Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China.
Orthop Surg. 2024 Jul;16(7):1603-1613. doi: 10.1111/os.14092. Epub 2024 May 21.
Both two-level anterior cervical corpectomy and fusion (t-ACCF) and posterior open-door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t-ACCF and ODLP on the occipito-atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito-atlantoaxial complex in OPLL patients treated with t-ACCF and ODLP.
This was a retrospective study that included 74 patients who underwent t-ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3-month, and 1-year postoperative cervical neutral, flexion-extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2-7, C0-2, C0-1, C1-2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS.
In the ODLP group, the SCS (C2-7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p < 0.05), and the UCS (C0-2) Cobb angle was significantly compensated for at 1 year postoperatively compared with the t-ACCF group (3.05 ± 4.09 vs 0.79 ± 2.62; p < 0.01). The SCS and lateral flexion ROM of the ODLP group was better maintained than t-ACCF (14.51 ± 6.00 vs 10.72 ± 3.79; 6.87 ± 4.56 vs 3.81 ± 1.67; p < 0.01). The compensatory increase in C0-2, C0-1, and C1-2 ROM was pronounced in both groups, especially in the ODLP group. The results of multiple linear regression showed that only the surgical procedure was a significant factor influencing UCS.
The loss of the SCS Cobb angle was more pronounced in ODLP relative to t-ACCF, resulting in a significant compensatory increase in UCS and atlantoaxial Cobb angle. The ROM of the UCS, atlantooccipital, and atlantoaxial joints was significantly increased in both groups, this may accelerate degenerative changes in the occipital-atlantoaxial complex, may leading to poorer outcomes in the long-term; of these, ODLP should receive more attention. In contrast, t-ACCF better maintains normal curvature of the SCS and occipito-atlantoaxial complex but loses more ROM.
颈椎前路双节段椎体次全切除融合术（t-ACCF）和后路单开门椎管扩大成形术（ODLP）均为治疗后纵韧带骨化症（OPLL）的有效手术方法。既往研究已经确定了不同手术方法对上颈椎（UCS）和下颈椎（SCS）的不同影响，但对于 t-ACCF 和 ODLP 对枕颈寰枢复合体的影响尚无研究。因此，本研究旨在比较 t-ACCF 和 ODLP 治疗 OPLL 患者后枕颈寰枢复合体矢状参数和运动范围（ROM）的变化。
这是一项回顾性研究，纳入了 2012 年 1 月至 2022 年 8 月在我院接受 t-ACCF 或 ODLP 治疗的 74 例 OPLL 患者。术前、术后 3 个月和 1 年拍摄颈椎中立位、屈伸位和侧屈位 X 线片。测量矢状参数，包括 C2-7、C0-2、C0-1、C1-2、C2 斜率和 ROM。术前及术后 3 个月和 12 个月采用 JOA、VAS 和 NDI 评分评估临床疗效。采用多元线性回归分析影响 UCS 变化的因素。
在 ODLP 组中，SCS（C2-7） Cobb 角显著减小（12.85°±10.0 至 7.68°±11.27°；p<0.05），与 t-ACCF 组相比，UCS（C0-2） Cobb 角在术后 1 年显著代偿（3.05°±4.09 至 0.79°±2.62°；p<0.01）。与 t-ACCF 组相比，ODLP 组 SCS 和侧屈 ROM 更好地维持（14.51°±6.00 至 10.72°±3.79；6.87°±4.56 至 3.81°±1.67；p<0.01）。两组患者的 C0-2、C0-1 和 C1-2 ROM 的代偿性增加均较为明显，尤其是 ODLP 组。多元线性回归结果显示，只有手术方式是影响 UCS 的显著因素。
与 t-ACCF 相比，ODLP 导致 SCS Cobb 角丢失更为明显，导致 UCS 和寰枢 Cobb 角显著代偿性增加。两组患者的 UCS、寰枕和寰枢关节 ROM 均显著增加，这可能会加速枕颈寰枢复合体的退行性改变，可能导致长期预后较差；其中，ODLP 应受到更多关注。相比之下，t-ACCF 更好地维持了 SCS 和枕颈寰枢复合体的正常曲度，但丢失了更多的 ROM。
