Chen Kefu, Dong Xingcheng, Lu Yiwei, Zhang Jian, Liu Xiaodong, Jia Lianshun, Guo Ying, Chen Xiongsheng
Department of Orthopaedics, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China.
Orthopedics Department, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde, China.
Bone Jt Open. 2024 Sep 18;5(9):768-775. doi: 10.1302/2633-1462.59.BJO-2024-0041.R1.
Surgical approaches to cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. The purpose of the present study was to analyze and compare the long-term neurological recovery following anterior decompression with fusion (ADF) and posterior laminectomy and fusion with bone graft and internal fixation (PLF) based on > ten-year follow-up outcomes in a single centre.
Included in this retrospective cohort study were 48 patients (12 females; mean age 55.79 years (SD 8.94)) who were diagnosed with cervical OPLL, received treatment in our centre, and were followed up for 10.22 to 15.25 years. Of them, 24 patients (six females; mean age 52.88 years (SD 8.79)) received ADF, and the other 24 patients (five females; mean age 56.25 years (SD 9.44)) received PLF. Clinical data including age, sex, and the OPLL canal-occupying ratio were analyzed and compared. The primary outcome was Japanese Orthopaedic Association (JOA) score, and the secondary outcome was visual analogue scale neck pain.
Compared with the baseline, neurological function improved significantly after surgery in all patients of both groups (p < 0.001). The JOA recovery rate in the ADF group was significantly higher than that in the PLF group (p < 0.001). There was no significant difference in postoperative cervical pain between the two groups (p = 0.387). The operating time was longer and intraoperative blood loss was greater in the PLF group than the ADF group. More complications were observed in the ADF group than in the PLF group, although the difference was not statistically significant.
Long-term neurological function improved significantly after surgery in both groups, with the improvement more pronounced in the ADF group. There was no significant difference in postoperative neck pain between the two groups. The operating time was shorter and intraoperative blood loss was lower in the ADF group; however, the incidence of perioperative complications was higher.
颈椎后纵韧带骨化症（OPLL）的手术治疗方法仍存在争议。本研究的目的是基于单中心超过十年的随访结果，分析和比较前路减压融合术（ADF）与后路椎板切除减压植骨融合内固定术（PLF）后的长期神经功能恢复情况。
本回顾性队列研究纳入了48例诊断为颈椎OPLL的患者（12例女性；平均年龄55.79岁（标准差8.94）），这些患者在本中心接受治疗，并随访了10.22至15.25年。其中，24例患者（6例女性；平均年龄52.88岁（标准差8.79））接受了ADF，另外24例患者（5例女性；平均年龄56.25岁（标准差9.44））接受了PLF。对年龄、性别和OPLL椎管占位率等临床资料进行了分析和比较。主要结局指标为日本骨科协会（JOA）评分，次要结局指标为视觉模拟评分法颈部疼痛评分。
与基线相比，两组所有患者术后神经功能均有显著改善（p < 0.001）。ADF组的JOA恢复率显著高于PLF组（p < 0.001）。两组术后颈部疼痛无显著差异（p = 0.387）。PLF组的手术时间比ADF组长，术中出血量比ADF组多。ADF组观察到的并发症比PLF组多，尽管差异无统计学意义。
两组术后长期神经功能均有显著改善，ADF组改善更明显。两组术后颈部疼痛无显著差异。ADF组手术时间短，术中出血量少；然而，围手术期并发症发生率较高。
