Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament
Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament
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DOI：
10.1016/j.spinee.2015.01.028
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发表时间：
2015-05-01
期刊：
影响因子：
4.5
通讯作者：
Ha, Yoon
中科院分区：
文献类型：
--
作者：
Kim, Byeongwoo;Yoon, Do Heum;Ha, Yoon
背景：前路减压融合术 (ADF) 治疗后纵韧带骨化 (OPLL) 技术要求高，且与并发症相关。虽然影响后路减压临床结果的各种因素已被研究，但 ADF 的预后因素仍不清楚。 目的：本研究的目的是确定 ADF 治疗 OPLL 所致脊髓型颈椎病的手术结果和预后因素。研究设计：这是一项回顾性病例研究。患者样本：2005 年至 2012 年间，913 名患者在我们机构接受了颈椎 OPLL 减压手术。其中，131 名接受 ADF 的患者和 221 名接受椎板成形术的患者入组。纳入标准为（1）诊断为后纵韧带骨化（OPLL）； (2)脊髓型颈椎病； (3) 无外伤、感染、肿瘤或既往手术。由于随访不充分或缺乏术前脊髓病，我们排除了 60 名 ADF 患者和 157 名接受椎板成形术的患者。最后，71 名 ADF 患者和 64 名椎板成形术患者纳入本研究（平均随访时间为 48 个月与 41 个月）。 结果指标：使用日本骨科协会 (JOA) 脊髓型颈椎病评分系统进行神经系统评估。通过比较术前和术后JOA评分来计算神经功能改善率。 方法：研究年龄、性别、体重指数（BMI）、是否患有糖尿病（DM）、吸烟史、后纵韧带骨化（OPLL）类型、骨化病灶形状、后纵韧带骨化（OPLL）占位比、磁共振成像（MRI）髓内信号强度（ISI）是否存在以及颈椎矢状面排列等变量对手术结果的影响。根据 T2 加权矢状 MRI，ISI 的严重程度分为三组： 0 级，无； 1级，ISI仅限于一个光盘级别；或 2 级，ISI 超出一个光盘级别。这项工作得到了韩国卫生和福利部 2013 年韩国卫生技术研发项目 (A120254) 的支持。 结果：对于占位率 >= 60% 或 MRI 存在 ISI 的患者，ADF 比椎板成形术产生更好的手术效果。较高的 ISI 等级 (B = -28.5，p = .000) 和较高的占有率 (B = 0.88，p = .04) 与较低的回收率显着相关 (R = 0.56，p = .006)。年龄较大也与较低的康复率相关。性别、体重指数、是否存在糖尿病、吸烟史、后纵韧带骨化类型、骨化病变形状、颈椎排列与恢复率无关。 结论：对于占位率≥60%或MRI存在ISI的患者，前路减压融合术具有良好的预后。较高的 ISI 等级、较高的占位比和较高的年龄与长期手术预后不良相关。因此，术前MRI评估ISI和占位比对于选择合适的手术入路和预测后纵韧带状脊髓型颈椎病术后临床结局具有重要意义。 (C) 2015 Elsevier Inc. 保留所有权利。
BACKGROUND CONTEXT: Anterior decompression and fusion (ADF) for ossification of the posterior longitudinal ligament (OPLL) is technically demanding and associated with complications. Although various factors affecting clinical outcome have been investigated in posterior decompression, prognostic factors of ADF remain unclear.PURPOSE: The purpose of the study was to identify surgical outcome and prognostic factors of ADF for cervical myelopathy due to OPLL.STUDY DESIGN: This was a retrospective case study.PATIENT SAMPLE: Between 2005 and 2012, 913 patients underwent decompression surgery for cervical OPLL at our institution. Among them, 131 who underwent ADF and 221 who underwent laminoplasty were enrolled. Inclusion criteria were (1) diagnosis of OPLL; (2) cervical compressive myelopathy; and (3) no trauma, infection, tumor, or previous surgery. We excluded 60 patients with ADF and 157 patients with laminoplasty owing to inadequate follow-up or absence of preoperative myelopathy. Finally, 71 patients with ADF and 64 patients with laminoplasty were enrolled in this study (mean follow-up, 48 vs 41 months).OUTCOME MEASURES: Neurologic assessment was conducted using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. Rate of neurologic improvement was calculated by comparing preoperative and postoperative JOA scores.METHODS: We investigated the effects of such variables as age, gender, body mass index (BMI), presence of diabetes mellitus (DM), smoking history, type of OPLL, shape of the ossified lesion, occupying ratio of OPLL, presence of intramedullary increased signal intensity (ISI) on magnetic resonance imaging (MRI), and sagittal alignment of the cervical spine on surgical outcome. Severity of ISI was classified into three groups based on T2-weighted sagittal MRI as follows: Grade 0, none; Grade 1, ISI limited to one disc level; or Grade 2, ISI beyond one disc level. This work was supported by the 2013 Korea Health Technology R&D Project of the Ministry of Health and Welfare of the Republic of Korea (A120254).RESULTS: In patients with an occupying ratio >= 60% or with presence of ISI on MRI, ADF yielded better surgical outcome than laminoplasty. A higher ISI grade (B = -28.5, p = .000) and a higher occupying ratio (B = 0.88, p = .04) were significantly associated with a lower recovery rate (R = 0.56, p = .006). Older age also was associated with a lower recovery rate. Gender, BMI, presence of DM, smoking history, type of OPLL, shape of the ossified lesion, and cervical alignment were not associated with recovery rate.CONCLUSION: Anterior decompression and fusion has favorable outcome in patients with an occupying ratio >= 60% or with presence of ISI on MRI. Presence of higher ISI grade, higher occupying ratio, and older age were associated with a poor long-term surgical prognosis. Therefore, evaluating ISI and occupying ratio on preoperative MRI is important for selecting the appropriate surgical approach and for predicting clinical outcome after surgery for cervical compressive myelopathy due to OPLL. (C) 2015 Elsevier Inc. All rights reserved.