Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui, Japan.
Spine (Phila Pa 1976). 2019 Dec 15;44(24):E1452-E1460. doi: 10.1097/BRS.0000000000003173.
A retrospective study.
The aim of this study was to assess the outcome, perioperative complications, and prognostic factors of anterior cervical decompression and fusion (ACDF) in patients with cervical ossification of posterior longitudinal ligament (OPLL).
There is little information on the long-term surgical outcome of ACDF including postsurgical remnant ossified spinal lesion.
Between 1993 and 2013, 80 patients with cervical myelopathy towing to OPLL underwent ACDF at our hospital. Among these, 42 patients were followed-up for at least 5 years and their data were analyzed.
The mean follow-up period was 7.9 ± 2.8 years, and the overall improvement rate was 59.2% ± 15.0%. Although 12 (15.0%) perioperative complications were observed in 6 patients, accompanied by neurological deterioration, none of the patients had chronic complications. Multivariate logistic regression analysis that included the preoperative Japanese Orthopaedic Association (JOA) score, type of OPLL, occupying ratio of OPLL, and number of fused segments and increase in the transverse area of the cord identified the latter parameter as the only independent and significant determinant of radiological and clinical improvement of >50%. Among the patients with remaining ossified spinal lesions out of the decompressed range (16 patients), postoperative progression was observed in 6 cases (14.3%) who were all of the mixed type; floated lesions within the decompressed range did not show progression during the follow-up. Adjacent segment degeneration was seen in nine (21.4%) patients, and neurological signs and symptoms were seen in only three of the nine patients and only one patient required revision surgery.
The long-term clinical outcome of patients with cervical OPLL after ACDF is considered satisfactory. Surgery-related complications and adjacent segment diseases should not be reasons to avoid ACDF. Care should be taken in selecting ACDF with postsurgical remnant ossified spinal lesion, as it could progress postoperatively especially in the mixed type OPLL.
回顾性研究。
本研究旨在评估颈椎后纵韧带骨化症（OPLL）患者行前路颈椎减压融合术（ACDF）的预后、围手术期并发症和预后因素。
关于 ACDF 术后残留骨化脊髓病变的长期手术结果信息较少。
1993 年至 2013 年，我院对 80 例颈椎脊髓病合并 OPLL 的患者行 ACDF 治疗。其中，42 例患者获得至少 5 年的随访，并对其数据进行了分析。
平均随访时间为 7.9±2.8 年，总体改善率为 59.2%±15.0%。尽管 6 例患者（15.0%）出现了 12 种（15.0%）围手术期并发症，伴有神经功能恶化，但无患者出现慢性并发症。多变量逻辑回归分析包括术前日本矫形协会（JOA）评分、OPLL 类型、OPLL 占位率、融合节段数和脊髓横截面积增加，确定后者为影像学和临床改善>50%的唯一独立和显著决定因素。在减压范围外仍有骨化脊髓病变的患者（16 例）中，术后进展发生在 6 例（14.3%），均为混合型；减压范围内的漂浮病变在随访期间未进展。9 例（21.4%）患者出现邻近节段退变，仅 9 例患者中的 3 例出现神经症状，仅 1 例患者需要翻修手术。
颈椎 OPLL 患者行 ACDF 后的长期临床效果令人满意。手术相关并发症和邻近节段疾病不应成为避免 ACDF 的理由。对于术后残留骨化脊髓病变的 ACDF，应慎重选择，因为特别是在混合型 OPLL 中，术后可能会进展。
4 级。
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