Posterior cervical laminectomy + fusion fixation is a commonly used procedure for the treatment of cervical spine trauma combined with multisegmental cervical stenosis, which has the advantages of adequate decompression and immediate restoration of cervical stability. However, it has the disadvantages of loss of mobility, lack of protection of the posterior spinal cord, and excessive spinal cord drift leading to C5 nerve root paralysis. In this paper, we investigated the clinical value of posterior hybrid fixation (Single-open-door enlarged spinal canal plasty, mini titanium plate combined with short segmental nail-rod hybrid fixation) in cervical trauma combined with multisegmental spinal stenosis through a comparative clinical study.

A total of 72 cases of cervical trauma combined with multisegmental cervical spinal stenosis were treated with posterior hybrid fixation approach or traditional laminectomy decompression + fusion fixation from January 2017 to December 2018 at Department of Orthopedics, General Hospital of Northern Theater Command. There were a total of 72 cases, including 39 males and 33 females, with a mean age of 58.2 years (35-73 years old); they were divided into a hybrid group (n=37) and a conventional group (n=35) according to the surgical approach; in the hybrid group, a single-door cervical spinal canal enlargement was performed at the responsible segment, and lateral block nail-rod fixation and fusion with implants were performed at the same time in the unstable gap; and in the conventional group, a laminectomy decompression was performed at the responsible segment, and the long segment was fixed and fused with a nail-rod fixation. In the conventional group, laminectomy and decompression were performed at the responsible segment, and long segment fusion was performed.

With a mean follow-up of 2.2 years (1-3.5 years), the incidence of axial neck and shoulder pain was similar in both groups at the last follow-up, and the JOA scores were significantly improved compared with the preoperative period (P<0.05), and there was no significant difference between the groups. However, the incidence of C5 nerve root palsy in the hybrid group was significantly lower than that in the conventional group (P<0.05). X-rays showed that the cervical spine sequences of the two groups were satisfactory, and the fused segments were all fused, with no loosening of the internal fixation, kyphosis, destabilisation, or "re-closing" of the door. However, the cervical mobility of the hybrid group was significantly better than that of the conventional group (P<0.05).

For cervical trauma combined with multisegmental spinal stenosis, both the hybrid and traditional surgical groups significantly improved neurological function, but the former was significantly better than the latter in preserving the range of motion of the cervical spine and reducing C5 nerve root palsy. Therefore, the hybrid fixation of spinal canal enlargement and mini-titanium plate combined with short-segment nail and rod is an effective method for the treatment of multisegmental spinal stenosis combined with cervical spine trauma.