Goel Atul, Grasso Giovanni, Shah Abhidha, Rai Survendra, Dandpat Saswat, Vaja Tejas, Jadhav Dikpal, Jadhav Neha
Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, India; Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, India.
Neurosurgical Clinic, Department of Biomedicine, Neurosciences & Advanced Diagnostics, Deputy Rector for Relationships with Medical & Scientific Associations and Charities, University of Palermo, Palermo, Italy.
World Neurosurg. 2020 Aug;140:556-563. doi: 10.1016/j.wneu.2020.03.198.
Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic condition resulting in a progressive narrowing of the spinal canal and subsequent neurologic deficits. Although systemic and local factors in combination with genetic abnormality have been considered in its etiopathogenesis, OPLL remains a poorly understood pathology. Surgical management of OPLL and the choice of the most appropriate treatment are still controversial issues. Here the authors report a series of OPLL-affected patients treated by "only-fixation" technique.
Between June 2012 and June 2019, 52 patients having OPLL were treated by a surgical strategy involving only spinal fixation without any form of bone or soft tissue decompression. Facetal fixation for both the atlantoaxial and subaxial spine formed the basis of the surgical treatment. Clinical parameters, analysis of video recordings before and after surgery, and patient self-assessment were included in the analysis of outcome.
During the mean follow-up period there was an immediate postoperative and progressive recovery in symptoms in 51 patients. Of 14 patients who were wheelchair bound before surgery, 12 walked independently on follow-up assessment of 6 months. All patients had successful arthrodesis in the surgically treated segments. There were no infective- or implant-related complications.
Decision making in the surgical management of cervical OPLL is still controversial. The concept of spinal instability has been shown to be a nodal point in the pathogenesis of OPLL, and "only-spinal fixation" can be considered a rationale for an appropriate surgical treatment.
后纵韧带骨化（OPLL）是一种骨质增生性疾病，可导致椎管逐渐狭窄并继发神经功能缺损。尽管在其发病机制中已考虑到全身和局部因素与基因异常的综合作用，但OPLL仍然是一种了解甚少的病理学疾病。OPLL的手术治疗及最合适治疗方法的选择仍然是有争议的问题。在此，作者报告了一系列采用“单纯固定”技术治疗的OPLL患者。
在2012年6月至2019年6月期间，52例患有OPLL的患者接受了一种仅涉及脊柱固定而无任何形式的骨或软组织减压的手术策略治疗。寰枢椎和下颈椎的关节突固定构成了手术治疗的基础。结果分析包括临床参数、手术前后视频记录分析以及患者自我评估。
在平均随访期内，51例患者术后症状立即出现并逐渐恢复。术前14例依赖轮椅的患者中，12例在6个月的随访评估时能够独立行走。所有患者在手术治疗节段均成功实现了关节融合。没有感染或与植入物相关的并发症。
颈椎OPLL手术治疗的决策仍存在争议。脊柱不稳定的概念已被证明是OPLL发病机制中的一个关键点，“单纯脊柱固定”可被视为一种合适的手术治疗基本原理。
