Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up
Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up
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DOI：
10.3171/spi.2002.96.2.0180
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发表时间：
2002-03-01
影响因子：
4.1
通讯作者：
Yonenobu, K
中科院分区：
文献类型：
--
作者：
Iwasaki, M;Kawaguchi, Y;Yonenobu, K
对象。作者报告了颈椎椎板成形术治疗颈椎后纵韧带骨化的长期（超过10年）结果以及影响术后长期病程的因素。作者回顾了1982年至1990年间92例接受宫颈子宫内膜成形术的患者的资料。失访3例。手术10年内死亡25例，随访10年以上64例。使用日本骨科协会（JOA）颈椎脊髓病评分系统对结果进行评估。恢复率采用Hirabayashi法计算，术后前10年平均神经系统恢复率为64%，最后一次随访时平均随访时间为12.2年，神经系统恢复率降至60%。术后5 - 15年，8例患者（14%）出现晚期神经功能恶化。晚期恶化最常见的原因是退行性腰椎疾病（3例）、继发于黄韧带骨化的胸椎脊髓病（2例）或手术水平的OPLL术后进展（2例）。70%的患者发现骨化病变的术后进展，但只有2例患者（31%）发现有相关的神经功能恶化。1例（2%）患者因骨化韧带进展继发的神经功能恶化需要额外的颈椎手术。作者进行了多变量逐步分析，发现与较好的临床结果相关的因素是手术年龄较小和先前存在的脊髓病较轻。手术年龄较小，以及混合型和连续型或OPLL。高度预测OPLL的进展。8%的患者术后出现后凸畸形进展，但未引起神经系统恶化。当考虑到手术相关并发症的发生率和术后OPLL生长的可能性时，作者建议对OPLL进行广泛的椎板成形术。
Object. The authors report the long-term (more than 10-year) results of cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine as well as the factors affecting long-term postoperative course.Methods. The authors reviewed data obtained in 92 patients who underwent cervical huninoplast between 1982 and 1990. Three patients were lost to follow up. 25 patients died within 10 years of surgery, and 64 patients were followed for more than 10 years. Results were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate was calculated using the Hirabayashi method, The mean neurological recovery rate during the first 10 years after surgery was 64%, which declined to 60% at the last follow-up examination (mean follows up 12.2 years). Late neurological deterioration occurred in eight patients ( 14%) from 5 to 15 years after surgery. The most frequent causes of late deterioration were degenerative lumbar disease (three patients) thoracic myelopathy secondary to ossification of the ligamentum flavum (two patients), or postoperative progression of OPLL at the operated level (two patients). postoperative progression of the ossified lesion was noted in 70%( of the patients, but only two patients (31%) were found to ha,e related neurological deterioration. Additional cervical surgery was required in one patient (2%) because of neurological deterioration secondary to progression of the ossified ligament. The authors performed a multivariate stepwise analysis, and found that ractors related to better clinical results were younger age at operation and less severe preexisting myelopathy. Younger age at operation, as well as mixed and continuous types or OPLL. was highly predictive of progression of OPLL. Postoperative progression of kyphotic deformity was observed in 8% of the patients although it did not cause neurological deterioration.Conclusions. When the incidence of surgery-rclated complications and the strong possibility of postoperative growth of OPLL are taken into consideration, the authors, recommend expansive and extensive laminoplasty for OPLL.