Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.
Arch Orthop Trauma Surg. 2023 Jun;143(6):2919-2927. doi: 10.1007/s00402-022-04498-y. Epub 2022 Jun 9.
To compare the outcomes of expansive open-door laminoplasty with instrumented fusion (ELIF) and expansive open-door laminoplasty with instrumented non-fusion (ELINF) for multilevel cervical ossification of the posterior longitudinal ligament (OPLL).
Patients who underwent ELIF or ELINF due to multilevel cervical OPLL from June 2013 to June 2019 were identified. Clinical and radiological outcomes were compared between the two groups.
A total of 78 patients were enrolled in this study with a minimum follow-up of 24 months, including 42 patients in the ELIF group and 36 patients in the ELINF group. At the final follow-up, sagittal vertical axis (SVA) and C2-C7 Cobb angle in the ELIF group were significantly better than those in the ELINF group, and cervical range of movement (ROM) in the ELIF group decreased significantly than that in the ELINF group. The incidence of OPLL progression at the final follow-up was 4.76% (2/42) in the ELIF group and 27.78% (10/36) in the ELINF group. Postoperative Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) score improved significantly in each group, but JOA score and recovery rate (RR) in the ELIF group were significantly better than those in the ELINF group at the final follow-up. When K-line was positive, the difference in the final JOA score between the two groups was not significant, but the RR in the ELIF group was significantly better than that in the ELINF group. When K-line was negative, the final JOA score and RR in the ELIF group were significant higher than those in the ELINF group.
ELIF and ELINF were two effective surgical procedures for treating multilevel cervical OPLL. However, ELIF was superior to ELINF due to better postoperative JOA score and RR, significant improvement of C2-C7 Cobb angle and maintenance of SVA, and suppressant effect on OPLL progression, especially for patients with K-line ( - ) OPLL.
比较多节段颈椎后纵韧带骨化症（OPLL）行扩大开门椎板成形术伴内固定融合（ELIF）与不伴内固定融合（ELINF）的疗效。
回顾性分析 2013 年 6 月至 2019 年 6 月因多节段颈椎 OPLL 行 ELIF 或 ELINF 治疗的患者。比较两组患者的临床和影像学结果。
本研究共纳入 78 例患者，随访时间均至少 24 个月，其中 ELIF 组 42 例，ELINF 组 36 例。末次随访时，ELIF 组的矢状垂直轴（SVA）和 C2-C7 Cobb 角明显优于 ELINF 组，颈椎活动度（ROM）明显低于 ELINF 组。ELIF 组末次随访时 OPLL 进展的发生率为 4.76%（2/42），ELINF 组为 27.78%（10/36）。两组术后日本骨科协会（JOA）评分、颈部残疾指数（NDI）和视觉模拟评分（VAS）均显著改善，但末次随访时 ELIF 组的 JOA 评分和改善率（RR）明显优于 ELINF 组。K 线阳性时，两组末次 JOA 评分无显著差异，但 ELIF 组的 RR 明显优于 ELINF 组。K 线阴性时，ELIF 组的末次 JOA 评分和 RR 明显高于 ELINF 组。
ELIF 和 ELINF 是治疗多节段颈椎 OPLL 的两种有效手术方法。但 ELIF 术后 JOA 评分和 RR 更高，C2-C7 Cobb 角改善更明显，SVA 维持更稳定，对 OPLL 进展的抑制作用更明显，尤其对 K 线（-）型 OPLL 患者更具优势。
