈椎病的临床疗效和影像学改变。方法回顾2012年9月至2014年3月收治的行单节段人工颈椎间盘置换术的神经根型颈椎病患者30例,其中获得完整随访资料的21例,于术前及术后7 d、1个月、3个月、6个月行临床评估和影像学数据采集。使用Odom评级、疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese orthopaedic association,JOA)评分及颈椎功能障碍指数(neck disability index,NDI)评分评估临床疗效及神经功能的改善情况,通过颈椎正侧位、动力位X线片观察颈椎整体、置换节段脊柱功能单位的曲度及活动度,以及置换节段相邻节段的活动度。结果 21例患者获得完整随访,随访时间6~9个月,平均6.8个月。NDI评分自术前(40±8.4)分下降到末次随访的(12±7.3)分(P0.05),JOA评分由术前(9±3.2)分提高到末次随访的(13.6±3.0)分(P0.05),上肢疼痛VAS评分由术前(7.6±1.6)分下降至末次随访(1.8±0.4)分(P0.05)。术后3个月颈椎曲度、置换功能节段曲度、颈椎活动度及置换功能节段的活动度较术前明显改善。术后3、6个月邻近节段活动度无明显改变。结论人工颈椎间盘假体行椎间盘置换术临床效果可靠,影像学资料显示术后可改善颈椎整体及置换节段曲度和活动度,保留临近节段活动度。     

人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病

目的评价人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病的临床效果。方法采用人工颈椎间盘置换联合颈前路融合治疗18例多节段脊髓型颈椎病患者。根据术前、术后、随访时的颈椎X线片观察人工椎间盘、内固定、植骨融合以及JOA评分改善情况。结果 18例均获随访,时间24~60(36±9.6)个月。置换间隙平均活动度术前为13.8°±6.5°,末次随访时为12.5°±5.3°,与术前比较差异无统计学意义(P0.05)。JOA评分术前为9.5分±1.5分,术后4个月时为14.2分±2.2分,平均改善率62.7%±11.2%,其中优9例,良5例,可2例,差2例。所有病例内置物无松动、移位及断裂,人工椎间盘位置良好。结论人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病能维持颈椎活动度,减少固定融合节段,同时又减少邻近节段运动负荷。     

双节段BRYAN人工颈间盘置换的中期疗效分析

[目的]观察相邻双节段BRYAN人工颈椎间盘置换术治疗相邻节段颈椎病的临床疗效与影像学结果.[方法]回顾2006年1月～ 2009年2月在本院行相邻双节段BRYAN人工颈椎间盘置换术并获得随访的颈椎病患者19例.术前及术后1周,术后3、6、12、24、36个月进行JOA评分、NDI评分及颈痛VAS评分,评估手术临床疗效;术前及术后3、6、12、24、36个月通过颈椎动力位X线片评定置换节段、上下相邻节段和C2-7颈椎活动度;术后12、24、36个月,通过X线椎间盘退变评分系统评估手术相邻节段退变.[结果]所有患者术后神经症状均明显好转,各随访点JOA评分、NDI评分、颈痛VAS评分较术前显著改善,差异有统计学意义(P＜0.05),3个月后各随访时点两两比较差异无统计学意义(P＞0.05).两置换节段活动度术后各随访点与术前比较差异有统计学意义(P＜0.05);3个月后随访,上下相邻节段活动度与术前相比略减小,C2-7活动度较术前略增加,差异无统计学意义(P＞0.05).至末次随访时,手术未导致相邻节段椎间盘退变加剧,无严重并发症发生.[结论]BRYAN人工颈椎间盘置换治疗相邻双节段颈椎间盘退变性疾病临床疗效良好,不仅保留了颈椎的运动学特性,防止置换节段与相邻节段退变,而且术后近中期无严重并发症.     

