*Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan †Department of Orthopedic Surgery, Osaka Rosai Hospital, Osaka, Japan; and ‡Department of Orthopedic Surgery, Osaka Koseinenkin Hospital, Osaka, Japan.
Spine (Phila Pa 1976). 2014 Jan 1;39(1):58-67. doi: 10.1097/BRS.0000000000000054.
Retrospective study.
We sought to determine the long-term outcomes of laminoplasty versus anterior decompression and fusion in the treatment of cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) and to ascertain what factors should be considered in selecting appropriate surgical procedure.
There are little data about long-term results of cervical myelopathy due to OPLL with an occupying ratio 60% or more.
We retrospectively studied 27 patients having OPLL with an occupying ratio 60% or more and a follow-up period of at least 2 years. Clinical outcome was evaluated using Japanese Orthopaedic Association scores and recovery rates (≥75%, excellent; 50%-74%, good; 25%-50%, fair; and <25%, poor).
The mean age and the mean duration of follow-up were 57 years and 10.2 years. The mean Japanese Orthopaedic Association score was 9.3 before surgery and 12.4 at the final follow-up examination. There were 15 patients in the laminoplasty group (LAM group) and 12 patients in the anterior decompression and fusion group (ADF group). The ADF group had a significantly better recovery rate at final evaluation (53% vs. 30%; P = 0.04), a longer duration of surgery (314 vs. 128 min; P < 0.01), and greater blood loss (600 vs. 240 mL; P < 0.01) than did the LAM group. In the LAM group, 4 patients with excellent or good results had a significantly larger degree of cervical lordosis (30°vs. 10°; P = 0.002) than others.
The ADF group had a significantly better recovery rate than the LAM group, although the degree of surgical invasiveness was high. ADF is generally recommended for OPLL with an occupying ratio 60% or more.
回顾性研究。
我们旨在确定后路减压融合术与前路减压融合术治疗后纵韧带骨化症（OPLL）所致颈椎脊髓病的长期疗效，并确定在选择合适手术方式时应考虑哪些因素。
对于后纵韧带骨化症所致颈椎脊髓病，占椎管面积 60%以上的患者，长期疗效数据较少。
我们回顾性研究了 27 例后纵韧带骨化症患者，占椎管面积 60%以上，随访时间至少 2 年。采用日本矫形外科学会（JOA）评分和恢复率（≥75%为优，50%-74%为良，25%-50%为可，<25%为差）评估临床疗效。
患者平均年龄为 57 岁，平均随访时间为 10.2 年。术前平均 JOA 评分为 9.3 分，末次随访时为 12.4 分。后路减压融合术组（LAM 组）有 15 例，前路减压融合术组（ADF 组）有 12 例。ADF 组末次随访时恢复率（53%比 30%；P = 0.04）显著优于 LAM 组，手术时间（314 分钟比 128 分钟；P < 0.01）和出血量（600 毫升比 240 毫升；P < 0.01）显著大于 LAM 组。在 LAM 组中，4 例优、良患者的颈椎前凸角度显著大于其他患者（30°比 10°；P = 0.002）。
ADF 组的恢复率显著优于 LAM 组，尽管手术侵袭程度较高。对于后纵韧带骨化症所致颈椎脊髓病，占椎管面积 60%以上的患者，一般推荐行 ADF。
3 级。
