[Clinical study of the application of enhanced recovery after surgery in cervical spondylotic myelopathy]

Abstract

Objective: To evaluate the role of enhanced recovery after surgery in treating cervical spondylotic myelopathy.

Methods: The clinical data of 55 patients with cervical spondylotic myelopathy underwent surgical treatment from January 2012 to December 2015 were retrospectively analyzed. There were 30 males and 25 females, age from 36 to 71 years old with an average of (45.2±3.2) years, course of disease was for 1 to 12 months with an average of (4.5±1.8) months. The concept of enhanced recovery after surgery and perioperative management were applied to surgical treatment in 35 patients (study group), and the same period, 20 patients without strategy of enhanced recovery after surgery (control group). Thirty-eight patients were treated by anterior cervical discectomy decompression and fixation(ACDF), 17 patients were treated by posterior single-open door laminoplasty decompression. The activity time out of bed, hospitalization days after surgery were compared between two groups. Japanese Orthopaedic Association (JOA) score and visual analogue score(VAS) before operation, after operation at 1, 7, 30 days and 6, 12 months was respectively used to evaluate the neurological function and pain.

Results: All the patients were followed up for 12 to 18 months with an average of (14.3±1.5) months. There was no significant difference in age, gender, surgical methods, preoperative VAS, JOA score between two groups (P>0.05). The activity time out of bed was 3 to 8 h with an average of (5.54±1.54) h, postoperative hospitalization time was 3 to12 d with an average of (5.62±1.59) d in study group, while in control group, the activity time out of bed was 24 to 48 h with an average of (18.80±4.78) h, and postoperative hospitalization time was 7 to 17 d with an average of (9.85±1.94) d; there was significant difference between two groups (P<0.01). There was significant difference in VAS and JOA scores between two groups at 1, 7, 30 d after operation (P<0.01), and there was no significant difference at 6, 12 months after operation(P>0.05). There were no neurologic function deterioration, hematoma, wound infection, internal fixation loosening and other complications in study group during hospitalization and following-up;there were 2 cases of superficial wound infection in the control group, who healed by dressing change for 2 weeks;there was no significant difference between two groups(P>0.05).

Conclusions: The strategy of enhanced recovery after surgery in treating cervical spondylotic myelopathy can promote the early recovery, shorten the length of stay and improve the patient's degree of satisfaction.

Keywords: Cervical spondylotic myelopathy; Enhanced recovery after surgery; Surgical procedures, operative.