1Department of Orthopaedic Surgery, Tohoku University School of Medicine; and.
2Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan.
J Neurosurg Spine. 2020 Dec 11;34(3):492-497. doi: 10.3171/2020.7.SPINE20411. Print 2021 Mar 1.
OBJECTIVE: Thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) remains one of the most difficult-to-treat disorders for spine surgeons. In Japan, approximately 75% of patients with this condition are treated using posterior decompression with instrumented spinal fusion (PDF). In contrast, anterior decompression is the most effective method for relieving spinal cord compression. The authors treated nonambulatory patients with thoracic OPLL by either PDF or by their technique using anterior decompression through a posterior approach. In this study the surgical results of these procedures are compared. METHODS: This was a retrospective case series. From 2008 to 2018, 9 patients with thoracic OPLL who could not walk preoperatively were treated surgically. Three patients were treated by PDF (the PDF group) and 6 patients were treated by anterior decompression through a posterior approach (the modified Ohtsuka group). The degree of surgical invasion and the neurological conditions of the patients were assessed. RESULTS: The PDF group had a shorter operative duration (mean 477 ± 122 vs 569 ± 92 minutes) and less intraoperative blood loss (mean 613 ± 380 vs 1180 ± 614 ml), although the differences were not statistically significant. The preoperative Japanese Orthopaedic Association (JOA) score was almost identical between the two groups; however, the latest JOA score and the recovery rate were significantly better in the modified Ohtsuka group than in the PDF group (8.8 ± 1.5 vs 5.0 ± 1.7 and 71.3% ± 23.7% vs 28.3% ± 5.7%, respectively). The walking ability was evaluated using the modified Frankel scale. According to this scale, 3 patients showed three grade improvements, 2 patients showed two grade improvements, and 1 patient showed one grade improvement in the modified Ohtsuka group. Three patients in the modified Ohtsuka group could walk without any support at the final follow-up. CONCLUSIONS: The present study clearly indicated that the surgical outcomes of the authors' modified Ohtsuka procedure were significantly better than those of PDF for patients who could not walk preoperatively.
目的：胸段脊髓病由后纵韧带骨化（OPLL）引起，一直是脊柱外科医生最难治疗的疾病之一。在日本，约 75%的此类患者采用后路减压和器械脊柱融合（PDF）治疗。相比之下，前路减压是缓解脊髓压迫最有效的方法。作者采用 PDF 或后路入路前路减压治疗非运动障碍型胸段 OPLL 患者。本研究比较了这些方法的手术效果。
方法：这是一项回顾性病例系列研究。2008 年至 2018 年，9 例术前不能行走的胸段 OPLL 患者接受手术治疗。3 例采用 PDF（PDF 组）治疗，6 例采用后路入路前路减压（改良 Ohtsuka 组）治疗。评估手术侵袭程度和患者神经状况。
结果：PDF 组手术时间较短（平均 477 ± 122 分钟比 569 ± 92 分钟），术中出血量较少（平均 613 ± 380 毫升比 1180 ± 614 毫升），但差异无统计学意义。两组术前日本矫形协会（JOA）评分几乎相同；然而，改良 Ohtsuka 组末次 JOA 评分和恢复率明显优于 PDF 组（8.8 ± 1.5 比 5.0 ± 1.7 和 71.3% ± 23.7%比 28.3% ± 5.7%）。步行能力采用改良 Frankel 量表评估。根据该量表，改良 Ohtsuka 组 3 例患者改善 3 级，2 例患者改善 2 级，1 例患者改善 1 级。改良 Ohtsuka 组 3 例患者最终随访时无需任何支撑即可行走。
结论：本研究明确表明，对于术前不能行走的患者，作者改良 Ohtsuka 手术的手术效果明显优于 PDF。
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