Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China.
Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China.
Spine J. 2022 Aug;22(8):1388-1398. doi: 10.1016/j.spinee.2022.03.007. Epub 2022 Mar 26.
Multilevel ossification of the posterior longitudinal ligament in thoracic spine (mT-OPLL) is a rare but clinically significant spinal condition. Various surgical methods have been developed to address this disease. However, the outcomes are commonly unfavorable, and no standard surgical strategy has been established. To solve this problem, we introduced a new surgical strategy based on an innovative decompression concept, namely "de-tension."
This study aimed to investigate the safety and efficacy of this new treatment, and to establish an improved surgical strategy.
A prospective observational study with at least 3 years of follow-up.
Fifty-one patients with consecutive mT-OPLL who were treated between August-2012 and June-2018 were enrolled in this study.
A modified Japanese Orthopedic Association (mJOA) scale assessing thoracic spine, recovery rate (RR), and surgical complications.
All patients underwent 1-stage thoracic posterior laminectomy, selective OPLL resection, and spinal column shortening with/without reduction of kyphosis (dekyphosis). Initially, we recommended that when thoracic kyphosis of T1-T12 in sagittal reconstruction CT (TK) was less than 20°, no dekyphosis should be performed; when this angle was greater than 20°, dekyphosis could be conducted. Patients' demographic data, radiological findings, and intra/postoperative complications were recorded and analyzed. Neurological status was evaluated with mJOA score and RR. The correlation of preoperative TK or kyphosis angle in fusion area (FSK) with postoperative dekyphosis angle and spinal column shortening distance (SD) were respectively evaluated by Pearson correlation analysis.
Cerebrospinal fluid leakage (58.8%) and neurological deterioration (15.7%) were the most common complications. Average mJOA score was improved from preoperative 4.0±2.1 to 8.9±2.4 at the last follow-up, and the mean RR was 71.3±33.7%. There was no correlation between preoperative TK and SD (p=.56) or between preoperative FSK and SD (p=.21), but dekyphosis angle was significantly correlated with TK (r=0.504, p<.01) and FSK (r=0.5734, p<.01). TK of 24.6° and FSK of 23.0° were determined as the critical angles for dekyphosis, and a modified surgical strategy was formulated.
This new strategy provided a novel solution for mT-OPLL, and was proved to be safe and effective during long-term follow-up. Further rigorously designed large-scale prospective studies are needed to validate our findings.
胸椎多节段后纵韧带骨化症（mT-OPLL）是一种罕见但具有临床意义的脊柱疾病。已经开发了各种手术方法来治疗这种疾病。然而，结果通常不理想，也没有建立标准的手术策略。为了解决这个问题，我们引入了一种基于创新减压概念的新手术策略，即“去张力”。
本研究旨在探讨这种新治疗方法的安全性和有效性，并建立一种改进的手术策略。
前瞻性观察研究，随访时间至少 3 年。
2012 年 8 月至 2018 年 6 月期间，连续收治的 51 例 mT-OPLL 患者纳入本研究。
改良日本矫形协会（mJOA）量表评估胸椎、恢复率（RR）和手术并发症。
所有患者均接受 1 期胸椎后路椎板切除术、选择性 OPLL 切除术和脊柱缩短术，伴或不伴有后凸畸形（dekyphosis）的矫正。最初，我们建议当矢状位 CT（TK）重建胸椎 T1-T12 后凸角（TK）小于 20°时，不进行 dekyphosis；当这个角度大于 20°时，可以进行 dekyphosis。记录并分析患者的人口统计学数据、影像学发现和围手术期并发症。神经功能状态采用 mJOA 评分和 RR 进行评估。采用 Pearson 相关分析分别评估术前 TK 或融合区（FSK）后凸角与术后 dekyphosis 角和脊柱缩短距离（SD）的相关性。
最常见的并发症是脑脊液漏（58.8%）和神经功能恶化（15.7%）。末次随访时，平均 mJOA 评分从术前的 4.0±2.1 提高到 8.9±2.4，平均 RR 为 71.3±33.7%。术前 TK 与 SD 之间（p=.56）或术前 FSK 与 SD 之间（p=.21）均无相关性，但 dekyphosis 角与 TK（r=0.504，p<.01）和 FSK（r=0.5734，p<.01）显著相关。TK 为 24.6°和 FSK 为 23.0°被确定为 dekyphosis 的临界角，并制定了改良手术策略。
这种新策略为 mT-OPLL 提供了一种新的解决方案，并且在长期随访中被证明是安全有效的。需要进一步进行严格设计的大规模前瞻性研究来验证我们的研究结果。
