The patients were followed up effectively. Group A includes 74 patients and Group B includes 58 patients. Two patients in group A died 50 and 60 days after surgery due to respiratory and digestive diseases. One patient in group B died 30 days after surgery due to digestive system disease, and the follow-up was terminated.
3.1 Comparison of preoperative and post-operative imaging data of all patients in groups A and B
All of the patients in groups A and B achieved bone healing (Postoperative imaging showed no bone defect or edema around the internal implant, and the position of the internal fixation was satisfactory) after post-operative review. There was no loosening, slipping, or fracture of the internally fixed titanium plates and screws. None of the patients presented with increased neurological symptoms. The preoperative and post-operative imaging data of the patients in groups A and B were compared (Fig 1).
3.2 Comparison of operation time, intraoperative blood loss, post-operative blood loss, and follow-up time between groups A and B
There was no statistically significant difference in the operation time between groups A and B (Table1 and Fig 2(1)). This might suggest that the operation time of patients in group A and Group B was not different due to different surgical methods.
There was no statistical significance in the comparison of the intraoperative and post-operative blood loss between groups A and B (Table 1 and Fig 2(2)). This might suggest that the intraoperative and post-operative blood loss of patients in group A and Group B was not different due to different surgical methods.
The patients in both groups were followed up for 12 months. However, 2 patients in group A died at 50 and 60 days after surgery due to respiratory and digestive diseases. One patient in group B died 30 days after surgery due to digestive system disease, and the follow-up was terminated (Table 1 and Fig 2(3)).This might suggest that the follow-up time of patients in group A and Group B was not different due to different surgical methods.
3.3 Comparison of the incidence (%) of AS and severe AS (%) in the male and female patients in group A
There were 54 male and 20 female patients in group A presenting axial pain before surgery, 1 week after surgery, 1, 3, and 6 months after surgery, and 1 year after surgery. We compared the incidence of axial pain over time and found no statistical difference (Table 2 and Fig 3a). This might suggest that there is no difference between male and female patients in group A in the occurrence of axial pain.
The incidence rates of severe axial pain in the male and female patients in group A before surgery, 1 week after surgery, 1, 3, and 6 months after surgery, and 1 year after surgery respectively were compared. The results showed no statistical significance (Table 2 and Fig 3b). This might suggest that there is no difference between male and female patients in group A in the occurrence of severe axial pain.
3.4 Comparison of the incidence (%) of AS and severe AS (%) in the male and female patients in group B
There were 41 male and 17 female patients in group B presenting axial pain before surgery, 1 week after surgery, 1, 3, and 6 months after surgery, and 1 year after surgery. We compared the incidence of axial pain over time and found no statistical differences (Table 3 and Fig 4a). This might suggest that there is no difference between male and female patients in group B in the occurrence of axial pain.
The incidence rates of severe axial pain in the male and female patients in group B before surgery, 1 week after surgery, 1, 3, and 6 months after surgery, and 1 year after surgery respectively were compared. The results showed no statistical significance (Table 3 and Fig 4b). This might suggest that there is no difference between male and female patients in group B in the occurrence of severe axial pain.
3.5 Comparison of the incidence (%) of AS in groups A and B
The incidence of axial pain in groups A and B was not statistically significant before surgery, one week after surgery, and one month after surgery, but was statistically significant 3 months, 6 months, and 1 year after surgery (Table 4 and Fig 5). This might suggest that the incidence of axial pain was different between groups A and B with the extension of postoperative time.
3.6 Comparison of the incidence (%) of severe AS in groups A and B
The incidence of severe axial pain was compared between groups A and B. Except for no statistical significance before surgery, all of the other periods were statistically significant (Table 5 and Fig 6). This might suggest that the incidence of severe axial pain was different between groups A and B with the extension of postoperative time.
3.7 VAS scores of patients in groups A and B were compared
We compared the VAS scores in the patients in groups A and B. The preoperative VAS score had no statistical significance, but every other period of time had statistical significance. One week after surgery, 1 month after surgery, and three months after surgery, the P value was less than 0.001. Six months after surgery, the P value was less than 0.01. One year after surgery, the P value was less than 0.05 (Table 6 and Fig 7). This might suggest that there is a difference in the severity of postoperative axial pain between group A and Group B.
3.8 Comparison of the CCI values between groups A and B before and after surgery
The preoperative and post-operative CCI of groups A and B were compared between groups and within groups. The preoperative CCI values of the patients in groups A and B were not statistically significant, while the post-operative CCI values of the patients in groups A and B were statistically significant. The preoperative and post-operative CCI values of the group A patients were not statistically significant, while the preoperative and post-operative CCI values of the group B patients were statistically significant. We also compared the preoperative and post-operative CCI values of the patients in groups A and B. There was a significant statistical difference between the two groups (Table 7 and Fig 8). This might suggest that the comparison of post-operative CCI values of patients in group A and Group B was difference due to different surgical methods.
3.9 Comparison of the muscle area of the posterior cervical vertebra between groups A and B before and after surgery
We compared the preoperative and post-operative changes in the posterior cervical muscle area between groups A and B. The statistical comparisons of the C3/4, C4/5, and C5/6 levels and the total posterior cervical muscle areas were statistically significant (Table 8 and Fig 9). This might suggest that the comparison of muscle area of the posterior cervical vertebra of patients in group A and Group B was difference due to different surgical methods.