Xu JunJie, Zhang Kai, Ma XiangYang, Yin QingShui, Wu ZengHui, Xia Hong, Wang ZhiYun
Department of Orthopedics, Liuhuagiao Hospital, Guangzhou, People’s Republic of China.
Orthopedics. 2011 Aug 8;34(8):e397-402. doi: 10.3928/01477447-20110627-15.
There have been no standards or guidelines for the treatment of ossification of posterior longitudinal ligament, especially multilevel ossification of posterior longitudinal ligament. The purpose of this study was to compare results of major surgical treatment for multilevel ossification of posterior longitudinal ligament. Databases including MEDLINE, EMBASE, the Cochrane library, and bibliographies of identified and review articles were searched to find randomized, controlled trials or retrospective cohort studies comparing anterior and posterior approach from 1980 to December 2010. Approximately 1375 articles were found initially, 92 abstracts were screened, 23 articles were retrieved in full; 3 studies were included in the review. No randomized, controlled studies were identified. Because all the studies included in this study are cohort studies with disparity of surgical interventions, heterogeneity of outcome measures and different qualities, we were unable to perform a meta-analysis. All comparison studies are retrospective cohort studies, comparing surgical outcomes of anterior approach (corpectomy and fusion) with that of posterior approach (laminoplasty or laminectomy) for the treatment of multilevel ossification of posterior longitudinal ligament in the cervical spine. A systematic review of retrospective cohort studies was performed to determine which surgical treatment is the most effective in patients with multilevel ossification of posterior longitudinal ligament. Definitive conclusions regarding the surgical treatment of multilevel ossification of posterior longitudinal ligament could not be made in this article. Multilevel corpectomy and fusion are more technical and have a significantly higher rate of cerebrospinal fluid leakage and graft, instrumentation related complications. A well-designed, prospective, randomized controlled, multicenter trial is needed.
对于后纵韧带骨化症，尤其是多节段后纵韧带骨化症，目前尚无治疗标准或指南。本研究的目的是比较多节段后纵韧带骨化症主要手术治疗方法的效果。检索了包括MEDLINE、EMBASE、Cochrane图书馆以及已识别和综述文章的参考文献等数据库，以查找1980年至2010年12月期间比较前路和后路手术的随机对照试验或回顾性队列研究。最初找到约1375篇文章，筛选了92篇摘要，全文检索了23篇文章；纳入综述的有3项研究。未找到随机对照研究。由于本研究纳入的所有研究均为队列研究，手术干预存在差异、结局指标存在异质性且质量不同，因此无法进行荟萃分析。所有比较研究均为回顾性队列研究，比较前路手术（椎体次全切除融合术）和后路手术（椎板成形术或椎板切除术）治疗颈椎多节段后纵韧带骨化症的手术效果。对回顾性队列研究进行系统评价，以确定哪种手术治疗方法对多节段后纵韧带骨化症患者最有效。本文无法就多节段后纵韧带骨化症的手术治疗得出明确结论。多节段椎体次全切除融合术技术要求更高，脑脊液漏、植骨及内固定相关并发症的发生率显著更高。需要进行一项设计良好的前瞻性随机对照多中心试验。
