Department of Orthopedic Surgery, Tokyo Medical and Dental University.
Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo.
Clin Spine Surg. 2021 Dec 1;34(10):E594-E600. doi: 10.1097/BSD.0000000000001243.
This was a prospective multicenter study.
The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL).
Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures.
We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications.
Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2-C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery.
In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2-C7 angle were the independent risk factors for motor palsy.
Level III.
这是一项前瞻性多中心研究。
本研究旨在探讨颈椎后纵韧带骨化症（OPLL）后路手术的围手术期并发症。
颈椎 OPLL 的手术治疗存在多种并发症的高风险。椎板成形术（LAMP）和后路减压固定融合术（PDF）对多节段颈椎 OPLL 有效；然而，很少有研究关注这两种手术的手术并发症。
我们前瞻性纳入 380 例接受颈椎 OPLL 后路手术的患者（LAMP：270 例，PDF：110 例），并对包括神经并发症在内的全身和局部并发症进行了调查。我们进一步评估了与神经并发症相关的危险因素。
发现 40 例（10.5%）患者存在运动障碍，上肢运动障碍最常见（8.9%），尤其是接受 PDF 治疗的患者（14.5%）。下肢运动障碍 6 例（1.6%）。局部并发症方面，硬膜撕裂（3.9%）和手术部位感染（2.6%）较为常见。单因素分析显示，体重指数、术前颈椎排列、融合手术和手术节段数量是运动障碍的相关因素。多因素分析显示，融合手术和术前 C2-C7 角度较小是运动障碍的独立相关因素。下肢运动障碍倾向于在手术后早期发现，所有患者均完全恢复。上肢运动障碍发生较晚，68.8%的 PDF 患者恢复良好，81.3%的 LAMP 患者恢复良好。
颈椎 OPLL 后路手术中，上肢节段性运动障碍最为常见，尤其是接受 PDF 治疗的患者。融合和术前 C2-C7 角度较小是运动障碍的独立危险因素。
III 级。
