Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid- Wulumuqi Rd, Shanghai 200040 China.
Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA.
Spine J. 2021 Jul;21(7):1168-1175. doi: 10.1016/j.spinee.2021.01.023. Epub 2021 Feb 2.
Surgical treatment is indicated for symptomatic thoracic ossification of posterior longitudinal ligament (OPLL), and circumferential decompression (CD) is a promising option. However, the risk of postoperative paralysis in ventral decompression of CD is as high as 30%. Therefore, it is important to balance surgical outcomes and safety of ventral decompression.
To investigate the role of intraoperative motor-evoked potential (MEP) changes in decision-making of one-staged CD via posterior approach for treating thoracic OPLL.
A retrospective cohort analysis PATIENT SAMPLE: Twenty-five thoracic OPLL patients in this study underwent posterior decompression (PD) alone, and the other 21 patients accepted CD.
Intraoperative MEP monitoring from both abductor hallucis and tibialis anterior, and modified Japanese Orthopaedic Association (mJOA) scores.
MEPs were recorded in all patients before and after PD, and patients accepting CD underwent further MEP recordings after ventral decompression. According to MEP changes after PD, patients were divided into MEP improvement, MEP deterioration and no MEP change. Postoperative MEP improvement rates were measured in all tested muscles. Additionally, all patients accepted mJOA scores before and 2 years after operation.
Patients in both CD and PD groups exhibited improved mJOA scores after operation (p<.05), and both mJOA and MEP improvement rates were similar between these two groups (p>.05). In no MEP change group, patients accepting CD exhibited increased mJOA improvement rates compared with those accepting PD (p<.05). In MEP deterioration group, higher mJOA improvement rates were observed in PD group than in CD group (p<.05). In MEP improvement group, mJOA improvement rates were similar between CD and PD groups (p>.05).
Both CD and PD can effectively treat thoracic OPLL, and which of these two strategies can achieve better functional recovery may be related to different MEP changes after PD. Therefore, monitoring MEP changes may provide additional references in decision-making of one-staged CD for treating thoracic OPLL.
对于有症状的胸段后纵韧带骨化症（OPLL），手术治疗是指征，而环形减压（CD）是一种有前途的选择。然而，CD 后路减压术后瘫痪的风险高达 30%。因此，平衡手术效果和安全性非常重要。
研究术中运动诱发电位（MEP）变化在经后路一期 CD 治疗胸段 OPLL 中的决策作用。
回顾性队列分析。
本研究共 25 例胸段 OPLL 患者接受单纯后路减压（PD），另 21 例患者接受 CD。
术中记录拇展肌和胫骨前肌的 MEP 以及改良日本矫形协会（mJOA）评分。
所有患者在 PD 前后均记录 MEP，接受 CD 的患者在腹侧减压后进一步记录 MEP。根据 PD 后 MEP 的变化，患者分为 MEP 改善、MEP 恶化和 MEP 无变化。测量所有测试肌肉的术后 MEP 改善率。此外，所有患者在术前和术后 2 年均接受 mJOA 评分。
CD 组和 PD 组患者术后 mJOA 评分均有所改善（p<0.05），两组间 mJOA 和 MEP 改善率相似（p>0.05）。在 MEP 无变化组中，接受 CD 的患者与接受 PD 的患者相比，mJOA 改善率增加（p<0.05）。在 MEP 恶化组中，PD 组的 mJOA 改善率高于 CD 组（p<0.05）。在 MEP 改善组中，CD 组和 PD 组的 mJOA 改善率相似（p>0.05）。
CD 和 PD 均可有效治疗胸段 OPLL，哪种策略能获得更好的功能恢复可能与 PD 后不同的 MEP 变化有关。因此，监测 MEP 变化可为经后路一期 CD 治疗胸段 OPLL 的决策提供额外参考。
