Department of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku Ward, Tokyo, Japan.
Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan.
Spine (Phila Pa 1976). 2021 Dec 1;46(23):E1238-E1245. doi: 10.1097/BRS.0000000000004094.
A prospective multicenter study.
To evaluate and compare the surgical outcomes after open-door (OD) and double-door (DD) laminoplasties in subjects with cervical ossification of the posterior longitudinal ligament (OPLL).
Although previous studies compared clinical results after OD and DD laminoplasties, they were performed at a single institution with a relatively small sample size targeting mixed pathologies, including cervical spondylotic myelopathy.
This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of these, 41 and 164 patients received OD and DD laminoplasties, respectively. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, and visual analog scale scores.
Age, sex, symptom duration, and comorbidities were not significantly different between the groups. Segmental ossification was the most frequent in both the groups. No significant differences in K-line type, canal occupying ratio, C2 to C7 angles, and range of motion were found. Both the procedures reduced the cervical range of motion postoperatively. A comparable frequency of perioperative complications was observed between the groups. The cervical Japanese Orthopaedic Association scores showed a similar improvement at 2 years postopera- tively. The reduction in visual analog scale score for neck pain was favorable in the OD group (P = 0.02), while other pain assessments did not show any significant differences between the groups. The functional outcomes assessed using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire presented equivalent effective rates.
The results demonstrated almost comparable surgical outcomes between OD and DD laminoplasties. Lamino- plasty is a valuable technique as a therapeutic option for cervical OPLL.Level of Evidence: 2.
前瞻性多中心研究。
评估和比较颈椎后纵韧带骨化（OPLL）患者行单开门（OD）和双开门（DD）椎管扩大成形术后的手术效果。
尽管先前的研究比较了 OD 和 DD 椎管扩大成形术后的临床结果，但这些研究都是在单家机构进行的，样本量相对较小，针对的是包括颈椎病性脊髓病在内的混合病变。
这项研究是由日本脊柱韧带骨化多中心研究组织进行的。2014 年至 2017 年，来自 28 家机构的 478 例因颈椎 OPLL 导致的脊髓病患者前瞻性登记，并随访 2 年。其中，41 例和 164 例患者分别接受了 OD 和 DD 椎管扩大成形术。收集了人口统计学信息、病史和影像学发现。使用颈椎日本矫形协会评分、日本矫形协会颈椎病评估问卷和视觉模拟评分评估临床结果。
两组患者的年龄、性别、症状持续时间和合并症无显著差异。两组中最常见的是节段性骨化。K 线类型、管腔占用率、C2 至 C7 角和活动度无显著差异。两种手术方式均降低了术后颈椎活动度。两组术后并发症的发生率相当。2 年后，颈椎日本矫形协会评分显示相似的改善。OD 组颈痛视觉模拟评分降低有显著意义（P = 0.02），而其他疼痛评估两组之间无显著差异。使用日本矫形协会颈椎病评估问卷评估的功能结果显示等效有效率。
结果表明，OD 和 DD 椎管扩大成形术的手术效果几乎相当。椎管扩大成形术是治疗颈椎 OPLL 的一种有价值的治疗方法。
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