Long-Term Follow-Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study.
Long-Term Follow-Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study.
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DOI：
10.1111/os.13182
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发表时间：
2022-03
影响因子：
2.1
通讯作者：
Li WS
中科院分区：
文献类型：
--
作者：
Liu X;Zhai SH;Song QP;Wei F;Jiang L;Sun CG;Liu XG;Li WS
检查多节段胸椎后纵韧带（OPLL）在环周减压（CD）节段的术后进展，并评价经后路CD术后的长期结果。回顾性评价了2007年至2014年在单中心接受CD的16例继发于OPLL的胸椎脊髓病患者的临床数据，并随访超过60个月。所有性别和年龄的患者均纳入研究。分析了手术时和最近随访时获得的薄层计算机断层扫描。在CD水平上最明显骨化突起的轴位重建扫描上测量骨化面积。采用改良的日本骨科协会（乔亚）评分和Hirabayashi恢复率（HRR）评价神经功能结局。连续变量表示为平均值±标准差，并使用Student t检验进行分析，而分类变量使用Fisher精确检验进行检验。其中混合型9例（56.3%），局限型2例（12.5%），连续型5例（31.2%）。6例合并黄韧带骨化，2例合并颈椎后纵韧带骨化。所有患者CD水平的OPLL面积均增加。平均随访期为5.5 ± 0.92年（范围5-8年）。平均骨化面积从手术时的35.63 ± 39.23 mm 2增加到末次随访时的99.94 ± 65.39 mm 2（P < 0.01）。术后任何计算机断层扫描均未发现内固定障碍。所有患者的平均乔亚评分从术前的4.2 ± 2.2分改善至末次随访时的8.4 ± 2.6分（P < 0.01）。总体HRR为61.8%。无患者因OPLL进展而表现出任何神经功能恶化。1例患者由于腰椎管狭窄恶化（一个无关的原因）而出现严重步态障碍，但其他15例患者步态障碍改善。根据长期随访结果，尽管OPLL进展在切除OPLL肿块后没有减少或停止，但CD是一种安全有效的手术，可以提供足够的储备腹侧空间以科普术后OPLL进展。 骨化的水平和面积。(A)手术后的胸部切片。(B)末次随访时的脊髓切片(C)术后轴向切片。(D)末次随访时的轴向切片。箭头指的是圆周减压水平。
To examine the postoperative progression of multilevel thoracic posterior longitudinal ligament (OPLL) at circumferential decompression (CD) levels and evaluate the long‐term results after CD via the posterior approach. Clinical data from 16 patients with thoracic myelopathy secondary to OPLL who underwent CD at a single center were evaluated retrospectively from 2007 to 2014 and were followed up for more than 60 months. Patients of all sexes and ages were included in the study. Thin‐slice computed tomography scans obtained at the time of surgery and the most recent follow‐up were analyzed. The ossified area was measured on the axial reconstructed scan of the most obvious protrusion of ossification at the CD level. The neurological outcomes were evaluated using modified Japanese Orthopaedic Association (JOA) scores and Hirabayashi recovery rates (HRRs). Continuous variables were presented as the mean ± standard deviation and were analyzed using the Student's t‐test, while categorical variables were tested using Fisher's exact test. Among all patients, the most predominant type was the mixed type (9/16, 56.3%), while the circumscribed type was only found in two patients (12.5%), and the continuous type was found in five patients (31.2%). Six cases were associated with ossification of the ligamentum flavum, and two cases were combined with cervical OPLL. The OPLL area at the CD level increased in all patients. The mean follow‐up period was 5.5 ± 0.92 years (range 5–8 years). The mean area of ossification increased from 35.63 ± 39.23 mm2 at the time of surgery to 99.94 ± 65.39 mm2 at the last follow‐up visit (P < 0.01). There was no internal fixation disorder on any computed tomography scan after the operation. The average JOA score of all patients improved from 4.2 ± 2.2 points before surgery to 8.4 ± 2.6 points at the final follow‐up (P < 0.01). The overall HRR was 61.8%. None of the patients exhibited any neurological deterioration due to OPLL progression. One patient developed a severe gait disturbance due to worsening lumbar canal stenosis, an unrelated cause, but the other 15 experienced gait disturbance improvements. According to the long‐term follow‐up results, although OPLL progression did not decrease or stop after removing the OPLL mass, CD is a safe and effective procedure that can provide adequate reserve ventral space to cope with postoperative OPLL progression. Level and area of the ossification. (A) Sagittal section postoperatively. (B) Sagittal section at the last follow‐up time. (C) Axial section postoperatively. (D) Axial section at the last follow‐up time. The arrow refers to the circumferential decompression level.
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影响因子：
2.8
作者：
Yamazaki, Masashi;Okawa, Akihiko;Koda, Masao
通讯作者：
Koda, Masao
影响因子：
4.5
作者：
Ma, Xuexiao;An, Howard S.;Chen, Bohua
通讯作者：
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影响因子：
3
作者：
Fujimori, Takahito;Watabe, Tadashi;Oda, Takenori
通讯作者：
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影响因子：
4.1
作者：
McClendon, Jamal, Jr.;Sugrue, Patrick A.;Liu, John C.
通讯作者：
Liu, John C.
影响因子：
2.1
作者：
Xu, Zhao-wan;Hu, Yong-cheng;Zhuang, Qing-shan
通讯作者：
Zhuang, Qing-shan