Five-year Follow-up Evaluation of Surgical Treatment for Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament A Prospective Comparative Study of Anterior Decompression and Fusion With Floating Method Versus Laminoplasty
Five-year Follow-up Evaluation of Surgical Treatment for Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament A Prospective Comparative Study of Anterior Decompression and Fusion With Floating Method Versus Laminoplasty
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DOI：
10.1097/brs.0b013e31821f4a51
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发表时间：
2012-03-01
期刊：
影响因子：
3
通讯作者：
Shinomiya, Kenichi
中科院分区：
文献类型：
--
作者：
Sakai, Kenichiro;Okawa, Atsushi;Shinomiya, Kenichi
研究设计。目的：前瞻性、可比性临床研究。目的比较前路浮动减压融合术与椎板成形术治疗后纵韧带骨化性脊髓型颈椎病的临床疗效。目前还没有报道对前路减压和后路减压后的手术结果进行准确和前瞻性的比较。对于OPLL所致的脊髓型颈椎病，我们分别于1997年、1999年、2001年、2003年、2004年和1996年、1998年、2000年、2002年在同一机构行前路浮动减压融合术(ADF)和法式椎板成形术(LAMP)。ADF组20例，LAMP组22例，随访5年。评估以下标准：手术时间、出血量、并发症和日本骨科协会评分。测量OPLL的椎管狭窄率、C2-C7的前凸角和骨化病变的术后进展。ADF组手术时间明显长于LAMP组。两组平均出血量差异无统计学意义。ADF组有5例发生并发症，LAMP组无一例发生并发症。ADF组脊髓型颈椎病的平均日本骨科学会评分系统和恢复率均优于LAMP组，尤其是术前椎管受OPLL或颈椎后凸排列影响大于50%的患者。ADF组术后OPLL进展率为5%，LAMP组为50%。尽管与LAMP相比，ADF的手术相关并发症发生率较高，但ADF被认为特别适用于有大量OPLL并术前颈椎后凸排列的病例。
Study Design. Prospective, comparative clinical study.Objective. To compare the clinical outcome of anterior decompression and fusion with floating method and laminoplasty in the treatment of cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL).Summary of Background Data. There have been no reports that have accurately and prospectively compared surgical outcomes after anterior decompression and posterior decompression.Methods. For cervical myelopathy caused by OPLL, we performed anterior decompression and fusion with floating method (ADF) in 1997, 1999, 2001, 2003, and 2004 and French-door laminoplasty (LAMP) in 1996, 1998, 2000, and 2002 at one institution. Twenty patients in the ADF group and 22 patients in the LAMP group were evaluated for 5 years' follow-up. The following criteria were evaluated: operation time, blood loss, complications, and Japanese Orthopedic Association score. For radiographic evaluation, canal narrowing ratio of OPLL, lordotic angle at C2-C7, and postoperative progression of the ossified lesion were measured.Results. The operation time in the ADF group was longer than that in the LAMP group. The average blood loss showed no statistical difference between the 2 groups. Complications occurred in 5 cases in the ADF group, but none occurred in the LAMP group. The mean Japanese Orthopedic Association score system for cervical myelopathy and the recovery rate in the ADF group were superior to those in the LAMP group, especially for cases with greater than 50% of the spinal canal compromised by OPLL or kyphotic alignment of the cervical spine, preoperatively. Postoperative progression of OPLL was observed in 5% of the ADF group and 50% of the LAMP group.Conclusion. ADF is considered especially suitable for cases with massive OPLL and preoperative kyphotic alignment of the cervical spine, although it leads to a higher incidence of surgery-related complications compared with LAMP.