Circumferential decompression via the posterior approach for the surgical treatment of multilevel thoracic ossification of the posterior longitudinal ligaments: a single institution comparative study
Circumferential decompression via the posterior approach for the surgical treatment of multilevel thoracic ossification of the posterior longitudinal ligaments: a single institution comparative study
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后路环向减压手术治疗胸椎后纵韧带多节段骨化症的单机构对比研究
DOI：
10.3760/cma.j.issn.0366-6999.20140557
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发表时间：
2014-10-05
影响因子：
6.1
通讯作者：
Dang Gengting
中科院分区：
文献类型：
--
作者：
Liu Xiao;Zhu Bin;Dang Gengting
背景关于胸后纵韧带多节段骨化的治疗策略报道甚少。本研究的目的是探讨多节段T-OPLL的临床结果和并发症，并比较两种不同的OPLL治疗方法（切除或漂浮）。方法回顾性分析2005年1月至2012年2月间接受手术治疗的多节段T-OPLL致胸椎管狭窄患者的资料。根据手术入路的不同，将患者分为两组。A组为后路减压患者，B组为后路行环周减压患者。B组进一步分为两个亚组：亚组1（切除组）完全切除OPLL，亚组2（漂浮组）漂浮OPLL。结果49例患者纳入研究。A组14例单纯后路减压，B组35例行环周减压。B组29例完全切除骨化后纵韧带，其余6例行浮力手术。39例患者的随访数据。平均JOA评分由A组的5.4 +/- 1.8分提高到7.5 +/- 2.8分，由b组的3.7 +/- 1.8分提高到7.9 +/- 2.4分。主要并发症为脑脊液（CSF）漏出和术后神经功能恶化（ND）。25例术后脑脊液漏患者中有23例在末次随访时完全恢复，15例ND患者中有12例在末次随访时神经功能有所改善。结论经后路环形减压术是治疗胸椎多节段上锁性椎体狭窄的有效手术方法。完全切除骨化后纵韧带的患者可能比“漂浮”组有更好的恢复率。
Background The treatment strategies for multilevel thoracic ossification of the posterior longitudinal ligaments (T-OPLL) were rarely reported. The aim of this study was to investigate the clinical outcomes and complications of circumferential decompression for multilevel T-OPLL and compare two different methods in the management of the OPLL (resection or floating).Methods Data of sequentially treated patients who received surgical treatment for thoracic spinal stenosis caused by multilevel T-OPLL from January 2005 to February 2012 were retrospectively reviewed. Based on the surgical approaches applied, the patients were divided into two groups. Group A consisted the patients who received posterior decompression and group B consisted the patients who received circumferential decompression via the posterior approach. Group B was further divided into two subgroups: subgroup 1 (the resection group) where the OPLL was completely resected and subgroup 2 (the floating group) where the OPLL was floated.Results A total of 49 patients were included in the study. Fourteen patients with single posterior decompression were included in group A and 35 patients who received circumferential decompression were included in group B. In group B, 29 patients had complete resection of the ossified posterior longitudinal ligaments, while the other six underwent a flotation procedure. The follow-up data were available in 39 patients. Mean JOA scores improved from 5.4 +/- 1.8 to 7.5 +/- 2.8 in group A and from 3.7 +/- 1.8 to 7.9 +/- 2.4 in group B. The main complications included cerebrospinal fluid (CSF) leakage and postoperative neurologic deterioration (ND). Twenty-three of the 25 cases with postoperative CSF leakage achieved a complete recovery at the last follow-up and 12 of the 15 cases with ND achieved some neurological improvement at the last follow-up.Conclusions Circumferential decompression via the posterior approach is an effective surgical method for thoracic spinal stenosis caused by multilevel OPLL of the thoracic spine. Patients who receive complete resection of the ossified posterior longitudinal ligaments may have better recovery rate than the "floating" group.