Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
J Bone Joint Surg Am. 2024 Sep 4;106(17):1600-1609. doi: 10.2106/JBJS.23.01475. Epub 2024 Aug 5.
We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL).
We retrospectively evaluated 51 patients followed for ≥10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression.
A significant improvement was observed in the JOA score from preoperatively (3.7) to 2 years postoperatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 preoperatively to 0.68 at 10 years postoperatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from preoperatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after 2 years. Fourteen (27.5%) of the patients experienced postoperative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade.
Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years.
Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
我们评估了手术治疗胸椎后纵韧带骨化（T-OPLL）的临床、功能和生活质量（QoL）结局。
我们回顾性评估了 51 例接受后路减压和矫正融合手术后随访≥10 年的 T-OPLL 患者。收集的数据包括人口统计学、合并症以及术前和术后症状。使用日本矫形协会（JOA）评分、背部和腿部疼痛数字评分量表（NRS）以及 EuroQol-5 维度-5 级（EQ-5D-5L）评估神经功能、疼痛和 QoL。进行影像学评估以评估后凸角度和骨化进展的变化。
JOA 评分从术前的 3.7 分显著改善至术后 2 年的 7.9 分（p<0.05）；此后评分保持稳定。EQ-5D-5L 评分从术前的 0.53 分提高到术后 10 年的 0.68 分（p<0.001）。背部和腿部疼痛的 NRS 评分分别从术前的 5.4 分和 4.0 分降至术后 10 年的 3.5 分和 3.0 分（均 p<0.001）。影像学结果显示后凸角度和骨化面积发生变化，术后 2 年后无明显进展。14 例（27.5%）患者术后出现并发症。其中，8 例（15.7%）需要再次手术，6 例（11.8%）在围手术期，2 例（3.9%）在术后。4 例（7.8%）患者因腰椎椎管狭窄和颈椎 OPLL 等情况进行了额外手术。尽管如此，所有术后并发症或额外手术的患者在 10 年内身体功能均保持稳定。
手术治疗 T-OPLL 可有效改善神经功能、QoL 和疼痛管理，且疗效可长期维持。T-OPLL 手术的长期结果表明，尽管颈椎和腰椎病变导致了再次手术，但并未影响 QoL，即使在 10 年后仍保持相对改善。
治疗性 IV 级。请参阅作者指南，以获取完整的证据等级描述。
