Hou Y, Liang L, Shi G D, Xu P, Xu G H, Shi J G, Yuan W
Department of Orthopaedic Surgery, Changzheng Hospital, No. 415, Feng Yang Road, 200003 Shanghai, China.
Department of Orthopaedic Surgery, Changzheng Hospital, No. 415, Feng Yang Road, 200003 Shanghai, China.
Orthop Traumatol Surg Res. 2017 Sep;103(5):733-740. doi: 10.1016/j.otsr.2017.05.011. Epub 2017 Jun 12.
The laminoplasty has been the most widely used surgical method for OPLL. In recent years, increasing attention has been drawn to the anterior operative approaches for surgical treatment of cervical OPLL. However, which method is the optimum selection for therapy of cervical OPLL is still obscure. Therefore, we performed this prospective nonrandomized clinical study in patients with multilevel cervical myelopathy due to OPLL and compare the therapeutic efficiency of laminoplasty and anterior approach (cervical discectomy and/or cervical corpectomy) in the management of multilevel cervical OPLL.
There is no difference in clinical effects between anterior cervical spine surgery and laminoplasty in the treatment of multilevel cervical OPLL.
A total of 150 consecutive patients with multilevels of cervical OPLL underwent anterior approaches (ACDF, ACCF and HDF) from July 2010 to June 2014, which were enrolled in this study. During the same period, one hundred and two patients receiving the laminoplasty were enrolled in the study. The clinical effects, alignment and range of motion (ROM) of cervical spine in patients of the anterior group and posterior group were assessed, respectively. The effects of high signals in T2 weighed MRI scans and percentage of spinal canal stenosis in these patients were also evaluated. Finally, postoperative complications regarding each group were analyzed.
Although significant differences in types of OPLL and preoperative sagittal alignment of cervical spine occurred in the two groups (P<0.05), clinical effects of the two groups were similar (P>0.05). The cervical curvature in laminoplasty group showed significant decrease at final follow-up (P<0.05). For ROM of cervical spine, no significant alteration was observed in both groups. The high T2 weighed signals and rate of spinal canal stenosis can influence clinical effects of both anterior group and laminoplasty group. In addition, significantly higher complication rate was observed in laminoplasty group compared with anterior group (P<0.05).
Both anterior and laminoplasty approaches can be considered effective and safe procedures in the treatment of the multilevel OPLL. However, the anterior approach with relatively lower incidence of postoperative complications is a better choice for cases with poor cervical curvature and serious spinal canal stenosis.
Level 3 nonrandomized, controlled clinical trials.
椎板成形术一直是治疗颈椎后纵韧带骨化症（OPLL）应用最广泛的手术方法。近年来，颈椎OPLL手术治疗的前路手术入路越来越受到关注。然而，治疗颈椎OPLL的最佳选择方法仍不明确。因此，我们对因OPLL导致多节段颈椎病的患者进行了这项前瞻性非随机临床研究，比较椎板成形术和前路手术（颈椎间盘切除术和/或颈椎椎体次全切除术）治疗多节段颈椎OPLL的疗效。
颈椎前路手术和椎板成形术治疗多节段颈椎OPLL的临床效果无差异。
2010年7月至2014年6月，共有150例连续的多节段颈椎OPLL患者接受了前路手术（ACDF、ACCF和HDF），纳入本研究。同期，102例接受椎板成形术的患者纳入研究。分别评估前路组和后路组患者的临床效果、颈椎排列和活动度（ROM）。还评估了这些患者T2加权MRI扫描中的高信号影响以及椎管狭窄百分比。最后，分析每组术后并发症情况。
尽管两组在OPLL类型和颈椎术前矢状位排列方面存在显著差异（P<0.05），但两组的临床效果相似（P>0.05）。椎板成形术组颈椎曲度在末次随访时显著降低（P<0.05）。对于颈椎ROM，两组均未观察到显著改变。T2加权高信号和椎管狭窄率可影响前路组和椎板成形术组的临床效果。此外，与前路组相比，椎板成形术组的并发症发生率显著更高（P<0.05）。
前路手术和椎板成形术在治疗多节段OPLL方面均可视为有效且安全的手术方法。然而，对于颈椎曲度差和椎管严重狭窄的病例，术后并发症发生率相对较低的前路手术是更好的选择。
3级非随机对照临床试验。
