Long-term follow-up results of laminectomy for cervical myelopathy caused by ossification of the posterior longitudinal ligament
Long-term follow-up results of laminectomy for cervical myelopathy caused by ossification of the posterior longitudinal ligament
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DOI：
10.3171/jns.1998.89.2.0217
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发表时间：
1998-08-01
影响因子：
4.1
通讯作者：
Ochi, T
中科院分区：
文献类型：
--
作者：
Kato, Y;Iwasaki, M;Ochi, T
Object.本回顾性研究旨在评估颈椎椎板切除术治疗颈椎后纵韧带骨化症（OPLL）的长期疗效。作者回顾了1970年至1985年间（平均随访14.1年）接受颈椎椎板切除术的52例患者中的44例的病历。椎板切除术后1年和5年的神经功能恢复率分别为44.2%和42.9%。手术结果在5年后保持不变，但在术后5 - 10年期间恶化：末次随访审查时的恢复率为32.8%。采用多因素逐步分析，发现影响临床结果的术前因素是手术时的年龄，先前存在的脊髓病的严重程度和创伤史。44例患者中有10例（23%）观察到晚期神经功能恶化。最早恶化发生在术后1年，最晚发生在术后17年（平均9.5年）。最常见的恶化原因是跌倒造成的创伤（6例患者），其次是黄韧带骨化（3例患者）。70%的患者术后发现OPLL扩散，但仅1例患者明确为神经功能恶化的原因。椎板切除术后，47%的患者术后出现后凸畸形进展，但这些变化不会导致神经功能恶化。作者建议OPLL早期手术减压，因为年轻患者和日本骨科协会系统测量的评分较高的患者结局更好。
Object. This retrospective study was performed to assess the long-term results of cervical laminectomy in treating ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.Methods. The authors reviewed medical records in 44 of 52 patients who underwent cervical laminectomy between 1970 and 1985 (mean follow up 14.1 years). The neurological recovery rate after laminectomy was 44.2% after 1 year and 42.9% after 5 years. The surgical outcome was maintained after 5 years but worsened between 5 and 10 years postsurgery: the recovery rate at the last follow-up review was 32.8%. Using multivariate stepwise analysis, the preoperative factors that affected clinical results were found to be the age at operation, the severity of preexisting myelopathy, and a history of trauma. Late neurological deterioration was observed in 10 (23%) of 44 patients. The earliest deterioration occurred at 1 year and the latest was at 17 years postsurgery (mean 9.5 years). The most frequent cause of deterioration was trauma due to a fall (six patients), followed by ossification of the ligamentum flavum (three patients). Postoperative spread of the OPLL was noted in 70% of the patients, but it was clearly the cause of neurological deterioration in only one of them. After laminectomy, postoperative progression of kyphotic deformity was observed in 47% of patients, but these changes did not cause neurological deterioration.Conclusions. The authors recommend early surgical decompression fur OPLL because the outcome is better for younger patients and for those with a higher score as measured by the Japanese Orthopedic Association's system.