Yoshii Toshitaka, Morishita Shingo, Egawa Satoru, Sakai Kenichiro, Kusano Kazuo, Tsutsui Shunji, Hirai Takashi, Matsukura Yu, Wada Kanichiro, Katsumi Keiichi, Koda Masao, Kimura Atsushi, Furuya Takeo, Maki Satoshi, Nagoshi Narihito, Nishida Norihiro, Nagamoto Yukitaka, Oshima Yasushi, Ando Kei, Nakashima Hiroaki, Takahata Masahiko, Mori Kanji, Nakajima Hideaki, Murata Kazuma, Miyagi Masayuki, Kaito Takashi, Yamada Kei, Banno Tomohiro, Kato Satoshi, Ohba Tetsuro, Inami Satoshi, Fujibayashi Shunsuke, Katoh Hiroyuki, Kanno Haruo, Taneichi Hiroshi, Imagama Shiro, Kawaguchi Yoshiharu, Takeshita Katsushi, Matsumoto Morio, Yamazaki Masashi, Okawa Atsushi
Department of Orthopedic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama 332-8558, Japan.
J Clin Med. 2022 Nov 27;11(23):7012. doi: 10.3390/jcm11237012.
The ideal surgical strategy for cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial due to the lack of high-quality evidence. Herein, we prospectively investigated the surgical outcomes of anterior cervical decompression with fusion (ADF) and laminoplasty (LAMP) with cervical OPLL. Three hundred patients were included in this study (ADF: = 89; LAMP: = 211 patients), and propensity score matching yielded 67 pairs of patients with ADF and LAMP, in which clinical outcomes were compared. Crude analysis revealed that the ADF group showed greater neurological recovery in cervical Japanese Orthopedic Association scores at two years, compared with that in the LAMP group (53.1% vs. 44.3%, = 0.037). The ratio of minimum clinically important difference (MCID) success was significantly greater in the ADF group (59.6% vs. 43.6%, = 0.016). Multivariate analysis showed that the factors affecting MCID success were age, body mass index, duration of symptoms, and choice of ADF. In the 1:1 matched analysis, neurological improvement was more favorable in the ADF group (57.2%) compared to the LAMP group (46.8%) at two years ( = 0.049). However, perioperative complications, such as dysphagia and graft-related complications, were more common in the ADF group.
由于缺乏高质量证据，颈椎后纵韧带骨化症（OPLL）的理想手术策略仍存在争议。在此，我们前瞻性地研究了颈椎OPLL患者行颈椎前路减压融合术（ADF）和椎板成形术（LAMP）的手术效果。本研究纳入了300例患者（ADF组：89例；LAMP组：211例），通过倾向评分匹配得到67对接受ADF和LAMP治疗的患者，并比较了他们的临床结局。粗略分析显示，与LAMP组相比，ADF组在术后两年时颈椎日本骨科协会评分的神经功能恢复情况更佳（53.1% 对44.3%，P = 0.037）。ADF组最小临床重要差异（MCID）成功的比例显著更高（59.6% 对43.6%，P = 0.016）。多变量分析表明，影响MCID成功的因素包括年龄、体重指数、症状持续时间和ADF的选择。在1:1匹配分析中，术后两年时ADF组的神经功能改善情况优于LAMP组（57.2% 对46.8%，P = 0.049）。然而，ADF组围手术期并发症，如吞咽困难和移植物相关并发症更为常见。
