Nayak Nikhil R, Piazza Matthew, Milby Andrew, Thawani Jayesh P, Smith Lachlan J, Stein Sherman C, Malhotra Neil R
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2018 Apr;112:e375-e384. doi: 10.1016/j.wneu.2018.01.051. Epub 2018 Jan 31.
Ossification of the posterior longitudinal ligament (OPLL) often leads to cervical myelopathy. Although multiple procedures have been shown to be effective in the treatment of OPLL, outcomes are less predictable than in degenerative cervical myelopathy, and surgery is associated with high rates of complications and reoperation, which affect quality of life. In this study, we performed a decision analysis using postoperative complication data and health-related quality of life (HRQoL) utility scores to assess the average expected health utility and 5-year quality-adjusted life years (QALYs) associated with the most common surgical approaches for multilevel cervical OPLL.
We searched Medline, EMBASE, and the Cochrane Library for relevant articles published between 1990 and October 2017. Meta-analytically pooled complication data and HRQoL utility scores associated with each complication were evaluated in a long-term model.
The overall incidence of perioperative complications ranged from 6.2% for laminectomy alone to 11.0% for anterior decompression and fusion. Revision surgery for hardware/fusion failure or progression was highest for laminectomy alone (3.0%) and lowest for laminectomy and fusion (1.6%). Laminoplasty resulted in the highest 5-year QALYs gained, compared with laminectomy and anterior approaches (P < 0.001). There was no significant difference in QALY gained between laminectomy-fusion and laminoplasty.
The results suggest that owing to the higher rates of complications associated with anterior cervical approaches, laminoplasty may result in improved long-term outcomes from an HRQoL standpoint. These findings may guide surgeons in cases where either procedure is a reasonable option.
后纵韧带骨化（OPLL）常导致脊髓型颈椎病。尽管多种手术方法已被证明对OPLL治疗有效，但与退变性脊髓型颈椎病相比，其结果的可预测性较差，且手术并发症和再次手术率较高，这会影响生活质量。在本研究中，我们使用术后并发症数据和健康相关生活质量（HRQoL）效用评分进行决策分析，以评估与多节段颈椎OPLL最常见手术方法相关的平均预期健康效用和5年质量调整生命年（QALY）。
我们检索了Medline、EMBASE和Cochrane图书馆，查找1990年至2017年10月期间发表的相关文章。在一个长期模型中评估了荟萃分析汇总的并发症数据以及与每种并发症相关的HRQoL效用评分。
围手术期并发症的总体发生率范围为：单纯椎板切除术为6.2%，前路减压融合术为11.0%。因内固定/融合失败或病情进展而进行的翻修手术，单纯椎板切除术最高（3.0%），椎板切除融合术最低（1.6%）。与椎板切除术和前路手术相比，椎板成形术获得的5年QALY最高（P < 0.001）。椎板切除融合术和椎板成形术在获得的QALY方面无显著差异。
结果表明，由于颈椎前路手术相关并发症发生率较高，从HRQoL角度来看，椎板成形术可能会带来更好的长期效果。这些发现可能会在两种手术都是合理选择的情况下为外科医生提供指导。
