الفهرس 
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Abstract
This retrospective study included 30 patients with cervical spondylotic myelopathy who admitted to Minia University Hospital between June 2021 to January 2023.
Patients were dividied into two groups ; the first group (group A) includes 15 patients who underwent posterior cervical laminectomy while the second group ( group B) include 15 patients too who underwent posterior cervical laminectomy with lateral masss fixation.
The procedure, possible complications, benefits, risks and other alternative interventions were all explained to the patients and an informed consent was obtained.
Patients were subjected to :
• Complete history taking including personal history , complaint , Degree of myelopathy using Modified Japanese orthopedic association (mJAO) score , Sphincteric manifestations , family history and past history .
• Examination that includes general examination and neurological examination (mental status, motor examination, deep tendon reflexes, sensory examination , gait disturbance).
• Laboratory investigations ( CBC, Renal fuctions tests , liver fuctions tests , coagulation profile and random blood sugar ).
• Radiographic evaluation including MRI cervical spine and Plain X-rays to asses the cervical sagittal aligment using C2-C7cobb angle and CT cervical if needed .
Surgical intervention either posterior laminectomy only or posterior laminectomy with lateral mass fixation:
group A (underwent posterior cervical laminectomy only,N=15):
Under general anesthesia and hypotensive anathesia was recommended to decrease blood loss
A linear incision is made on the skin, exposing the area from the C2 to C7.The muscular tissue was carefully separated from the centerline towards the sides to reveal the underlying skeletal structure. Decompressive laminectomy was done by drilling two gutters on both sides of the lamina.
group B (underwent posterior cervical laminectomy with lateral mass fixation,N=15)
Using an awl, a shallow hole was drilled one millimeter medially & above the center of the lateral mass (Magerl technique). Next, A drilling tool was used to make a hole with a depth of one centimeter in the lateral masses on both sides.screws were inserted using the Magerl technique, 20 to 30 degree lateral angulations with sagittal inclination parallel to the facet joint line to prevent damage to the spinal nerve root & vertebral artery. The same ball tip probe was used to measure the screw length. Screws of the same length were inserted after measuring the length of the probe at the point where it just hooks the outer perforated cortex. drilled the proximal entry area’s perimeter and used a 2.5-mm tap to set the trajectory. We used screws measuring 3.5 mm for every patient. The rods were shaped to the desired angle & positioned on both sides using screw covers. Posterior decompression is performed in the same manner as in group A. The facet joints should be curetted & filled with bone grafts harvested from the spinous processes.
Wound closure for both groups as following :
Closure needs to be accurate . A last look should be done to determine the decompressed levels, and exclude any remaining foreign bodies. Closed suction drainage system was then implanted, and the wound was closed in a layers. The fascial layer in particular should always be closed in a watertight fashion. The drain was extracted either after a period of two days or if the drainage volume was below fifty milliliters.
Patients were followed postoperative clinically and radiologically as follow :
• Clinically : by assessing myelopathy score using the( mJAO) score immediately postoperative , 6 months , 12 months post operative.
• Radioogically : following patients using plain X-rays and CT scan at discharge , 6 months , 12 months post operativ. Also using cervical cobb angle to assess the cervical sagittal aligment.
• Our results we concluded that in posterior cervical laminectomy with lateral mass fixation group , there was statistically significant difference between preoperative and postoperative cobb angle for patients with straightening or kyphotic curve, while there was no statistically significant difference between preoperative and postoperative cobb angle for patients with straightening or kyphotic curve in posterior cervical laminectomy without lateral mass fixation group.
This results encouarges us to operate patients with cervical spondylotic myelopathy with altered normal sagittal aligment ( straightening of curve or kyphotic curve ) with posterior cervical laminectomy with lateral mass fixation to improve deformity.
Further studies with larger scales are needed for confirming our results.