Kim Soo Yeon, Hyun Seung-Jae, Kim Ki-Jeong, Jahng Tae-Ahn
Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
J Korean Neurosurg Soc. 2020 Jan;63(1):89-98. doi: 10.3340/jkns.2018.0177. Epub 2019 May 14.
Ossification of posterior longitudinal ligament (OPLL) in the thoracic spine may cause chronic compressive myelopathy that is usually progressive, and unfavorable by conservative treatment. Although surgical intervention is often needed, the standard surgical method has not been established. Recently, it has been reported that posterior decompression with dekyphosis is effective surgical technique for favorable clinical outcome. The purpose of this study was to evaluate the surgical outcomes in patients with thoracic OPLL according to dekyphosis procedure and to identify predictive factors for the surgical results.
A total of 25 patients with thoracic OPLL who underwent surgery for myelopathy from May 2004 to March 2017, were retrospectively reviewed. Patients with cervical myelopathy were excluded. We assessed the clinical outcomes according to various surgical approaches. The modified Japanese orthopedic association (JOA) scores for the thoracic spine (total, 11 points) and JOA recovery rates were used for investigating surgical outcomes.
Of the 25 patients, 10 patients were male and the others were female. The mean JOA score was 6.7±2.3 points preoperatively and 8.8±1.8 points postoperatively, yielding a mean recovery rate of 53.8±31.0%. The mean patients' age at surgery was 52.4 years and mean follow-up period was 40.2 months. According to surgical approaches, seven patients underwent anterior approaches, 13 patients underwent posterior approaches, five patients underwent combined approaches. There was no significant difference of the surgical outcomes related with different surgical approaches. Age (≥55 years) and high signal intensity on preoperative magnetic resonance (MR) image in the thoracic spine were significant predictors of the lower recovery rate after surgery (p<0.05). Posterior decompression with dekyphosis procedure was related to the excellent surgical outcomes (p=0.047). Dekyphosis did not affect the complication rates.
In this study, our result elucidated that old age (≥55 years) and presence of intramedullary high signal intensity on preoperative MR images were risk factors related to poor surgical outcomes. In the meanwhile, posterior decompression with dekyphosis affected favorable clinical outcome. Posterior approach with dekyphosis procedure can be a recommendable surgical option for favorable results.
胸椎后纵韧带骨化（OPLL）可导致慢性压迫性脊髓病，通常呈进行性发展，保守治疗效果不佳。尽管常需手术干预，但标准手术方法尚未确立。最近，有报道称后凸畸形减压后路减压术是一种能取得良好临床效果的有效手术技术。本研究的目的是根据后凸畸形手术评估胸椎OPLL患者的手术效果，并确定手术结果的预测因素。
回顾性分析2004年5月至2017年3月期间因脊髓病接受手术的25例胸椎OPLL患者。排除颈椎脊髓病患者。我们根据不同的手术方式评估临床效果。采用改良的日本骨科协会（JOA）胸椎评分（满分11分）和JOA恢复率来研究手术效果。
25例患者中，男性10例，女性15例。术前JOA平均评分为6.7±2.3分，术后为8.8±1.8分，平均恢复率为53.8±31.0%。患者手术时的平均年龄为五十2.4岁，平均随访时间为40.2个月。根据手术方式，7例患者采用前路手术，13例患者采用后路手术，5例患者采用联合手术。不同手术方式的手术效果无显著差异。年龄（≥55岁）和术前胸椎磁共振（MR）图像上的高信号强度是术后恢复率较低的显著预测因素（p<0.05）。后凸畸形减压后路减压术与良好的手术效果相关（p=0.047）。后凸畸形不影响并发症发生率。
在本研究中，我们的结果表明年龄较大（≥55岁）和术前MR图像上存在髓内高信号强度是与手术效果不佳相关的危险因素。同时，后凸畸形减压后路减压术影响良好的临床效果。后凸畸形手术的后路手术可以是一个值得推荐的手术选择，以获得良好的结果。
