Iwasaki Motoki, Kawaguchi Yoshiharu, Kimura Tomoatsu, Yonenobu Kazuo
Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan.
J Neurosurg. 2002 Mar;96(2 Suppl):180-9.
The authors report the long-term (more than 10-year) results of cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine as well as the factors affecting long-term postoperative course.
The authors reviewed data obtained in 92 patients who underwent cervical laminoplasty between 1982 and 1990. Three patients were lost to follow up, 25 patients died within 10 years of surgery, and 64 patients were followed for more than 10 years. Results were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate was calculated using the Hirabayashi method. The mean neurological recovery rate during the first 10 years after surgery was 64%, which declined to 60% at the last follow-up examination (mean follow up 12.2 years). Late neurological deterioration occurred in eight patients (14%) from 5 to 15 years after surgery. The most frequent causes of late deterioration were degenerative lumbar disease (three patients), thoracic myelopathy secondary to ossification of the ligamentum flavum (two patients), or postoperative progression of OPLL at the operated level (two patients). Postoperative progression of the ossified lesion was noted in 70% of the patients, but only two patients (3%) were found to have related neurological deterioration. Additional cervical surgery was required in one patient (2%) because of neurological deterioration secondary to progression of the ossified ligament. The authors performed a multivariate stepwise analysis, and found that factors related to better clinical results were younger age at operation and less severe preexisting myelopathy. Younger age at operation, as well as mixed and continuous types of OPLL, was highly predictive of progression of OPLL. Postoperative progression of kyphotic deformity was observed in 8% of the patients, although it did not cause neurological deterioration.
When the incidence of surgery-related complications and the strong possibility of postoperative growth of OPLL are taken into consideration, the authors recommend expansive and extensive laminoplasty for OPLL.
作者报告颈椎后路纵韧带骨化症（OPLL）行颈椎椎板成形术的长期（超过10年）结果以及影响术后长期病程的因素。
作者回顾了1982年至1990年间接受颈椎椎板成形术的92例患者的数据。3例患者失访，25例患者在术后10年内死亡，64例患者随访超过10年。结果采用日本骨科协会（JOA）颈椎病评分系统进行评估。恢复率采用平林法计算。术后前10年的平均神经恢复率为64%，在最后一次随访检查时（平均随访12.2年）降至60%。8例患者（14%）在术后5至15年出现晚期神经功能恶化。晚期恶化最常见的原因是退行性腰椎疾病（3例）、黄韧带骨化继发胸段脊髓病（2例）或手术节段OPLL术后进展（2例）。70%的患者出现骨化病变术后进展，但仅2例患者（3%）出现相关神经功能恶化。1例患者（2%）因骨化韧带进展继发神经功能恶化而需要再次颈椎手术。作者进行了多因素逐步分析，发现与更好临床结果相关的因素是手术时年龄较轻和术前脊髓病较轻。手术时年龄较轻以及OPLL的混合型和连续型高度预测OPLL进展。8%的患者观察到术后后凸畸形进展，尽管未导致神经功能恶化。
考虑到手术相关并发症的发生率以及OPLL术后生长的强烈可能性，作者推荐对OPLL行扩大和广泛的椎板成形术。
