Shao Tuo, Gu Jiao, Zhu Yigeng, Tang Weilong, Li Qingsong, Lu Juncheng, Hu Yuhang, Yu Zhange, Shen Hongtao
Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Quant Imaging Med Surg. 2021 May;11(5):1888-1898. doi: 10.21037/qims-20-862.
Cervical ossification of the posterior longitudinal ligament (OPLL) causes spinal cord compression, which can lead to myelopathy or radiculopathy. Non-surgical treatments have little effect on this condition. Current OPLL classification systems offer little guidance on the selection of an appropriate operating procedure. In this study, we developed a modified axial computed tomography classification (MACTC) scheme. We then examined the usefulness of the MACTC scheme and two other existing classification schemes in guiding OPLL operation choice.
Following screening in which a defined exclusion criteria was used, a total of 91 patients with OPLL participated in the study. Patients' follow-up data for at least 2 years were obtained. The recovery rate of the Japanese Orthopaedic Association (JOA) scores was compared to two other classification schemes.
According to the MACTC, central-sharp-type OPLL had a lower recovery rate of the JOA score than that of central-gentle-type OPLL (36.05±32.38 83.90±23.52, P≤0.05). The recovery rate of the JOA scores in the ipsilateral open-door OPLL group was significantly lower than that in the contralateral group of the lateral-steep type (36.67±41.5 88.89±17.21, P=0.04), but not of that in the lateral-gentle type. There was no significant difference in the recovery rates of the JOA scores between groups when using either existing classification scheme (P>0.05).
The MACTC scheme can assist surgeons to choose the most appropriate operating procedure, and provide an accurate prognosis. If operations on central-sharp-type OPLL are not performed using both the posterior and anterior approaches, prognosis will be poor. The contralateral side should be the first choice for door opening in laminoplasty, especially for patients with lateral-steep-type OPLL. Severe OPLL may not be an absolute contraindication for the posterior approach.
颈椎后纵韧带骨化（OPLL）可导致脊髓受压，进而引发脊髓病或神经根病。非手术治疗对此病症效果甚微。当前的OPLL分类系统在选择合适的手术方式方面几乎没有指导作用。在本研究中，我们制定了一种改良的轴向计算机断层扫描分类（MACTC）方案。然后，我们检验了MACTC方案以及其他两种现有分类方案在指导OPLL手术选择方面的实用性。
采用明确的排除标准进行筛选后，共有91例OPLL患者参与了本研究。获取了患者至少2年的随访数据。将日本骨科协会（JOA）评分的恢复率与其他两种分类方案进行比较。
根据MACTC，中央尖锐型OPLL的JOA评分恢复率低于中央温和型OPLL（36.05±32.38对83.90±23.52，P≤0.05）。同侧开门型OPLL组的JOA评分恢复率显著低于外侧陡峭型的对侧组（36.67±41.5对88.89±17.21，P = 0.04），但低于外侧温和型的对侧组。使用任何一种现有分类方案时，各组间JOA评分恢复率均无显著差异（P>0.05）。
MACTC方案可协助外科医生选择最合适的手术方式，并提供准确的预后评估。如果对中央尖锐型OPLL不采用前后联合入路进行手术，预后将较差。在椎板成形术中，对侧应作为开门的首选，尤其是对于外侧陡峭型OPLL患者。严重的OPLL可能并非后入路的绝对禁忌证。