双节段颈椎间盘置换联合cage融合术治疗颈椎病

目的观察连续双节段Bryan人工颈椎间盘置换联合邻近节段cage融合术治疗三节段颈椎病的临床疗效,探讨该联合术式(Hybrid术式)的可行性及节段选择标准。方法采用双节段Bryan人工颈椎间盘置换联合邻近节段cage融合术治疗58例连续三节段病变的颈椎病患者。术前、术后进行JOA评分(17分法)和颈椎残障功能量表(NDI)评定;术后进行Odom标准评定;随访观察椎间盘假体稳定性、假体活动度、cage融合状态及cage位移情况等。结果手术均顺利完成,未出现严重术中不良事件,手术时间60~125(88.3±10.5)min;术中出血量10~60(30.3±12.1)ml。58例均获随访,时间6~48(22.2±8.3)个月。末次随访时,JOA评分由术前5~10(8.6±1.2)分增至12~17(14.1±1.5)分(P0.01);NDI评分由术前34~42(40.5±2.6)分降至13~20(16.8±3.3)分(P0.01)。Odom评定:优36例,良12例,可6例,差4例,优良率为93.1%。人工椎间盘稳定,置换节段活动度为16°~21°(18.2°±5.6°),与术前17°~23°(19.1°±4.8°)比较差异无统计学意义(P0.05),术后颈椎整体活动度为26°~41°(33.8°±10.3°),与术前33°~52°(40.3°±12.6°)比较差异无统计学意义(P0.05)。Cage植骨全部融合,无cage松动和沉陷。结论连续双节段颈椎间盘置换联合邻近节段cage融合为三节段颈椎病患者的手术治疗提供了新的术式选择,兼顾了颈椎的稳定和运动功能,初、中期随访疗效让人满意。     

Bryan颈椎人工椎间盘置换术后10年随访结果

目的 :观察Bryan颈椎人工椎间盘置换术后10年随访结果和并发症。方法:纳入在我院骨科行Bryan颈椎人工椎间盘置换术且获得长期随访、临床和影像学资料均完整的60例患者,其中神经根型颈椎病15例,脊髓型颈椎病41例,混合型颈椎病(脊髓型+神经根型)4例。47例患者为单节段置换,12例为双节段置换,1例为3节段置换。随访时间为124.0±8.3个月(117～150个月)。采用mJOA评分和VAS评分分别评估脊髓型颈椎病和神经根型颈椎病临床疗效,分析二次手术的原因和二次手术方案;颈椎屈伸位X线片评估末次随访时节段活动度情况,采用McAfee异位骨化分级观察末次随访时异位骨化情况。结果:脊髓型颈椎病患者术前mJOA评分为13.4±2.2分,末次随访时为15.8±1.1分(P0.05)。神经根型颈椎病患者术前上肢VAS评分为5.7±2.2分,末次随访时为0.7±0.9分(P0.05);术前颈痛VAS评分为4.7±2.2分,末次随访时为1.0±1.0分(P0.05)。混合型颈椎病患者术前m JOA评分为13.3±3.6分,末次随访时为15.4±1.1分;术前上肢VAS评分为4.3±2.6分,末次随访时为1.0±1.4分;术前颈痛VAS评分为2.8±1.5分,末次随访时为2.5±1.9分。7例患者接受了二次手术治疗,其中6例为手术节段异位骨化(包括初次手术单节段椎间盘置换术5例,双节段置换术1例;二次手术时3个节段异位骨化分级为Ⅲ级,4个节段为Ⅳ级)导致的新症状而行手术节段二次手术,1例为邻椎病行后路单开门椎管扩大成形术。74个手术节段的术前活动度为7.0°±2.9°,末次随访时活动度为4.6°±4.1°(P0.05)。末次随访时74个手术节段中有53个节段出现异位骨化,根据Mc Afee异位骨化分级,其中5个节段为Ⅱ级,21个节段为Ⅲ级,27个节段为Ⅳ级。结论:Bryan颈椎人工椎间盘置换术后随访10年取得了较好的疗效,但异位骨化的发生率较高,降低了手术节段的活动度,严重的异位骨化会导致手术节段出现新的神经症状而被迫行二次手术。     

