Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Japanese Multicenter Research Organization for Ossification of the Spinal Ligament.
Spine (Phila Pa 1976). 2023 Jul 1;48(13):937-943. doi: 10.1097/BRS.0000000000004634. Epub 2023 Mar 20.
A prospective multicenter study.
The objective of this study is to compare the surgical outcomes of anterior and posterior fusion surgeries in patients with K-line (-) cervical ossification of the posterior longitudinal ligament (OPLL).
Although laminoplasty is effective for patients with K-line (+) OPLL, fusion surgery is recommended for those with K-line (-) OPLL. However, whether the anterior or posterior approach is preferable for this pathology has not been effectively determined.
A total of 478 patients with myelopathy due to cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for two years. Of the 478 patients, 45 and 46 with K-line (-) underwent anterior and posterior fusion surgeries, respectively. After adjusting for confounders in baseline characteristics using a propensity score-matched analysis, 54 patients in both the anterior and posterior groups (27 patients each) were evaluated. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire.
Both approaches showed comparable neurological and functional recovery. The cervical range of motion was significantly restricted in the posterior group because of the large number of fused vertebrae compared with the anterior group. The incidence of surgical complications was comparable between the cohorts, but the posterior group demonstrated a higher frequency of segmental motor paralysis, whereas the anterior group more frequently reported postoperative dysphagia.
Clinical improvement was comparable between anterior and posterior fusion surgeries for patients with K-line (-) OPLL. The ideal surgical approach should be informed based on the balance between the surgeon's technical preference and the risk of complications.
一项前瞻性多中心研究。
本研究旨在比较 K 线（-）型颈椎后纵韧带骨化症（OPLL）患者前路和后路融合手术的手术结果。
尽管对于 K 线（+）型 OPLL 患者，椎板成形术是有效的，但对于 K 线（-）型 OPLL 患者，推荐融合手术。然而，对于这种病理，前路还是后路更优尚未得到有效确定。
2014 年至 2017 年，从 28 个机构前瞻性登记了 478 例因颈椎 OPLL 引起的脊髓病患者，并随访了两年。在 478 例患者中，45 例和 46 例 K 线（-）患者分别接受了前路和后路融合手术。在使用倾向评分匹配分析调整基线特征中的混杂因素后，对两组各 54 例患者（每组 27 例）进行了评估。使用颈椎日本矫形协会和日本矫形协会颈椎脊髓病评估问卷评估临床结果。
两种方法均显示出相似的神经和功能恢复。由于融合的椎骨数量较多，后路组的颈椎活动度明显受限。两组的手术并发症发生率相当，但后路组发生节段性运动麻痹的频率较高，而前路组术后吞咽困难的频率较高。
对于 K 线（-）型 OPLL 患者，前路和后路融合手术的临床改善相似。理想的手术方法应根据术者的技术偏好和并发症风险之间的平衡来确定。
