Safety and effectiveness of ultrasonic osteotome in posterior cervical laminectomy decompression and fusion / 中国修复重建外科杂志

Objective: To explore the safety of ultrasonic osteotome used in posterior cervical laminectomy decompression surgery and its effect on surgical outcome. Methods: A clinical data of 52 patients with ossification of posterior longitudinal ligament of cervical spine (C-OPLL) undergoing posterior cervical laminectomy decompression and fusion (PCLDF) between April 2013 and April 2017 was retrospectively analysed. The patients were divided into two groups according to whether using the ultrasonic osteotome during operation: group A (20 cases, ultrasonic osteotome group) and group B (32 cases, traditional gun-clamp decompression group). There was no significant difference in gender, age, body weight, height, preoperative hemoglobin, and Japanese Orthopedic Association (JOA) score between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time, complications, hemoglobin at 1 day after operation, and JOA score at 6 months after operation were recorded and compared between the two groups, and the improvement rate of JOA was calculated. Results: The operation time and intraoperative blood loss in group A were significantly less than those in group B ( P0.05). The hemoglobin of group B was slightly higher than that of group A at 1 day after operation, but there was no significant difference between the two groups ( t=-1.260, P=0.214). All the patients were followed up 6-10 months (mean, 7.6 months). No serious complications such as C 5 nerve paralysis, dural tear, infection, epidural hematoma, deep venous thrombosis, pulmonary embolism, transfusion allergy, or shock occurred during and after operation. The JOA scores of the two groups were significant improved at 6 months after operation when compared with preoperative scores ( P0.05). Conclusion: Compared with the traditional gun-clamp decompression, the effectiveness of PCLDF in treatment of C-OPLL by using ultrasonic osteotome is comparable, but the latter can effectively reduce the operation time and blood loss.

Surgical Treatment for Ossification of the Posterior Longitudinal Ligament of the Cervical Spine

Ossification of the posterior longitudinal ligament(OPLL) is a degenerative disease of the spine, usually found in the cervical vertebrae. The etiology and pathogenesis have not been clarified, and its natural course is still unknown. The choice of operative approach, anterior vs. posterior, is still controversial. During the past 13 years, we have operated on 116 patients with myelopathy associated with cevical OPLL; 34 cases(29.3%) were of the continuous type, 30(25.9%) were segemental, 37(31.9%) were mixed, and 15(12.9%) were other type respectively. Forty-six patients underwent anterior cervical decompression by corpectomy, disectomy, and removal of the OPLL, and in these patients, segmental and other types of OPLL were more common and were found in 73% of these cases. On the other hand, 70 patients underwent posterior cervical decompression by cervical laminectomy or expansive laminoplasty; among them, the continuous and mixed type were more common and accounted for 84% of these cases. Surgical outcome was better in patients in whom the duration of pre-operative symptoms was shorter(p<0 .05). Age at surgery, trauma history and surgical approach did not, however, significantly affect the outcome. In conclusion, anterior cervical decompression was seen to give the best results, but was limited to patients with segmental or other types of OPLL, single or two levels of OPLL, and OPLL with herniated cervical disc. The posterior approach, on the other hand, was palliative, and gave better results in patients with continuous or mixed type of OPLL, OPLL of more than level three, and generally compromised patients.

Posterior Approach for Cervical Spondylosis with Radiculomyelopathy

Of the 68 cervical spondyltic patients showing symptoms of radiculomyelopathy, assessments were made on 29 patients who underwent neural decompressive surgery with cervical laminectomy through posterior approach for the results of surgery. Analyses were also made on the anterior-posterior diameters of cervical canal on the plain film of cervical spine. The mean values of anterior-posterior diameters measured on the levels of cervical C3-7 were 16.5+/-1.83 mm in the normal adult and 7.3+/-1.08 mm in the cervical spondylotic patients with radiculomyelopathy, which is far narrower than that of the normal. In cervical spondylotic patients, the anterior-posterior diameters of directly upper and lower parts of the lesions were 11.9+/-1.20 mm and 12.1+/-1.61 mm respectively, also much narrower mean values than those of the normal control group. The results of the 29 patients who received cervical laminectomy by posterior approach were much improved for 51.7% and improved for 44.8%.