Discover颈人工椎间盘置换术治疗颈椎病的临床研究

目的:比较分析Discover颈人工椎间盘置换术和颈椎前路减压融合术治疗颈椎病的临床疗效.方法:回顾分析2009年4月～2010年5月手术治疗的101例颈椎病患者,所有患者按照手术方法的不同分为人工椎间盘置换和椎间融合两组.其中人工椎间盘置换组46例(男27例,女19例,年龄46.2±10.3岁)采用Discover颈人工椎间盘置换术治疗.椎间融合组55例(男32例,女23例,年龄44.8±11.4岁)采用颈椎前路减压融合术治疗,分别对两组患者术前和末次随防时疼痛视觉模拟评分(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)、术后症状改善优良率以及C2～C7的Cobb角(C2-C7角)、手术节段脊柱功能单位Cobb角(FSU角)、手术相邻节段活动度等影像学指标进行观察分析,评价患者的颈椎功能改善情况,并进行两组间的对比分析.结果:椎间融合组手术时间为149.3±51.7min,术中出血量为213.5±42.6ml;人工椎间盘组手术时间为132.5±44.1min,术中出血量为173.2±56.4ml,两组间比较无统计学差异(P＞0.05).人工椎间盘组和椎间融合组随访时间分别为24.2±3.2个月和25.6±2.9个月.随访期间两组均未发现假体或植骨松动及移位,无内固定松动及断裂.两组患者术后神经功能均有显著恢复,疼痛症状明显改善,椎间融合组VAS及NDI评分末次随访时分别较术前下降了65.1％和63.7％,人工椎间盘组分别下降了67.1％和63.6％,两组之间比较无统计学差异(P＞0.05).末次随访时椎间融合组C2-C7角和FSU角较术前分别下降了28.1％和68.8％,手术相邻上节段和下节段活动度较术前分别上升了21.3％和28.4％,差异有显著性(P＜0.05);人工椎间盘组C2-C7角、FSU角较术前分别上升了7.7％和11.2％,手术相邻上节段及下节段活动度较术前分别上升了5.5％及9.3％,差异无统计学意义(P＞0.05). C2-C7角、FSU角和手术相邻节段活动度术后改变两组间比较有统计学差异(P＜0.05).人工椎间盘组和椎间融合组术后症状改善优良率分别为91.3％和87.3％,两组间比较无统计学差异(P＞0.05).结论:采用Discover颈人工椎间盘置换术治疗颈椎病能够取得和颈椎前路减压融合术相近的临床疗效,同时手术节段运动功能得到了保留,手术相邻节段的活动度并无增加,可作为颈椎病的有效治疗方法.     

人工颈椎间盘置换术治疗脊髓型颈椎病的近期疗效

目的探讨Bryan人工颈椎间盘置换术治疗脊髓型颈椎病的近期疗效。方法应用Bryan人工颈椎间盘置换术治疗26例脊髓型颈椎病患者,在术前及末次随访时的颈椎X线片上测量置换节段矢状位、冠状位活动度。应用JOA评分评价术后神经功能。结果术后患者症状均明显缓解。26例均获随访,时间29~48个月。末次随访JOA评分由术前平均8.3分±4.6分增加到16.1分±5.3分,置换节段矢状位活动范围4.3°~7.2°(5.6°±2.4°);冠状位左右侧屈活动范围分别为3.1°~4.3°(3.8°±1.1°)和3.1°~4.6°(3.9°±0.9°)。随访期间假体无偏移松动或下沉,无置换节段假体周围异位骨化。结论 Bryan人工颈椎间盘置换术治疗脊髓型颈椎病近期临床效果较好,维持颈椎正常的活动范围、生理曲度和较好的生物力学稳定性。     

