Long-Term Outcome of Anterior Cervical Decompression with Fusion for Cervical Ossification of Posterior Longitudinal Ligament including Postsurgical Remnant Ossified Spinal Lesion.
Long-Term Outcome of Anterior Cervical Decompression with Fusion for Cervical Ossification of Posterior Longitudinal Ligament including Postsurgical Remnant Ossified Spinal Lesion.
复制标题
颈椎前路减压融合治疗颈椎后纵韧带骨化（包括术后残余骨化脊柱病变）的长期结果。
DOI：
10.1097/brs.0000000000003173
复制
发表时间：
2019
期刊：
影响因子：
3
通讯作者：
A. Matsumine
中科院分区：
文献类型：
--
作者：
H. Nakajima;Shuji Watanabe;Kazuya Honjoh;Ippei Kitade;Daisuke Sugita;A. Matsumine
研究设计
一项回顾性研究目的：评估颈椎前路减压融合术(ACDF)治疗颈椎纵韧带骨化症(OPLL)的疗效、围手术期并发症和预后因素。
背景数据摘要
很少有关于ACDF的长期手术结果的信息，包括手术后残留的骨化性脊柱病变。
方法
自1993-2013年间，对80例OPLL所致脊髓型颈椎病患者行ACDF治疗。对其中42例患者进行了至少5年的随访，并对其资料进行分析。
结果
平均随访7.9年 ± 2.8年，总改善率59.2 ± 15.0%。6例患者发生围手术期并发症12例(15.0%)，并伴有神经功能恶化，无一例发生慢性并发症。多因素Logistic回归分析包括术前日本骨科协会(JOA)评分、OPLL类型、OPLL占有率、融合节段的数量和脊髓横截面积的增加，确定后一参数是唯一独立和显著的决定50%的放射和临床改善的因素。在减压范围外残留骨化病变的患者(16例)中，6例(14.3%)术后进展，均为混合型；在减压范围内漂浮的病变在随访期内无进展。9例(21.4%)患者出现邻近节段退行性变，仅3例患者出现神经症状和体征，1例患者需要翻修手术。
结论
颈椎OPLL患者ACDF术后的远期临床结果被认为是令人满意的。手术相关并发症和邻近节段疾病不应成为避免ACDF的理由。对于术后残留骨化脊柱病变的ACDF，尤其是混合型OPLL，术后仍有可能进展，应慎重选择。
证据水平
4.
STUDY DESIGN
A retrospective study OBJECTIVE.: To assess the outcome, perioperative complications, and prognostic factors of anterior cervical decompression and fusion (ACDF) in patients with cervical ossification of longitudinal ligament (OPLL).
SUMMARY OF BACKGROUND DATA
There is little information on the long-term surgical outcome of ACDF including postsurgical remnant ossified spinal lesion.
METHODS
Between 1993 and 2013, 80 patients with cervical myelopathy due to OPLL underwent ACDF at our hospital. Among these, 42 patients were followed-up for at least 5 years and their data were analyzed.
RESULTS
The mean follow-up period was 7.9 ± 2.8 years, and the overall improvement rate was 59.2 ± 15.0%. Although 12 (15.0%) perioperative complications were observed in 6 patients, accompanied by neurological deterioration, none of the patients had chronic complications. Multivariate logistic regression analysis that included the preoperative Japanese Orthopaedic Association (JOA) score, type of OPLL, occupying ratio of OPLL, and number of fused segments and increase in the transverse area of the cord identified the latter parameter as the only independent and significant determinant of radiological and clinical improvement of >50%. Among the patients with remaining ossified spinal lesions out of the decompressed range (16 patients), postoperative progression was observed in 6 cases (14.3%) who were all of the mixed type; floated lesions within the decompressed range did not show progression during the follow-up. Adjacent segment degeneration was seen in 9 (21.4%) patients, and neurological signs and symptoms were seen in only 3 of the 9 patients and only 1 patient required revision surgery.
CONCLUSION
The long-term clinical outcome of patients with cervical OPLL after ACDF is considered satisfactory. Surgery-related complications and adjacent segment diseases should not be reasons to avoid ACDF. Care should be taken in selecting ACDF with postsurgical remnant ossified spinal lesion since it could progress postoperatively especially in the mixed type OPLL.
LEVEL OF EVIDENCE
4.
影响因子：
3
作者：
Sakai, Kenichiro;Okawa, Atsushi;Shinomiya, Kenichi
通讯作者：
Shinomiya, Kenichi
影响因子：
1.7
作者：
Uchida, K;Nakajima, H;Sato, R;Kokubo, Y;Yayama, T;Kobayashi, S;Baba, H
通讯作者：
Baba, H