Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
Orthop Surg. 2022 Sep;14(9):2361-2368. doi: 10.1111/os.13433. Epub 2022 Aug 18.
To report the outcomes and feasibility of a new technique to change K-line (-) to K-line (+) via only a posterior approach to treat multilevel non-continuous cervical ossification of the posterior longitudinal ligament (C-OPLL) with kyphotic deformity.
In this study, 17 consecutive cases of patients who underwent vertical pressure procedure (VP) combined with posterior cervical single-open-door laminoplasty and instrumented fusion from January 1, 2017 to December 31, 2019 were enrolled. The following radiographic parameters: C2-C7 Cobb angle, local Cobb angle, extent of OPLL, and the distance from OPLL to the K-line(DK) were measured and analyzed. Clinically, the JOA score, VAS-N and VAS-A, NDI, and complications were collected from medical records to evaluate the clinical outcomes.
All 17 cases shifted from K-line (-) to K-line (+).Comparing the preoperative images to the final follow-up images, the mean C2-7 Cobb angle changed from -6.94° ± 8.30° to 8.18° ± 4.43°, and the local Cobb angle altered from -9.12° ± 8.68° to 6.65° ± 6.11°. The mean DK increased from -2.64 ± 1.52 mm to 3.09 ± 2.19 mm. One patient showed C5 palsy and recovered within 3 months. The mean JOA score increased from 8.88 ± 2.11 to 14.71 ± 1.36. The average NDI decreased from 20.65 ± 7.80 to 8.94 ± 4.93. The mean VAS-N and VAS-A decreased from 3.44 ± 1.80 and 4.69 ± 1.97 to 1.25 ± 0.86 and 1.38 ± 1.16. All patients were followed up for at least 1 year.
A new technique added to posterior decompression and fusion (PDF), the vertical pressure procedure effectively corrects K-line (-) to K-line (+) and avoids the shortcomings of conventional anterior decompression and fusion (ADF) as well as PDF to provide a relatively safe and adequate decompression, cervical realignment. It pronounced satisfactory clinical outcome for extensive non-continuous OPLL with kyphotic deformity even though OPLL remains ventral to the spinal cord.
报告一种新的技术，通过仅后路入路即可将 K 线（-）变为 K 线（+），从而治疗伴有后凸畸形的多节段非连续颈椎后纵韧带骨化（C-OPLL）。
本研究纳入了 2017 年 1 月 1 日至 2019 年 12 月 31 日期间接受垂直加压术（VP）联合后路单开门颈椎椎板成形术和器械融合术的 17 例连续病例。测量并分析了以下影像学参数：C2-C7 Cobb 角、局部 Cobb 角、OPLL 程度和 OPLL 至 K 线（DK）的距离（DK）。临床方面，从病历中收集 JOA 评分、VAS-N 和 VAS-A、NDI 和并发症，以评估临床结果。
所有 17 例患者均从 K 线（-）变为 K 线（+）。与术前图像相比，末次随访时 C2-7 Cobb 角从-6.94°±8.30°变为 8.18°±4.43°，局部 Cobb 角从-9.12°±8.68°变为 6.65°±6.11°。DK 均值从-2.64±1.52mm 增加到 3.09±2.19mm。1 例患者出现 C5 麻痹，3 个月内恢复。JOA 评分从 8.88±2.11 增加到 14.71±1.36。NDI 平均从 20.65±7.80 降低到 8.94±4.93。VAS-N 和 VAS-A 均值分别从 3.44±1.80 和 4.69±1.97 降低到 1.25±0.86 和 1.38±1.16。所有患者均随访至少 1 年。
一种新的技术（VP）被添加到后路减压融合（PDF）中，垂直加压术可有效纠正 K 线（-）变为 K 线（+），并避免了传统前路减压融合（ADF）和 PDF 的缺点，提供了相对安全且充分的减压和颈椎复位。即使 OPLL 仍位于脊髓腹侧，对于伴有后凸畸形的广泛非连续 OPLL，它也能获得令人满意的临床效果。
