Anterior cervical ossified posterior longitudinal ligament en bloc resection for the treatment of cervical ossification of posterior longitudinal ligament / 中华骨科杂志

ABSTRACT

Objective To evaluate theclinical efficacy and safety of anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE),and analyze the advantages of ACOE compared to the traditionally anterior cervical surgery.Methods The clinical datawith more than one year follow-up of 96 patients suffered from cervical ossification of the posterior longitudinal ligament(OPLL) from April 2010 to March 2017 was retrospectively analyzed,including 57 males and 39 females,aged 32-69 years,average 54.6±8.7 years.There were 29 cases of nodular type (30.2％),48 cases of segmental type (50.0％),5 cases of continuous type(5.2％),and 14 cases of mixed type (14.6％).The neurological function assessments before and after operation were performed using the Japanese Orthopaedic Association (JOA) scoring system and the visual analogue scale (VAS) scoring system.The effect of ossified mass resection was observed by three-dimensional reconstruction CT scan.The spinal cord decompression was evaluated by MRI.The cervical curvature was compared before and after surgery by cervical lateral radiograph.The operation time,intraoperative blood loss,recovery rates of the JOA scores and complication rates of this group were compared with the cases of anterior cervical ossified posterior longitudinal ligament piecemeal resection (ACOP) reported by the recent literature to analyze the clinical efficacy,safety and advantages of ACOE.Results All the surgeries of 96 cases were successfully performed,including 57 cases (59.4％) with subtotal resectionof single vertebra,31 cases (32.3％) with subtotal resectionof doublevertebras,1 case (1.0％) with expanded intervertebral decompression,4 cases (4.2％) with "vertebra + semi-vertebra" subtotal resection,1 case (1.0％) with "semi-vertebra + vertebra + semi-vertebra" subtotal resection,2 cases with "double vertebras + semi-vertebra" subtotal resection (2.1％).Ninty-six cases were followed up for 12 to 78 months,with an average of 28.0±9.3 months.The preoperative JOA score with (11.38±2.80) scores was increased to 15.32± 1.62 scores at the last follow-up,and the recovery rate of JOA score was 74.63％±13.18％.The preoperative VAS score with 6.00±1.41 scores was reduced to 2.35±1.11 scores at the last follow-up.The cervical curvature increased from 10.4°±9.0° before surgery to 15.8°±8.1° at the last follow-up.CT showed that the ossified masses of the surgical segments were completely excised without residue;MRI showed that the compressionsof spinal cords and dural sacs were completely relieved,with nice morphology recovery.There was no neurological deterioration in this group.There were 6cases of cerebrospinal fluid leakage (CSFL),3 cases of C5 nerve palsy,1 case of Hornersyndrome,2 cases of dysphagia and hoarseness,1 case of titanium mesh subsidence with screw loosing.At the final followups,except one case of occasional throat foreign body sensation,the above complications were all remittedat different followup periods.Compared with the cases of ACOP reported by the recent meta-analysis,the operation time,the intraoperative blood loss,the complication rate of dysphagia with hoarseness and neurological deterioration were lower than those reported in the literature.The recovery rate of JOA scorewas higher than which reported in the literature.Conclusion ACOE is safe and effective for the treatment of cervical OPLL,which may be superior to traditional anterior cervical surgery in terms of surgical safe-ty,controllability of cerebrospinal fluid leakage and improvement of neurological function.