Department of Orthopaedic Surgery, National University Hospital, National University Health System Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore.
Department of Orthopaedic Surgery, National University Hospital, National University Health System Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore.
Spine J. 2021 Jul;21(7):1176-1184. doi: 10.1016/j.spinee.2021.03.022. Epub 2021 Mar 26.
Ossification of the posterior longitudinal ligament (OPLL) is a progressive, debilitating disease most commonly affecting the cervical spine. When compared to other degenerative pathologies, OPLL procedures carry a significantly higher risk of complications owing to increased case complexity and technical difficulties. Most previous studies have focused on functional outcomes and few have reported on risk factors for postoperative complications in OPLL patients.
To identify clinical and radiological risk factors of surgical complications following treatment for cervical OPLL STUDY DESIGN: Retrospective review PATIENT SAMPLE: One hundred thirty-one patients with cervical myelopathy secondary to OPLL who underwent surgical decompression with complete 2-year follow-up.
Surgical and medical postoperative complications were analyzed. Revision surgery rates and mortality rates were recorded.
Clinical, surgical, and radiological characteristics were collected for each patient. Complications within 30 days were identified. Univariate and multivariate analysis were performed to identify risk factors for surgical complications.
There were 39 (29.8%) surgical complications in the cohort, which included C5 palsy (7.6%), dural tear (3.1%), surgical site infection (3.1%), and epidural hematoma (1.5%). 2-year revision and mortality rates were 4.6% and 2.3%, respectively. Univariate analysis revealed that blood loss ≥750mL (OR 3.42, p=0.028), operative duration ≥5.5 hours (OR 3.16, p=0.008), hill-type OPLL (OR 3.08, p=0.011), K-line (-) OPLL (OR 5.39, p<0.001), and presence of a double-layer sign (OR 3.79, p=0.002) were significant risk factors. In multivariate analysis, only hill-type OPLL (OR 2.61, p=0.048) and K-line (-) OPLL (OR 2.98, p=0.031) were found to be significant. Patients with both hill-type and K-line (-) OPLL had a 3.5 times risk of developing surgical complications (p=0.009).
Patients with OPLL have a higher risk of perioperative surgical complications if they had a hill-shaped OPLL and K-line (-) OPLL on preoperative imaging studies. To the best of the authors' knowledge, this study is the first to link hill-type and K-line (-) OPLL morphology as risk factors for perioperative surgical complications.
骨化的后纵韧带（OPLL）是一种进行性、使人虚弱的疾病，最常影响颈椎。与其他退行性病变相比，由于病例复杂性和技术难度增加，OPLL 手术的并发症风险显著更高。大多数先前的研究都集中在功能结果上，很少有研究报告 OPLL 患者术后并发症的危险因素。
确定颈椎 OPLL 治疗后手术并发症的临床和影像学危险因素。
回顾性研究。
131 例颈椎 OPLL 导致的颈髓病患者，接受颈椎后路减压手术，随访时间完整，随访时间为 2 年。
分析手术和医疗术后并发症。记录翻修手术率和死亡率。
收集每位患者的临床、手术和影像学特征。确定 30 天内的并发症。进行单因素和多因素分析，以确定手术并发症的危险因素。
队列中有 39 例（29.8%）手术并发症，包括 C5 麻痹（7.6%）、硬脑膜撕裂（3.1%）、手术部位感染（3.1%）和硬膜外血肿（1.5%）。2 年翻修率和死亡率分别为 4.6%和 2.3%。单因素分析显示，出血量≥750mL（OR 3.42，p=0.028）、手术时间≥5.5 小时（OR 3.16，p=0.008）、山型 OPLL（OR 3.08，p=0.011）、K 线（-）OPLL（OR 5.39，p<0.001）和存在双层征（OR 3.79，p=0.002）是显著的危险因素。多因素分析显示，只有山型 OPLL（OR 2.61，p=0.048）和 K 线（-）OPLL（OR 2.98，p=0.031）是显著的。术前影像学检查显示，山型 OPLL 和 K 线（-）OPLL 患者发生围手术期手术并发症的风险增加 3.5 倍（p=0.009）。
术前影像学显示山型 OPLL 和 K 线（-）OPLL 的 OPLL 患者发生围手术期手术并发症的风险更高。据作者所知，这项研究首次将山型 OPLL 和 K 线（-）OPLL 形态学作为围手术期手术并发症的危险因素联系起来。
