Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine - Implication of the type of ossification and surgical options
Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine - Implication of the type of ossification and surgical options
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DOI：
10.1097/01.bsd.0000155033.63557.9c
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发表时间：
2005-12-01
影响因子：
--
通讯作者：
Ishiguro, N
中科院分区：
文献类型：
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作者：
Matsuyama, Y;Yoshihara, H;Ishiguro, N
目的：胸椎后纵韧带（OPLL）骨化通过脊髓前部压迫产生脊髓病，这种压迫通常是进行性的并且不受保守治疗的影响。因此，早期减压手术势在必行。然而，胸段脊髓病的减压手术难度大，且效果往往不佳。对21例胸部OPLL患者的手术结果进行回顾性研究，以评价哪种手术入路较好，哪种类型的胸部OPLL手术效果更好。 方法：纳入1985年3月至2000年10月在我科接受手术治疗的21例胸部OPLL患者（男10例，女11例，平均年龄54岁）。七名患者表现出扁平型后纵韧带骨化，并接受前路减压融合术（一名患者）、后路前路减压（三名患者）或扩张椎板成形术（三名患者）。 14 名患者表现出喙型 OPLL，并接受前路减压融合术（2 名患者）、经后路前路减压（6 名患者）或椎管扩大成形术（6 名患者）。 结果：无论手术方式如何，两种类型的 OPLL 之间在手术时间和失血量方面没有显着差异；与扩张椎板成形术相比，前路减压融合术以及后路前路减压术的手术时间更长，失血量更大。关于临床结果，有五例神经系统恶化。 5例恶化病例均为后路治疗的喙型后纵韧带骨化症。其中两名患者接受了椎板扩大成形术治疗。结论：在我们的胸部 OPLL 系列中，有 5 例神经功能恶化，且全部表现为喙型 OPLL。对于喙型后纵韧带骨化，后路减压过程中脊柱排列的细微改变可能会增加脊髓受压，导致症状恶化。应通过临时棒固定来避免椎板切除术后脊柱后凸的潜在增加。如果术中监测提示脊髓功能障碍，应尽快尝试前路减压手术。
Objective: Ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine produces myelopathy through anterior spinal cord compression that is Usually progressive and unaffected by conservative treatment. Therefore, early decompressive surgery is imperative. However, decompression surgery of thoracic myelopathy is difficult, and the outcome is often poor. A retrospective study was conducted to investigate the surgical outcome of 21 patients with thoracic OPLL to evaluate which type of surgical approach is better and which type of thoracic OPLL results in a better surgical outcome.Methods: A total of 21 patients with thoracic OPLL (10 men and I I women; mean age 54 years), who underwent surgical treatment at our department from March 1985 to October 2000, were included in the study. Seven patients exhibited the flat-type OPLL and underwent either anterior decompression and fusion (one patient), anterior decompression via a posterior approach (three patients), or expansive laminoplasty (three patients). Fourteen patients exhibited the beak-type OPLL and also underwent either anterior decompression and fusion (two patients), anterior decompression via a posterior approach (six patients), or expansive laminoplasty (six patients).Results: Regarding of operative time and blood loss, there were no marked differences between the two types of OPLL, regardless of the type of surgical procedure; anterior decompression and fusion and anterior decompression via a posterior approach yielded longer operative times and larger blood loss volumes than expansive laminoplasty. Concerning clinical outcome, there were five cases of neurologic deterioration. All of the five deteriorated cases were of the beak-type OPLL treated by a posterior approach. Two of these patients were treated with expansive laminoplasty.Conclusions: There were five instances of neurologic deterioration in our thoracic OPLL series, and all of them exhibited beak-type OPLL. In the beak-type OPLL, a subtle alteration in the spinal alignment during posterior decompression procedures may increase spinal cord compression, leading to the deterioration of symptoms. A potential increase in kyphosis following laminectomy should be avoided by fixation with a temporary rod. If intraoperative monitoring suggests spinal cord dysfunction, an anterior decompression procedure should be attempted as soon as possible.