Wu Dong-Zhao, Gu Zhen-Fang, Meng De-Jing, Hou Shu-Bing, Ren Liang, Sun Xian-Ze
Department of Spine Surgery, The Third Hospital of Shijiazhuang, No. 15 Tiyu Street, Shijiazhuang, 050000, China.
Emergency Follow-up Department, Shijiazhuang Emergency Center, Shijiazhuang, No. 188 Jianshe Street, 050000, China.
BMC Musculoskelet Disord. 2022 May 12;23(1):446. doi: 10.1186/s12891-022-05417-3.
The purpose of this study was to investigate the surgical efficacy of crossing the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL).
From October 2009 to October 2017, 46 consecutive patients with multilevel cervical OPLL underwent posterior cervical laminectomy and crossing the cervicothoracic junction fusion were obtained in the study. Their medical records were retrospectively collected. Cervical lordosis and cervical sagittal balance were used to assess radiographic outcomes. Japanese Orthopedic Association (JOA), axial symptom, C5 root palsy, blood loss, and operation time were used to assess clinical outcomes. The mean follow-up period was 20.7 ± 8.3 months.
The operation time was 205.2 ± 39.8 min and the intraoperative blood loss was 352.2 ± 143.7 ml. Analysis of the final follow-up data showed significant differences in JOA score (P < 0.01), C2-C7 lordosis angle (P < 0.01), and C2-C7 SVA (P < 0.01). CT confirmed that grafted bone was completely fused in all patients and progression of OPLL was observed in two patients (4.3%) at final follow-up. No adjacent segment disease (ASD) or instrument failure occurred in any patients.
Cervical laminectomy and crossing the cervicothoracic junction fusion are effective and safe methods to treat multilevel cervical OPLL. Randomized controlled studies compared constructs ending at cervical vertebrae or thoracic vertebrae are needed to confirm these results.
本研究旨在探讨后路颈椎椎板切除术及跨越颈胸交界区融合术治疗多节段颈椎后纵韧带骨化症（OPLL）的手术疗效。
2009年10月至2017年10月，本研究纳入46例连续接受后路颈椎椎板切除术及跨越颈胸交界区融合术的多节段颈椎OPLL患者。回顾性收集其病历资料。采用颈椎前凸和颈椎矢状面平衡评估影像学结果。采用日本骨科学会（JOA）评分、轴性症状、C5神经根麻痹、失血量及手术时间评估临床结果。平均随访时间为20.7±8.3个月。
手术时间为205.2±39.8分钟，术中失血量为352.2±143.7毫升。末次随访数据分析显示，JOA评分（P<0.01）、C2-C7前凸角（P<0.01）和C2-C7矢状面垂直轴（SVA，P<0.01）有显著差异。CT证实所有患者移植骨均完全融合，末次随访时2例患者（4.3%）观察到OPLL进展。所有患者均未发生相邻节段疾病（ASD）或内固定失败。
后路颈椎椎板切除术及跨越颈胸交界区融合术是治疗多节段颈椎OPLL的有效且安全的方法。需要进行随机对照研究比较止于颈椎或胸椎的内固定结构以证实这些结果。
