Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan.
Spine (Phila Pa 1976). 2011 Jul 1;36(15):E998-1003. doi: 10.1097/BRS.0b013e3181fda7fa.
Retrospective multi-institutional study.
To investigate the incidence of neurological deficits after cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL).
According to analysis of long-term results, laminoplasty for cervical OPLL has been reported as a safe and effective alternative procedure with few complications. However, perioperative neurological complication rates of laminoplasty for cervical OPLL have not been well described.
Subjects comprised 581 patients (458 men and 123 women; mean age: 62 ± 10 years; range: 30-86 years) who had undergone laminoplasty for cervical OPLL at 27 institutions between 2005 and 2008. Continuous-type OPLL was seen in 114, segmental-type in 146, mixed-type in 265, local-type in 24, and not judged in 32 patients. Postoperative neurological complications within 2 weeks after laminoplasty were analyzed in detail. Cobb angle between C2 and C7 (C2/C7 angle), maximal thickness, and occupying rate of OPLL were investigated. Pre- and postoperative magnetic resonance imaging was performed on patients with postoperative neurological complications.
Open-door laminoplasty was conducted in 237, double-door laminoplasty in 311, and other types of laminoplasty in 33 patients. Deterioration of lower-extremity function occurred after laminoplasty in 18 patients (3.1%). Causes of deterioration were epidural hematoma in 3, spinal cord herniation through injured dura mater in 1, incomplete laminoplasty due to vertebral artery injury while making a trough in 1, and unidentified in 13 patients. Prevalence of unsatisfactory recovery not reaching preoperative level by 6-month follow-up was 7/581 (1.2%). Mean occupying rate of OPLL for patients with deteriorated lower-extremity function was 51.2 ± 13.6% (range, 21.0%-73.3%), significantly higher than the 42.3 ± 13.0% for patients without deterioration. OPLL thickness was also higher in patients with deterioration (mean, 6.6 ± 2.2 mm) than in those without deterioration (mean, 5.7 ± 2.0 mm). No significant difference in C2/C7 lordotic angle was seen between groups.
Although most neurological deterioration can be expected to recover to some extent, the frequency of short-term neurological complications was higher than the authors expected.
回顾性多中心研究。
探讨颈椎后纵韧带骨化症（OPLL）后路椎板成形术后神经功能缺损的发生率。
根据长期结果分析，颈椎 OPLL 的椎板成形术被认为是一种安全有效的替代方法，并发症较少。然而，颈椎 OPLL 后路椎板成形术围手术期神经并发症的发生率尚未得到很好的描述。
研究对象为 2005 年至 2008 年间在 27 家机构接受颈椎 OPLL 后路椎板成形术的 581 例患者（458 例男性和 123 例女性；平均年龄：62±10 岁；范围：30-86 岁）。连续型 OPLL 114 例，节段型 146 例，混合型 265 例，局部型 24 例，未定型 32 例。详细分析了术后 2 周内的术后神经并发症。分析 C2 与 C7 之间的 Cobb 角（C2/C7 角）、最大厚度和 OPLL 的占位率。对术后出现神经并发症的患者进行术前和术后磁共振成像检查。
行开门式椎板成形术 237 例，双开门式椎板成形术 311 例，其他类型椎板成形术 33 例。术后 18 例（3.1%）下肢功能恶化。恶化的原因是硬膜外血肿 3 例，损伤硬脑膜后脊髓疝 1 例，因椎动脉损伤在制作槽时不完全椎板成形术 1 例，13 例原因不明。术后 6 个月随访时，未达到术前水平的不满意恢复率为 7/581（1.2%）。下肢功能恶化患者的 OPLL 占位率为 51.2±13.6%（范围：21.0%-73.3%），明显高于无恶化患者的 42.3±13.0%。恶化组的 OPLL 厚度也较高（平均 6.6±2.2mm），明显高于无恶化组（平均 5.7±2.0mm）。两组间 C2/C7 后凸角无显著差异。
尽管大多数神经功能恶化可以在一定程度上恢复，但短期神经并发症的发生率高于作者的预期。
