Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
World Neurosurg. 2024 Jan;181:e468-e474. doi: 10.1016/j.wneu.2023.10.083. Epub 2023 Oct 20.
Only a few studies have investigated the gap range of motion (gROM) in cervical myelopathy or deformity caused by ossification of the posterior longitudinal ligament (OPLL). The aim of this study is to investigate the correlation between the individual gROM and the postoperative clinical outcomes of patients with OPLL.
Consecutive patients of cervical myelopathy caused by OPLL were analyzed retrospectively. The clinical outcomes were evaluated using Visual Analogue Scale scores of the neck and arm pain and the Japanese Orthopaedic Association scores. Radiologic measurements included flexion ROM (fROM), which was defined as the difference of cervical lordosis in flexion and neutral positions, extension ROM (eROM), defined as the difference between neutral and extension positions, and gROM, defined as the difference between fROM and eROM. Patients were grouped by the values of gROM, and comparisons of all outcomes were made between the groups.
A total of 42 patients underwent surgery. The patients with greater gROM did not differ from those with smaller gROM by demographic characteristics. During follow-up (mean 45.8 months), both groups had similar improvements, but the C5 palsy rates were higher in the greater gROM group than in the smaller gROM group (71% and 22%, P < 0.05).
Simultaneous circumferential decompression and fixation is an effective surgical option for patients with cervical myelopathy caused by OPLL. A higher rate of postoperative C5 palsy was observed in the patients with greater gROMs after surgery, although all patients presented with similar clinical improvements.
仅有少数研究调查过因后纵韧带骨化（OPLL）导致的颈椎病或畸形的节段活动度（gROM）的差距。本研究旨在探讨个体 gROM 与 OPLL 患者术后临床结果之间的相关性。
回顾性分析连续因 OPLL 导致的脊髓型颈椎病患者。采用颈部和手臂疼痛的视觉模拟量表评分和日本矫形协会评分评估临床结果。影像学测量包括屈曲 ROM（fROM），定义为屈曲位与中立位颈椎前凸的差异；伸展 ROM（eROM），定义为中立位与伸展位的差异；以及 gROM，定义为 fROM 与 eROM 的差异。根据 gROM 值将患者分组，并比较各组之间的所有结果。
共有 42 例患者接受了手术。gROM 值较大的患者与 gROM 值较小的患者在人口统计学特征上没有差异。在随访期间（平均 45.8 个月），两组均有相似的改善，但 gROM 值较大组的 C5 瘫痪发生率高于 gROM 值较小组（71%和 22%，P<0.05）。
对于因 OPLL 导致的脊髓型颈椎病患者，环形减压和固定是一种有效的手术选择。尽管所有患者的临床改善相似，但手术后 gROM 值较大的患者出现 C5 瘫痪的发生率更高。
