Chen Yu, Liu Xiaowei, Chen Deyu, Wang Xinwei, Yuan Wen
Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Orthopedics. 2012 Aug 1;35(8):e1231-7. doi: 10.3928/01477447-20120725-25.
Ossification of the posterior longitudinal ligament is a common cause of cervical myelopathy, and controversy remains regarding surgical options. Between January 2004 and December 2007, a total of 164 patients with ossification of the posterior longitudinal ligament in the cervical spine who underwent surgical treatment at the authors' institution were included in this study. The choice of surgical option was based on pathological extent and cervical alignment. Short-segment pathology was treated via the anterior approach and long-segment pathology via the posterior approach. When the posterior approach was selected, laminoplasty was performed for the patients with cervical lordosis and laminectomy with fusion for those with cervical kyphosis. Consequently, anterior corpectomy and fusion was performed in 91 patients, laminoplasty in 41 patients, and laminectomy and instrumented fusion in 32 patients. The Japanese Orthopedic Association scoring system was used to evaluate patients' neurological status, and related complications were also recorded. Clinical results between different approaches and techniques were compared at mid-term follow-up. Based on the results of this study and a review of previous literature, no significant differences existed between different approaches and techniques for patients with mild ossification of the posterior longitudinal ligament, but anterior corpectomy and fusion had significantly better results in patients with severe ossification of the posterior longitudinal ligament. With respect to the posterior approach, laminectomy and instrumented fusion improved the surgical results of patients with cervical kyphosis, but a high incidence of C5 palsy existed simultaneously.
后纵韧带骨化是导致脊髓型颈椎病的常见原因，关于手术方案仍存在争议。在2004年1月至2007年12月期间，共有164例颈椎后纵韧带骨化患者在作者所在机构接受了手术治疗，并纳入本研究。手术方案的选择基于病变范围和颈椎曲度。短节段病变采用前路手术，长节段病变采用后路手术。当选择后路手术时，颈椎前凸患者行椎板成形术，颈椎后凸患者行椎板切除融合术。结果，91例行前路椎体次全切除融合术，41例行椎板成形术，32例行椎板切除内固定融合术。采用日本骨科协会评分系统评估患者神经功能状态，并记录相关并发症。在中期随访时比较不同手术入路和技术的临床结果。基于本研究结果及对既往文献的回顾，对于后纵韧带轻度骨化患者，不同手术入路和技术之间无显著差异，但对于后纵韧带重度骨化患者，前路椎体次全切除融合术效果明显更好。关于后路手术，椎板切除内固定融合术改善了颈椎后凸患者的手术效果，但同时存在较高的C5麻痹发生率。
