Perioperative Complications in Posterior Surgeries for Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Nationwide Investigation.
Perioperative Complications in Posterior Surgeries for Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Nationwide Investigation.
复制标题
颈椎后纵韧带骨化手术的围手术期并发症：全国范围内的前瞻性调查。
DOI：
10.1097/bsd.0000000000001243
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Egawa S,Sakai K,Kusano K,Nakagawa Y,Hirai T,Wada K,Katsumi K,Fujii K,Kimura A,Furuya T,Nagoshi N,Kanchiku T,Nagamoto Y,Oshima Y,Ando K,Takahata M,Mori K,Nakajima H,Murata K,Matsunaga S,Kaito T,Yamada K,Kobayashi S,Kato S,Ohba T,Inami S,Fujibayas
中科院分区：
文献类型：
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作者：
Yoshii T;Egawa S,Sakai K,Kusano K,Nakagawa Y,Hirai T,Wada K,Katsumi K,Fujii K,Kimura A,Furuya T,Nagoshi N,Kanchiku T,Nagamoto Y,Oshima Y,Ando K,Takahata M,Mori K,Nakajima H,Murata K,Matsunaga S,Kaito T,Yamada K,Kobayashi S,Kato S,Ohba T,Inami S,Fujibayas
研究设计：这是一项前瞻性多中心研究。目的：本研究的目的是探讨后路手术治疗颈椎后纵韧带骨化症（OPLL）的围手术期并发症。背景资料摘要：颈椎OPLL的手术治疗具有各种并发症的高风险。椎板成形术（LAMP）和后路减压和内固定融合术（PDF）是有效的多节段颈椎OPLL，然而，很少有研究集中在这2 procedures.Materials和Methods的手术并发症：我们前瞻性地包括380例接受颈椎OPLL后路手术的患者（LAMP：270例，PDF：110例），并调查了全身和局部并发症，包括神经系统并发症。结果：40例（10.5%）患者出现运动性瘫痪，其中上肢运动性瘫痪最多见（8.9%），尤其是接受PDF的患者（14.5%）。下肢运动性麻痹6例（1.6%）。关于局部并发症，硬脑膜撕裂（3.9%）和手术部位感染（2.6%）较为常见。在单因素分析中，体重指数、术前颈椎对线、融合术和手术节段数是运动性麻痹的相关因素。多变量分析显示，融合手术和术前C2− C7角度较小是运动性麻痹相关的独立因素。涉及下肢的运动性麻痹倾向于在手术后的早期时间点被发现，并且所有患者都完全康复。上肢运动麻痹发生在一个延迟的方式，和68.8%的PDF患者表现出良好的恢复，而81.3%的患者与LAMP表现出良好的recovery.Conclusions：在颈椎OPLL的后路手术，上肢节段性运动麻痹是最常见的，尤其是在接受PDF的患者。融合和术前C2− C7小角度是运动性麻痹的独立危险因素。证据等级：III级。后纵韧带骨化（OPLL）是一种退行性脊柱疾病，可导致中老年患者神经功能受损。1 OPLL的发生机制已知除了退行性因素外，还有遗传因素，如机械应力和老化。2据报道，东亚国家的OPLL患病率高于西方国家。2影像学上有OPLL的患者大多无神经系统症状。然而，随着OPLL的发展，脊髓和神经根被OPLL压迫，导致神经功能障碍。进行性脊髓病患者通常需要手术治疗。第三、四节
Study Design:This was a prospective multicenter study.Objective:The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL).Summary of Background Data:Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures.Materials and Methods:We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications.Results:Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2− C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery.Conclusions:In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2− C7 angle were the independent risk factors for motor palsy.Level of Evidence:Level III.Ossification of the posterior longitudinal ligament (OPLL) is a degenerative spine disease that causes neurological impairment in middle-aged to elderly patients. 1 The mechanism of the development of OPLL is known to have a genetic factor in addition to degenerative factors, such as mechanical stress and aging. 2 The prevalence of OPLL is reported to be higher in East Asian countries than in western countries. 2 Most of the patients who have radiologic OPLL do not show neurological symptoms. However, as OPLL develops, the spinal cord and nerve roots are compressed by OPLL, resulting in neurological impairments. Patients with progressive myelopathy often require surgical treatment. 3, 4