Cao Bing, Chen Jingxuan, Yuan Bo, Sun Yanqing, Zhou Shengyuan, Zhao Yin, Xu Zheng, Tang Yifan, Chen Xiongsheng
Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Bone Joint J. 2023 Mar 15;105-B(4):412-421. doi: 10.1302/0301-620X.105B4.BJJ-2022-0804.R2.
The optimal procedure for the treatment of ossification of the posterior longitudinal ligament (OPLL) remains controversial. The aim of this study was to compare the outcome of anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) with posterior laminectomy and fusion with bone graft and internal fixation (PTLF) for the surgical management of patients with this condition. Between July 2017 and July 2019, 40 patients with cervical OPLL were equally randomized to undergo surgery with an ACOE or a PTLF. The clinical and radiological results were compared between the two groups. The Japanese Orthopaedic Association (JOA) score and recovery rate in the ACOE group were significantly higher than those in the PTLF group during two years postoperatively, provided that the canal occupying ratio (COR) was > 50%, or the K-line was negative. There was no significant difference in JOA scores and rate of recovery between the two groups in those in whom the COR was < 50%, or the K-line was positive. There was no significant difference in the Cobb angle between C2 and C7, sagittal vertical axis, cervical range of motion (ROM), and complications between the two groups. Compared with PTLF, ACOE is a preferred surgical approach for the surgical management of patients with cervical OPLL in that it offers a better therapeutic outcome when the COR is > 50%, or the K-line is negative, and it also preserves better cervical curvature and sagittal balance. The prognosis of ACOE is similar to that of PTLE when the COR is < 50%, or the K-line is positive.
后纵韧带骨化症（OPLL）的最佳治疗方法仍存在争议。本研究的目的是比较颈椎前路后纵韧带骨化整块切除术（ACOE）与后路椎板切除术并植骨融合及内固定术（PTLF）治疗该疾病患者的手术效果。在2017年7月至2019年7月期间，40例颈椎OPLL患者被随机分为两组，分别接受ACOE或PTLF手术。比较两组的临床和影像学结果。术后两年，当椎管占位率（COR）>50%或K线为阴性时，ACOE组的日本骨科协会（JOA）评分和恢复率显著高于PTLF组。当COR<50%或K线为阳性时，两组的JOA评分和恢复率无显著差异。两组在C2至C7的Cobb角、矢状垂直轴、颈椎活动度（ROM）及并发症方面无显著差异。与PTLF相比，ACOE是治疗颈椎OPLL患者的首选手术方法，因为当COR>50%或K线为阴性时，它能提供更好的治疗效果，并且能更好地保留颈椎曲度和矢状面平衡。当COR<50%或K线为阳性时，ACOE的预后与PTLF相似。
