Katsumi Keiichi, Hirano Toru, Watanabe Kei, Ohashi Masayuki, Shoji Hirokazu, Mizouchi Tatsuki, Yamazaki Akiyoshi, Izumi Tomohiro, Sawakami Kimihiko, Denda Hiroshi, Takahashi Kazuo, Endo Naoto
Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-uonuma City, Niigata, Japan.
Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata City, Niigata, Japan.
J Clin Neurosci. 2018 Nov;57:74-78. doi: 10.1016/j.jocn.2018.08.033. Epub 2018 Aug 23.
Posterior decompression with instrumented fusion (PDF) is a suitable surgical treatment for K-line (-)-type cervical ossification of the posterior longitudinal ligament (OPLL). However, the adequate indications of PDF have not been clarified yet. The purpose of this study was to investigate the surgical results of PDF and perioperative factors that influence the surgical outcome, and to clarify the adequate indications of PDF.
Twenty-seven patients (21 men and 6 women, mean age: 61.4 years) who were diagnosed with a K-line (-)-type OPLL that was treated with PDF were included in this study. We evaluated these patients clinically and radiologically to investigate the outcomes of PDF and perioperative factors that influence improvements in the Japanese Orthopedic Association (JOA) score.
The mean recovery rate of JOA score at the final follow-up examination was 53.3%. In the statistical analysis, the preoperative C2-C7 angle and the C2-C7 angle immediately postoperatively significantly predicted the surgical outcome. The C2-C7 angle immediately postoperatively was the only most important predictor. Using a receiver operating characteristic curve analysis, we found that the cutoff value of the C2-C7 angle immediately postoperatively for good outcomes (recovery rate of JOA score ≥50%) was -2.0°.
PDF for K-line (-)-type OPLL patients with preoperative lordotic alignment can be expected to have favorable outcomes, which is the adequate indication for PDF. Since the C2-C7 angle immediately postoperatively was the most important predictor, the physician should pay attention to maintain the cervical lordotic alignment to enhance the surgical outcomes in surgical planning.
后路减压内固定融合术（PDF）是治疗K线阴性型颈椎后纵韧带骨化症（OPLL）的一种合适的手术方法。然而，PDF的适当适应证尚未明确。本研究的目的是探讨PDF的手术效果及影响手术结果的围手术期因素，并明确PDF的适当适应证。
本研究纳入了27例诊断为K线阴性型OPLL并接受PDF治疗的患者（21例男性和6例女性，平均年龄：61.4岁）。我们对这些患者进行了临床和影像学评估，以研究PDF的结果以及影响日本骨科协会（JOA）评分改善的围手术期因素。
末次随访时JOA评分的平均恢复率为53.3%。在统计分析中，术前C2-C7角和术后即刻C2-C7角显著预测手术结果。术后即刻C2-C7角是唯一最重要的预测因素。通过受试者工作特征曲线分析，我们发现术后即刻C2-C7角对于良好结果（JOA评分恢复率≥50%）的临界值为-2.0°。
对于术前存在前凸排列的K线阴性型OPLL患者，PDF有望取得良好的效果，这是PDF的适当适应证。由于术后即刻C2-C7角是最重要的预测因素，医生在手术规划中应注意维持颈椎前凸排列以提高手术效果。
