Okubo Toshiki, Nagoshi Narihito, Kono Hitoshi, Kobayashi Yoshiomi, Tsuji Osahiko, Aoyama Ryoma, Isogai Norihiro, Ishihara Shinichi, Takeda Kazuki, Ozaki Masahiro, Suzuki Satoshi, Matsumoto Morio, Nakamura Masaya, Watanabe Kota, Ishii Ken, Yamane Junichi
Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Keio Spine Research Group (KSRG), Tokyo, Japan.
Global Spine J. 2025 Apr;15(3):1703-1711. doi: 10.1177/21925682241260725. Epub 2024 Jun 3.
Study DesignRetrospective multicenter study.ObjectivesTo investigate surgical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL) when performed by board-certified spine (BCS) or non-BCS (NBCS) surgeons.MethodsWe included 203 patients with cervical OPLL who were followed for a minimum of 1 year after surgery. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed preoperatively and at the final follow-up using the Japanese Orthopedic Association (JOA) score and the visual analog scale (VAS) for the neck. We compared outcomes between BCS surgeons, who must meet several requirements, including experience in more than 300 spinal surgeries, and NBCS surgeons.ResultsBCS surgeons performed 124 out of 203 cases, while NBCS surgeons were primary in 79 cases, with 73.4% were directly supervised by a BCS surgeon. There was no statistically significant difference in surgical duration, estimated blood loss, and perioperative complication rates between the BCS and NBCS groups. Moreover, no statistically significant group differences were observed in each position of the C2-7 angle and cervical range of motion at preoperation and the final follow-up. Preoperative and final follow-up JOA scores, VAS for the neck, and JOA score recovery rate were comparable between the two groups.ConclusionsSurgical outcomes, including functional recovery, complication rates, and cervical dynamics, were comparable between the BCS and NBCS groups. Consequently, posterior decompression for cervical OPLL is considered safe and effective when conducted by junior surgeons who have undergone training and supervision by experienced spine surgeons.
研究设计
回顾性多中心研究。
目的
调查由获得脊柱专科认证(BCS)的外科医生或未获得认证(NBCS)的外科医生对颈椎后纵韧带骨化症(OPLL)进行后路减压术后的手术效果。
方法
我们纳入了203例颈椎OPLL患者,术后至少随访1年。收集了人口统计学信息、病史和影像学检查结果。术前及末次随访时采用日本骨科协会(JOA)评分和颈部视觉模拟量表(VAS)评估临床疗效。我们比较了必须满足多项要求(包括完成300余例脊柱手术经验)的BCS外科医生和NBCS外科医生的手术效果。
结果
203例病例中,BCS外科医生完成了124例,NBCS外科医生主刀79例,其中73.4%的手术有BCS外科医生直接监督。BCS组和NBCS组在手术时间、估计失血量和围手术期并发症发生率方面无统计学显著差异。此外,术前及末次随访时C2-7角各位置及颈椎活动度在两组间也未观察到统计学显著差异。两组间术前及末次随访时的JOA评分、颈部VAS评分及JOA评分恢复率相当。
结论
BCS组和NBCS组在包括功能恢复、并发症发生率和颈椎动力学等手术效果方面相当。因此,对于接受过经验丰富的脊柱外科医生培训和监督的初级外科医生而言,颈椎OPLL后路减压术被认为是安全有效的。