单节段ProDisc-CDisc-C人工颈椎间盘置换术后旋转中心的位置变化

目的探讨单节段Pro Disc-C人工颈椎间盘置换术的临床疗效以及术后置换节段屈伸活动旋转中心(center of rotation,COR)的位置变化及其临床意义。方法回顾分析2010年6月-2012年2月收治的23例行单节段Pro Disc-C人工颈椎间盘置换术患者临床资料。男9例,女14例;年龄27~65岁,平均45岁。病程10~84个月,平均25个月。其中神经根型颈椎病15例,脊髓型颈椎病5例,混合型颈椎病3例。病变节段:C4、5 5例,C5、6 14例,C6、7 4例。采用日本骨科学会评分(JOA)及颈椎功能障碍指数(NDI)评价临床疗效;比较术前和末次随访时颈椎整体活动度、置换节段及相邻节段活动度、椎间隙高度以及置换节段屈伸活动COR位置坐标(COR-X,COR-Y)的变化;比较分析COR位置变化与术后临床疗效以及影像学指标之间的关系。结果 23例患者均顺利完成手术,其中1例术后出现声嘶,术后3个月症状消失。患者均获随访6~36个月,平均18.3个月。末次随访时假体无移位、松动、下沉及断裂。末次随访时JOA评分较术前显著增加,NDI评分较术前显著减少,差异均有统计学意义(P0.05)。与术前比较,末次随访时颈椎整体活动度,置换节段活动度,上、下相邻节段活动度以及置换节段COR-Y差异均无统计学意义(P0.05);椎间隙高度、置换节段COR-X显著增加(P0.05)。置换节段COR-X变化与术后JOA、NDI、置换节段活动度均无明显相关性(P0.05)。根据手术前后COR-X之差是否小于均值1.86 mm将患者分为两组,两组间术后置换节段活动度差异有统计学意义(P0.05),而两组间术后JOA、NDI、颈椎整体活动度、邻近节段活动度及椎间隙高度差异均无统计学意义(P0.05)。结论单节段Pro Disc-C人工颈椎间盘置换术临床疗效满意,能有效维持颈椎整体活动度、置换节段和相邻节段活动度,增加置换节段的椎间隙高度。术后置换节段矢状面COR位置较术前显著前移,且术后置换节段活动度随COR前移距离增大而减小。     

人工颈椎间盘置换术治疗颈椎病的中期疗效观察

目的:观察人工颈椎间盘置换术治疗颈椎病的中期临床效果。方法:2004年10月至2008年2月,对24例颈椎病患者共31个椎间隙行人工颈椎间盘置换术,其中脊髓型颈椎病21例28个椎间隙,神经根型颈椎病3例3个椎间隙;10例12个椎间隙应用Bryan假体,14例19个椎间隙应用Prodisc-C假体。术后随访24～65个月,平均39个月,定期对患者进行JOA评分和Oswestry颈椎功能障碍指数(ONDI)评定,并摄颈椎X线片测量置换节段及其相邻上下节段的活动度。结果:1例术后10个月手术节段椎体前缘骨质增生并融合,活动度丢失。其余患者随访期间置换节段稳定,颈椎生理弧度没有明显丢失;没有假体下沉和明显偏移;术后1个月、2年及末次随访时的JOA和ONDI评分与术前比较有统计学差异(P0.01),术后各时间点两两比较无统计学差异(P0.01)。术后1个月、2年及末次随访时置换节段及其相邻上下节段屈伸、左右侧屈活动度与术前比较无统计学差异(P0.01),术后各时间点两两比较亦无统计学差异(P0.01)。结论:人工颈椎间盘置换术后中期疗效满意,但仍然需要更长期随访结果来进一步评价其功能和对邻近节段的影响。     

Mobi-C人工颈椎椎间盘治疗颈椎病的早期临床观察

目的观察应用Mobi-C人工颈椎椎间盘治疗颈椎病的早期临床疗效。方法 2009年5月～2010年6月应用Mobi-C人工颈椎椎间盘治疗35例患者,共进行了45个间隙的人工椎间盘置换。通过颈椎正侧位和过伸、过屈位X线片测量置换节段术前和术后的活动度（range of motion,ROM）和颈椎整体曲度。应用日本骨科学会（JapaneseOrthopaedic Association,JOA）评分和疼痛视觉模拟量表（visual analogue scale,VAS）评分评价术后颈脊髓功能以及颈部和上肢疼痛症状。对数据进行统计学分析。结果所有患者随访12～24个月,平均17.5个月,本组病例置换节段术前ROM为8.6°±2.4°,末次随访时ROM为9.1°±2.1°,与术前相比差异无统计学意义（P〉0.05）。颈椎整体曲度术前为11.7°±9.6°,末次随访时为14.5°±7.3°,与术前相比差异有统计学意义（P〈0.05）。24例患者术前有颈脊髓受压的表现J,OA评分为9.4±1.4分,末次随访时为15.0±1.1分,与术前相比差异有统计学意义（P〈0.05）。26例患者术前有不同程度的颈肩痛和上肢痛,VAS评分为6.7±1.2分,术后为1.3±0.8分,与术前相比差异有统计学意义（P〈0.05）。结论应用Mobi-C人工颈椎椎间盘置换术治疗颈椎病近期可以保持置换节段的运动,改善颈椎曲度,并取得良好的临床疗效。     

