Komagata Masashi, Inahata Yuji, Nishiyama Makoto, Endo Kenji, Tanaka Hidetoshi, Kobayashi Hiroto
Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
J Spinal Disord Tech. 2007 Jul;20(5):342-6. doi: 10.1097/BSD.0b013e31802dc5a0.
Postoperative long-term follow-up study of open door laminoplasty for the ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine.
Techniques and outcomes of open door laminoplasty were described. The efficacy of this procedure was discussed and compared with other surgical methods for thoracic OPLL reported in the literature.
OPLL of the thoracic spine is often associated with cervical OPLL or ossification of the yellow ligament (OYL) of the thoracic spine; therefore, it is extremely difficult to determine the most appropriate surgical therapeutic procedure. There are very few detailed reports about extensive laminoplasty for OPLL of the thoracic spine.
The subjects included in this study consisted of 13 consecutive patients of thoracic OPLL who were surgically treated between 1994 and 2003 by the open door laminoplasty using the spinal processes and ligament complex as spacers for the open side. The number of manipulated lamina, including the cervical spine, was from 7 to 14 (mean 10 laminae), the follow-up period was 75 months on average. We evaluated the clinical symptoms by the JOA scoring method and postoperative bone union and thoracic kyphosis by plain x-ray photograph and computed tomography.
Postoperatively, the JOA score improved from an average of 5.5 to 8.5 out of a maximum of 11 points and the mean recovery rate by Hirabayashi method was 54.5%. In all cases, bone union was seen at the hinge side between the opened lamina and the lateral mass. Neither restenosis of the opened lamina nor marked progression of kyphosis were seen on the final follow-up observation in any patient. There was no postoperative spinal cord injury.
Open door laminoplasty is a useful procedure for OPLL of the thoracic spine. This method enables wide-range posterior decompression, especially for the continuous type OPLL extending from the cervical spine to the thoracic spine, even if the apex of the thoracic kyphosis is included.
胸椎后纵韧带骨化症（OPLL）开门椎板成形术的术后长期随访研究。
描述开门椎板成形术的技术和结果。讨论该手术的疗效，并与文献中报道的其他治疗胸椎OPLL的手术方法进行比较。
胸椎OPLL常与颈椎OPLL或胸椎黄韧带骨化症（OYL）相关；因此，很难确定最合适的手术治疗方法。关于胸椎OPLL广泛椎板成形术的详细报道非常少。
本研究纳入的对象为1994年至2003年间连续13例接受手术治疗的胸椎OPLL患者，采用棘突和韧带复合体作为开门侧的间隔进行开门椎板成形术。包括颈椎在内的被操作椎板数量为7至14个（平均10个椎板），平均随访期为75个月。我们采用JOA评分法评估临床症状，通过X线平片和计算机断层扫描评估术后骨愈合和胸椎后凸情况。
术后，JOA评分从平均5.5分（满分11分）提高到8.5分，平林法平均恢复率为54.5%。在所有病例中，在开门椎板与侧块之间的铰链侧均可见骨愈合。在最后一次随访观察中，任何患者均未出现开门椎板再狭窄或后凸明显进展。无术后脊髓损伤。
开门椎板成形术是治疗胸椎OPLL的一种有效方法。即使包括胸椎后凸顶点，该方法也能实现广泛的后路减压，尤其适用于从颈椎延伸至胸椎的连续型OPLL。
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