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颈椎2节段后路单开门椎管扩大成形术联合C2半椎板切除术并内固定治疗颈椎2节段后纵韧带骨化症

Laminoplasty and simultaneous C2 semi-laminectomy with internal fixation in treating ossification of the posterior longitudinal ligament in cervical discs at C2 segment.

作者信息

Yang Yipeng, Wang Yu, Cao Junming, Lei Tao, Yang Zongyou, Xia Hehuan

机构信息

Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China.

出版信息

Am J Transl Res. 2022 Apr 15;14(4):2419-2427. eCollection 2022.

DOI:
PMID:35559397
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9091121/
Abstract

OBJECTIVE: To explore the effect of open-door laminoplasty and simultaneous C2 semi-laminectomy with lateral mass screw fixation (LSLF) in treating ossification of the posterior longitudinal ligament (OPLL) in cervical discs at C2 segment. METHODS: In this retrospective study, 76 patients diagnosed with OPLL in cervical discs at C2 segment from November 2016 to May 2019 were included. These patients were assigned into a LSLF group (n=41, LSLF surgery) and LF group (n=35, laminectomy and lateral mass screw fixation) according to the treatment they received. The surgery time and intraoperative blood loss were recorded. Improvements in neurological function (JOA score), cervical curvature index (CCI), spinal cord drift distance, cross-sectional area (CSA) of the posterior muscles from cervical spine, occurrence of C5 palsy, and severity of axial symptoms were evaluated between LSLF group and LF group. RESULTS: Compared with LF group, the operative time was longer and blood loss volume was higher in LSLF group (P<0.05). No statistical difference was found in decompression width between LSLF group and LF group, while the drift distance of spinal cord in LSLF group was larger than that in LF group (P<0.05). No obvious differences were observed in anteroposterior dural sac diameter after the surgery between LSLF group and LF group. CSA in LF group decreased more than that in LSLF group (P<0.05). No remarkable difference was obtained in CCI at the final follow-up between LSLF group and LF group. The NDI score after surgery in the LSLF group was significantly decreased compared to LF group (P<0.05), while no differences were observed in JOA scores or the neurological recovery rate between LSLF group and LF group. The occurrence of C5 palsy in the LSLF group was 4.9%, which was less than that of LF group (20.0%). In contrast to LF group, postoperative axial symptoms in LSLF group were decreased (P<0.05). CONCLUSION: Compared to LF, LSLF could better improve neck functions, and reduce the severity of axial symptoms and the occurrence of C5 palsy for patients with OPLL at C2 segment.

摘要

目的：探讨单开门椎管扩大成形术联合C2半椎板切除术及侧块螺钉固定术（LSLF）治疗C2节段颈椎后纵韧带骨化症（OPLL）的效果。 方法：本回顾性研究纳入了2016年11月至2019年5月期间诊断为C2节段颈椎OPLL的76例患者。根据所接受的治疗方法，将这些患者分为LSLF组（n = 41，LSLF手术）和LF组（n = 35，椎板切除术及侧块螺钉固定术）。记录手术时间和术中出血量。评估LSLF组和LF组之间神经功能（JOA评分）、颈椎曲度指数（CCI）、脊髓漂移距离、颈椎后肌横截面积（CSA）、C5麻痹的发生率以及轴性症状的严重程度。 结果：与LF组相比，LSLF组手术时间更长，出血量更多（P < 0.05）。LSLF组和LF组之间减压宽度无统计学差异，而LSLF组脊髓漂移距离大于LF组（P < 0.05）。LSLF组和LF组术后硬脊膜囊前后径无明显差异。LF组CSA下降幅度大于LSLF组（P < 0.05）。LSLF组和LF组末次随访时CCI无显著差异。LSLF组术后NDI评分较LF组显著降低（P < 0.05），而LSLF组和LF组之间JOA评分或神经恢复率无差异。LSLF组C5麻痹发生率为4.9%，低于LF组（20.0%）。与LF组相比，LSLF组术后轴性症状减轻（P < 0.05）。 结论：与LF相比，LSLF能更好地改善C2节段OPLL患者的颈部功能，减轻轴性症状的严重程度并降低C5麻痹的发生率。

相似文献

[1]
Laminoplasty and simultaneous C2 semi-laminectomy with internal fixation in treating ossification of the posterior longitudinal ligament in cervical discs at C2 segment.

