Comparison of Surgical Outcomes of Anterior and Posterior Fusion Surgeries for K-line (?) Cervical Ossification of the Posterior Longitudinal Ligament
Comparison of Surgical Outcomes of Anterior and Posterior Fusion Surgeries for K-line (?) Cervical Ossification of the Posterior Longitudinal Ligament
复制标题
颈椎K线后纵韧带骨化前后路融合手术的手术效果比较
作者：
Nagoshi N;Yoshii T;Egawa S;Sakai K;Kusano K;Tsutsui S;Hirai T;Matsukura Y;Wada K;Katsumi K;Koda M;Kimura A;Furuya T;Sato Y;Maki S;Nishida N;Nagamoto Y;Oshima Y;Ando K;Nakashima H;et al.
研究设计。目的：本研究的目的是比较k线（−）颈椎后纵韧带骨化（OPLL）患者的前后融合手术的手术效果。背景资料摘要。尽管椎板成形术对k线（+）型OPLL患者是有效的，但对于k线（-）型OPLL患者，建议进行融合手术。然而，对于这种病理，前路还是后路是更可取的，目前还没有有效的确定。材料与方法。2014年至2017年，来自28家机构的478例颈椎OPLL脊髓病患者进行前瞻性登记，随访2年。在478例患者中，45例和46例k线（−）患者分别接受了前路和后路融合手术。在使用倾向评分匹配分析调整基线特征的混杂因素后，对前后两组的54例患者（各27例）进行了评估。临床结果采用日本颈椎骨科协会和日本颈椎骨科协会颈椎脊髓病评估问卷进行评估。结果：两种方法均显示相当的神经和功能恢复。与前路组相比，后路组由于融合椎体较多，颈椎活动范围明显受限。手术并发症的发生率在队列之间是相似的，但后路组表现出更高频率的节段性运动麻痹，而前路组更频繁地报告术后吞咽困难。结论：k线（−）OPLL患者的前后路融合手术的临床改善是相似的。理想的手术入路应基于外科医生的技术偏好和并发症风险之间的平衡。
Study Design.A prospective multicenter study.Objective.The objective of this study is to compare the surgical outcomes of anterior and posterior fusion surgeries in patients with K-line (−) cervical ossification of the posterior longitudinal ligament (OPLL).Summary of Background Data.Although laminoplasty is effective for patients with K-line (+) OPLL, fusion surgery is recommended for those with K-line (−) OPLL. However, whether the anterior or posterior approach is preferable for this pathology has not been effectively determined.Materials and Methods.A total of 478 patients with myelopathy due to cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for two years. Of the 478 patients, 45 and 46 with K-line (−) underwent anterior and posterior fusion surgeries, respectively. After adjusting for confounders in baseline characteristics using a propensity score-matched analysis, 54 patients in both the anterior and posterior groups (27 patients each) were evaluated. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire.Results.Both approaches showed comparable neurological and functional recovery. The cervical range of motion was significantly restricted in the posterior group because of the large number of fused vertebrae compared with the anterior group. The incidence of surgical complications was comparable between the cohorts, but the posterior group demonstrated a higher frequency of segmental motor paralysis, whereas the anterior group more frequently reported postoperative dysphagia.Conclusions.Clinical improvement was comparable between anterior and posterior fusion surgeries for patients with K-line (−) OPLL. The ideal surgical approach should be informed based on the balance between the surgeon’s technical preference and the risk of complications.