Anterior cervical foramenotomy for cervical radiculopathy

Anterior cervical discectomy (ACD) is standard practice for cervical radiculopathy. Irrespective of the precise method used, it involves more or less complete disc removal with resultant anatomical and biomechanical derangements, and frequently the insertion of a bone or prosthetic graft. Anterior cervical foramenotomy is an alternative procedure that allows effective anterior decompression of the nerve root and lateral spinal cord, whilst conserving the native disc, preserving normal anatomy and movement, and protecting against later degeneration at adjacent spaces as far as possible. The aim of the study was to determine the safety and efficacy of anterior cervical foramenotomy in the treatment of cervical radiculopathy and took the form of a prospective study of 21 cases under the care of a single surgeon. All patients had a single level or two level anterior cervical foramenotomy. All had pre- and postoperative visual analogue scores for arm and neck pain, arm strength, sensation and overall use. A comparison between patients' perceptions and surgeon's observations was also made. Patients were followed up for between 10 and 36 months. Sixty-eight per cent completed full pre- and postoperative assessments. Twenty-eight per cent of the responders had complete arm pain resolution. There were statistically significant reductions in arm and neck pain, and overall disability. The surgeon's impression of improvement paralleled that of the patients. There was one complication with discitis. Anterior cervical foramenotomy is a safe and effective treatment for cervical radiculopathy caused by posterolateral cervical disc prolapse or uncovertebral osteophyte, and might also reduce adjacent segment degeneration.     

Posterior cervical laminoplasty formultilevel cervical spine stenosis

Cervical laminoplasty for treating multilevel spinal stenosis appears to be a good surgical alternative to the more traditional laminectomy or anterior decompression and fusion. This procedure avoids the morbidity associated with extensive anterior procedures and also appears not to be associated with late kyphosis, which can be seen in patients after a laminectomy. This review outlines the rationale, indications, contraindications, and early clinical results for patients undergoing a posterior laminoplasty.     

Alternating cervical laminoplasty for cervical spondylotic myelopathy

We present a novel method of performing an 'open-door' cervical laminoplasty. The complete laminotomy is sited on alternate sides at successive levels, thereby allowing the posterior arch to be elevated to alternate sides. Foraminotomies can be carried out on either side to relieve root compression. The midline structures are preserved. We undertook this procedure in 23 elderly patients with a spondylotic myelopathy. Each was assessed clinically and radiologically before and after their operation. Follow-up was for a minimum of three years (mean 4.5 years; 3 to 7). Using the modified Japanese Orthopaedic Association scoring system, the mean pre-operative score was 8.1 (6 to 10), which improved post-operatively to a mean of 12.7 (11 to 14). The mean percentage improvement was 61% (50% to 85.7%) after three years. The canal/vertebral body ratio improved from a mean of 0.65 (0.33 to 0.73) pre-operatively to 0.94 (0.5 to 1.07) postoperatively. Alternating cervical laminoplasty can be performed safely in elderly patients with minimal morbidity and good results.     

微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病

【摘要】 目的：探讨微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病的有效性。方法：2008年7月~2010年7月12例单侧神经根型颈椎病患者在延边大学医院接受微创前路经上位椎体椎间孔减压术。其中男7例,女5例,年龄为35~68岁,平均49岁。椎间孔狭窄部位：C5/6 4例,C6/7 5例,C7/T1 3例。软性髓核突出3例,钩椎关节骨质增生7例,突出的髓核钙化2例。均行前路手术,术中采用脊柱手术专用显微镜,在病变上位椎体确定钻孔起始部位,利用高速钻石气钻磨出一约6mm直径的通路达到病变区域,减压椎间孔。观察术前及末次随访时上肢放射性疼痛的VAS评分、颈椎功能障碍指数（NDI）及病变水平椎间盘高度。结果：手术时间为56~110min,平均86±6min;术中失血量为40~120ml,平均92±8ml。无椎动脉损伤、贺纳氏综合征、喉返神经损伤等并发症。术后随访时间为12~23个月,平均15.8±1.3个月。术前上肢疼痛VAS评分为8.5±0.5分（7~10分）,末次随访时为1.4±0.2分（0~3分）,两者比较有显著性差异（P<0.05）;术前NDI为26.4±1.3分（22~31分）,末次随访时为4.2±0.6分（3~8分）,两者比较有显著性差异（P<0.05）,改善率为84.1%;术前病变水平椎间盘高度为5.4±0.7mm（4.2~6.1mm）,末次随访时为4.9±0.7mm（3.6~5.8mm）,两者比较无显著性差异（P>0.05）。术后满意度为100%。结论：微创前路经上位椎体椎间孔减压术可减少对椎间盘的损伤,是治疗单侧神经根型颈椎病的有效手术方法。     

