Lee Dong-Ho, Park Sehan, Hong Chul Gie
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do, South Korea.
J Spine Surg. 2020 Mar;6(1):196-204. doi: 10.21037/jss.2019.12.05.
Conventional anterior cervical corpectomy and fusion (ACCF) for cervical ossification of the posterior longitudinal ligament (OPLL) is associated with a high incidence of surgery-related complications. A novel anterior decompression technique [vertebral body sliding osteotomy (VBSO)] has been developed to prevent such complications and achieve effective anterior decompression for severe OPLL patients. The purpose of this study was to describe the procedure of novel surgical technique and to evaluate the long-term surgical outcomes.
Between 2012 and 2014, 24 patients underwent VBSO for treatment of cervical myelopathy caused by severe OPLL. Operation time, estimated blood loss (EBL), neurologic outcomes and perioperative complications were investigated. Various radiographic parameters such as the preoperative canal occupying ratio, postoperative canal widening, and preoperative and postoperative cervical sagittal alignment were also measured. Minimum follow-up was 24 months.
The mean Japanese Orthopaedic Association score for cervical myelopathy (C-JOA score) improved from 12.4±2.9 preoperatively to 16.0±1.4 at the final follow-up (P<0.05). The mean recovery rate of the C-JOA score at the final follow-up was 68.65%±17.80%. The mean operating time was 130.7±21.0 minutes and the EBL was 176.3±38.0 mL. There were no perioperative complications. Pseudarthrosis was detected in two cases at 12 months postoperatively. The average spinal canal compromised ratio by OPLL decreased from 64.0%±15.0% preoperatively to 15.5%±12.2% postoperatively (P<0.05), with an average postoperative canal widening of 5.15±1.39 mm.
Novel anterior decompression technique termed VBSO may be an effective and safe surgical option for anterior decompression surgery in patients with severe cervical OPLL. Since, VBSO does not involve a direct manipulation of the OPLL mass or dissection of the interspace between the OPLL and dura mater, this may significantly decrease the incidence of surgery-related complications, operation time, and intraoperative blood loss.
传统的颈椎前路椎体次全切除融合术（ACCF）治疗颈椎后纵韧带骨化症（OPLL）手术相关并发症发生率较高。一种新型前路减压技术[椎体滑动截骨术（VBSO）]已被研发出来，以预防此类并发症，并为严重OPLL患者实现有效的前路减压。本研究的目的是描述这种新型手术技术的操作过程，并评估其长期手术效果。
2012年至2014年期间，24例患者接受了VBSO治疗严重OPLL所致的颈髓病。调查了手术时间、估计失血量（EBL）、神经功能结果和围手术期并发症。还测量了各种影像学参数，如术前椎管占位率、术后椎管扩大情况以及术前和术后颈椎矢状位对线情况。最短随访时间为24个月。
颈椎髓病的日本骨科协会平均评分（C-JOA评分）从术前的12.4±2.9提高到末次随访时的16.0±1.4（P<0.05）。末次随访时C-JOA评分的平均恢复率为68.65%±17.80%。平均手术时间为130.7±21.0分钟，EBL为176.3±38.0 mL。无围手术期并发症。术后12个月时，2例患者发现假关节形成。OPLL导致的平均椎管受压率从术前的64.0%±15.0%降至术后 的15.5%±12.2%（P<0.05），术后椎管平均扩大5.15±1.39 mm。
名为VBSO的新型前路减压技术可能是严重颈椎OPLL患者前路减压手术的一种有效且安全的手术选择。由于VBSO不涉及对OPLL团块的直接操作或OPLL与硬脑膜之间间隙的解剖，这可能会显著降低手术相关并发症的发生率、手术时间及术中失血量。
