后路纵韧带切除在神经根型颈椎病前路减压术中的作用。

Utility of Posterior Longitudinal Ligament Resection During Anterior Cervical Decompression for Radiculopathy.

机构信息

Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.

出版信息

World Neurosurg. 2020 May;137:e425-e429. doi: 10.1016/j.wneu.2020.01.216. Epub 2020 Feb 5.

DOI:10.1016/j.wneu.2020.01.216

PMID:32035200

Abstract

BACKGROUND

Anterior cervical diskectomy and fusion (ACDF) is the main surgical treatment of cervical radiculopathy. Controversy exists about the need to resect the posterior longitudinal ligament (PLL) to directly decompress the nerve roots, or if it is sufficient to indirectly decompress with diskectomy and graft placement. The objective of this study was to determine the effect of PLL resection after ACDF.

METHODS

A retrospective review was performed of all patients that underwent first-time ACDF for cervical radiculopathy at a single tertiary care institution between 1999 and 2013. Comparative analyses and multivariable logistic regression were performed.

RESULTS

Two hundred patients were included with a mean follow-up of 39 months. Average age was 54 years, 62% were women, and diabetes and current smoking status were noted in 11% and 15%, respectively. PLL resection was performed in 127 patients (64%), and no significant differences in baseline characteristics were observed between the 2 cohorts. One durotomy occurred in the resected PLL cohort, and none were seen in the unresected PLL group. No differences were seen in perioperative complications. At the time of last follow-up, improvement in radiculopathy was observed in 94% of the resected PLL group compared with 81% of the unresected PLL group (P = 0.008). After controlling for confounders, PLL resection had 3.8 times greater odds of leading to postoperative improvement in radiculopathy.

CONCLUSIONS

ACDF leads to a high rate of success in improvement of preoperative radiculopathy. Excision of PLL during surgery leads to 3.8 times greater odds of improvement in this symptom, with no significant difference in the complication rate.

摘要

背景

颈椎前路椎间盘切除术和融合术（ACDF）是治疗神经根型颈椎病的主要手术方法。对于是否需要切除后纵韧带（PLL）以直接减压神经根，还是通过椎间盘切除术和植骨间接减压存在争议。本研究旨在确定 ACDF 后 PLL 切除的效果。

方法

对 1999 年至 2013 年间在一家三级医疗机构接受首次 ACDF 治疗神经根型颈椎病的所有患者进行回顾性分析。进行了比较分析和多变量逻辑回归分析。

结果

共纳入 200 例患者，平均随访 39 个月。平均年龄为 54 岁，62%为女性，分别有 11%和 15%的患者患有糖尿病和当前吸烟。127 例（64%）患者行 PLL 切除术，两组患者基线特征无显著差异。在 PLL 切除组发生 1 例硬脊膜切开，而在未切除 PLL 组未观察到硬脊膜切开。两组围手术期并发症无差异。末次随访时，PLL 切除组的神经根病改善率为 94%，而未切除 PLL 组为 81%（P=0.008）。在控制混杂因素后，PLL 切除使术后神经根病改善的可能性增加了 3.8 倍。