Anterior cervical microforaminotomy for cervical radiculopathy--results and review

Analysis of anterior cervical microforaminotomy performed at the North Staffordshire University Hospital along with a review of literature of this minimally invasive procedure is presented. METHODS: A retrospective-prospective study was performed on 34 patients (24 males, 10 females) with cervical disc disease who had been surgically treated with anterior cervical microforaminotomy between 1999 and 2005. Age ranged from 37 to 75. MRI findings were disc prolapse in 28 and additional osteophytes in six. Microforaminotomy was performed according to the published technique. RESULTS: Single level operations were performed in 22 patients (21 unilateral, 1 bilateral) and multi-level operations were performed in 12 patients (7 unilateral and 5 bilateral). The short-term outcomes were excellent in 65% (i.e., complete resolution of all symptoms), good in 29% (relief of radiculopathy but some non-radicular discomfort persists), and fair in 6% (mild residual radiculopathy with or without non-radicular symptoms). Postoperative complications include one patient with partial C6 root damage, which was identified intraoperatively, but had excellent results at 2 months post operation. Long-term follow-up (using the cervical spine research society questionnaire) ranged from 2-48 months. The average pain score, neurological outcome and functional outcome improved after this operation. RE-OPERATION: One patient, who had 2 level bilateral surgeries, needed discectomies with fusion for new onset myelopathy 18 months later. CONCLUSION: Appropriate patient selection is cardinal in achieving good outcome in anterior microforaminotomy.     

前路颈椎椎间盘切除融合术与动态装置植入术治疗单节段颈椎椎间盘突出症

目的 对比前路颈椎椎间盘切除融合术(ACDF)与颈椎前路动态装置植入术(DCI)对单节段颈椎椎间盘突出症(CDH)患者颈椎活动度(ROM)及术后颈椎曲度的影响.方法 回顾性分析2018年6月—2019年9月海军军医大学长征医院收治的78例单节段CDH患者临床资料,其中42例采用ACDF治疗(ACDF组),36例采用DC...     

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

Background  

There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation.     

颈椎不稳在交感型颈椎病发病中的作用

目的：研究交感型颈椎病的病理因素及治疗方法。方法：回顾分析了1988-2000年收治的20例手术治疗的交感型颈椎病患者。根据术前及术后颈椎伸屈侧位X光片判断有无颈椎不稳。结果：20例患者术前均有颈椎不稳,颈椎不稳主要发生在C3-C4和C4-C5,颈椎高位硬膜外封闭对大部分患者有短期效果。每例患者均于不稳节段行颈前路融合术,手术有效率为90％。结论：颈椎不稳是导致交感型颈椎病发病的重要因素;颈椎高位硬膜外封闭可有短期疗效因此具有重要的诊断价值;颈椎前路植骨融合术是治疗交感型颈椎病的有效方法。     

Postoperative instability of cervical OPLL and cervical radiculomyelopathy

The presence of cervical spine instability with respect to preoperative and postoperative changes in angular, horizontal, and rotational displacement of the vertebral body were studied. With the anterior approach, the instability in the remaining unfused segments, and their relation to the kyphotic or lordotic fused segment were studied. With the posterior approach, postoperative ROM (range of motion) could be better maintained, and horizontal displacement was improved in more cases by laminoplasty compared with laminectomy. With the anterior approach, the compensatory function for the loss of motion of the segments resulting from fusion was most remarkable at the levels of C2-3 and C6-7. In the alignment of the anterior fused segments, it appears important that the physiologic lordotic position be maintained.