Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament
Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament
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DOI：
10.1007/s00586-009-1266-4
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发表时间：
2010-05-01
影响因子：
2.8
通讯作者：
Koda, Masao
中科院分区：
文献类型：
--
作者：
Yamazaki, Masashi;Okawa, Akihiko;Koda, Masao
我们评估了后纵韧带骨化导致的胸椎脊髓病后路减压内固定融合术（PDF）的临床结果。共有24例患者接受了PDF，通过日本骨科协会（JOA）评分（0-11分）和术后3、6、9和12个月的康复率以及平均最终随访4年5个月来评估他们的手术效果。术前JOA平均评分为3.7分。虽然有1例患者术后立即出现短暂性瘫痪（3.8%），但所有患者在最后随访时神经功能均恢复，平均JOA评分为8.0分，平均恢复率为58.1%。术后3、6、9、12个月的平均恢复率分别为36.7%、48.8%、54.0%、56.8%。JOA评分达到峰值的中位时间点为术后9个月。无患者选择经开胸行前路减压手术。目前的研究结果表明，尽管残留的OPLL对脊髓有持续的前撞击，但PDF可以导致相当大的神经系统恢复，术后瘫痪的风险很低。由于PDF后神经系统恢复进展缓慢，我们建议在恢复早期不需要额外的前路减压手术。
We evaluated the clinical results of posterior decompression with instrumented fusion (PDF) for thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). A total of 24 patients underwent PDF, and their surgical outcomes were evaluated by the Japanese Orthopaedic Association (JOA) scores (0-11 points) and by recovery rates calculated at 3, 6, 9 and 12 months after surgery and at a mean final follow-up of 4 years and 5 months. The mean JOA score before surgery was 3.7 points. Although transient paralysis occurred immediately after surgery in one patient (3.8%), all patients showed neurological recovery at the final follow-up with a mean JOA score of 8.0 points and a mean recovery rate of 58.1%. The mean recovery rate at 3, 6, 9 and 12 months after surgery was 36.7, 48.8, 54.0 and 56.8%, respectively. The median time point that the JOA score reached its peak value was 9 months after surgery. No patient chose additional anterior decompression surgery via thoracotomy. The present findings demonstrate that despite persistent anterior impingement of the spinal cord by residual OPLL, PDF can result in considerable neurological recovery with a low risk of postoperative paralysis. Since neurological recovery progresses slowly after PDF, we suggest that additional anterior decompression surgery is not desirable during the early stage of recovery.