Am J Transl Res. 2022-4-15

[2]
C3 laminectomy combined with modified unilateral laminoplasty and in situ reconstruction of the midline structures maintained cervical sagittal balance: a retrospective matched-pair case-control study.

Spine J. 2020-9

[3]
[Comparison of three different posterior cervical approaches for treating cervical spine trauma with ossification of posterior longitudinal ligament].

Zhonghua Wai Ke Za Zhi. 2019-3-1

[4]
Comparison of clinical and radiological outcomes in cervical laminoplasty versus laminectomy with fusion in patients with ossification of the posterior longitudinal ligament.

Neurosurg Rev. 2020-10

[5]
Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment?

Clin Spine Surg. 2016-2

[6]
Clinical and Radiographic Outcomes of Modified Unilateral Open-door Laminoplasty with Posterior Muscle-Ligament Complex Preservation for Cervical Spondylotic Myelopathy.

Spine (Phila Pa 1976). 2019-12-15

[7]
Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: A systematic review and meta-analysis.

Medicine (Baltimore). 2018-7

[8]
The impact of dynamic factors on surgical outcomes after double-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine.

J Neurosurg Spine. 2014-12

[9]
[Discussion of surgical indications for posterior expansive open-door laminoplasty extended to C1 level].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013-10

[10]
[Analysis of clinical efficacy of unilateral open-door cervical laminoplasty combined with foraminotomy for cervical ossification of posterior longitudinal ligament].

Zhongguo Gu Shang. 2018-4-25

引用本文的文献

[1]
Comparative Analysis of Postoperative Sagittal Balance in Expansive Open-Door Laminoplasty versus Laminectomy with Fusion for Multilevel Ossification of Posterior Longitudinal Ligament: A Retrospective Study.

Med Sci Monit. 2024-5-15

[2]
[Advances in surgical strategies for ossification of posterior longitudinal ligament involving the C segment].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023-6-15

本文引用的文献

[1]
Relationship of Change in Cervical Curvature after Laminectomy with Lateral Mass Screw Fixation to Spinal Cord Shift and Clinical Efficacy.

J Neurol Surg A Cent Eur Neurosurg. 2022-3

[2]
Efficacy and Safety of Ultrasonic Bone Curette-assisted Dome-like Laminoplasty in the Treatment of Cervical Ossification of Longitudinal Ligament.

Orthop Surg. 2021-2

[3]
A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety.

J Neurol Surg A Cent Eur Neurosurg. 2021-3

[4]
Segmental motion at the peak of the ossification foci is independent risk factor except for mal-alignment and thick ossification foci for poor outcome after laminoplasty for cervical ossification of the posterior longitudinal ligament: analyses in patients with positive K-line, lordotic alignment, and lower canal occupying ratio.

J Orthop Surg Res. 2020-9-14

[5]
Effect of K-line on posterior cervical surgery in patients with posterior longitudinal ligament ossification.

Eur Spine J. 2020-9

[6]
C3 laminectomy combined with modified unilateral laminoplasty and in situ reconstruction of the midline structures maintained cervical sagittal balance: a retrospective matched-pair case-control study.

Spine J. 2020-9

[7]
Does Ossification of the Posterior Longitudinal Ligament Progress After Fusion?

Neurospine. 2019-9

[8]
Comparison of clinical and radiological outcomes in cervical laminoplasty versus laminectomy with fusion in patients with ossification of the posterior longitudinal ligament.

Neurosurg Rev. 2020-10

[9]
Limited laminectomy and foraminal decompression combined with internal fixation for treating multi-segment cervical spondylotic myelopathy: Does it effectively improve neurological function and prevent C5 palsy?

Medicine (Baltimore). 2018-11

[10]
Ossification of the posterior longitudinal ligament in the cervical spine: a review.

Int Orthop. 2018-8-16

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