Zhang Yue-Hui, Liu Hai-Tao, Zhou Fu-Chao, Song Jia, Shao Jiang
Spine Center, 91603Xin Hua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Global Spine J. 2023 Mar;13(2):416-424. doi: 10.1177/2192568221997078. Epub 2021 Mar 18.
Technical note, retrospective case series.
The optimal surgical strategy for multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with a negative kyphosis line (K-line (-)) remains controversial. We present a novel single-stage posterior approach that converts the K-line from negative to positive in patients with multilevel cervical OPLL, using a posterior thick cervical pedicle screw (CPS) system and report the procedure's outcomes and feasibility.
Twelve consecutive patients with multilevel cervical OPLL and K-line (-) underwent single-stage posterior thick CPS fixation, with laminectomy and foraminal decompression. A pre-bent rod was installed to convert the K-line from negative to positive. Radiographic parameters, including the extent and occupying ratio of OPLL and the C2-C7 angle, were examined. CPS accuracy was assessed using computed tomography. The Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores were analyzed. Quality of life was assessed using the Neck Disability Index (NDI). The mean OPLL extent was 5 vertebral body levels, and posterior decompression was performed on 4.2 segments.
The average C2-C7 angle and the occupying ratio of OPLL improved from -9.0° to 14.3° and from 63% to 33%, respectively. The preoperative JOA, VAS, and NDI scores significantly improved from 8.4 to 13.3, from 7.1 to 2.2, and from 21.9 to 9.3, respectively. The K-line was converted from negative to positive in all cases. No severe complications were identified.
Single-stage posterior surgery with a thick CPS system may be a reliable and effective treatment for multilevel cervical OPLL and K-line (-).
技术说明，回顾性病例系列。
对于后纵韧带骨化症（OPLL）呈后凸线阴性（K线（-））的多节段颈椎，最佳手术策略仍存在争议。我们提出一种新颖的单阶段后路手术方法，使用后路粗壮颈椎椎弓根螺钉（CPS）系统，将多节段颈椎OPLL患者的K线由阴性转为阳性，并报告该手术的结果及可行性。
12例连续的多节段颈椎OPLL且K线（-）的患者接受了单阶段后路粗壮CPS固定术，并进行了椎板切除术和椎间孔减压术。安装预弯棒以将K线由阴性转为阳性。检查了包括OPLL的范围和占位率以及C2-C7角度等影像学参数。使用计算机断层扫描评估CPS的准确性。分析了日本骨科协会（JOA）和视觉模拟量表（VAS）评分。使用颈部功能障碍指数（NDI）评估生活质量。平均OPLL范围为5个椎体节段，在4.2个节段进行了后路减压。
平均C2-C7角度和OPLL占位率分别从-9.0°改善至14.3°，从63%改善至33%。术前JOA、VAS和NDI评分分别从8.4显著提高至13.3、从7.1显著提高至2.2、从21.9显著提高至9.3。所有病例中K线均由阴性转为阳性。未发现严重并发症。
采用粗壮CPS系统的单阶段后路手术可能是治疗多节段颈椎OPLL和K线（-）的一种可靠且有效的方法。
