Surgical Strategy for Ossification of the Posterior Longitudinal Ligament in the Cervical Spine
Surgical Strategy for Ossification of the Posterior Longitudinal Ligament in the Cervical Spine
复制标题
DOI：
10.3928/01477447-20120725-25
复制
发表时间：
2012-08-01
期刊：
影响因子：
1.1
通讯作者：
Yuan, Wen
中科院分区：
文献类型：
--
作者：
Chen, Yu;Liu, Xiaowei;Yuan, Wen
后纵韧带骨化是颈椎病的常见原因，关于手术选择仍存在争议。2004年1月至2007年12月期间，共有164例颈椎后纵韧带骨化患者在作者所在机构接受手术治疗，并纳入本研究。根据病变范围和颈椎对线选择手术方式。短节段病变通过前路治疗，长节段病变通过后路治疗。当选择后路时，对颈椎前凸患者进行椎板成形术，对颈椎后凸患者进行椎板切除融合术。因此，对91例患者进行了前路椎体次全切除术和融合术，对41例患者进行了椎板成形术，对32例患者进行了椎板切除术和内固定融合术。采用日本骨科协会评分系统评估患者的神经功能状态，并记录相关并发症。在中期随访时比较不同入路和技术的临床结果，根据本研究的结果和对以往文献的回顾，对于轻度后纵韧带骨化的患者，不同入路和技术之间不存在显著差异，但对于重度后纵韧带骨化的患者，前路椎体次全切融合术的结果明显更好。对于后路，椎板切除术和内固定融合术改善了颈椎后凸畸形患者的手术结果，但同时存在C5麻痹的高发生率。
Ossification of the posterior longitudinal ligament is a common cause of cervical myelopathy, and controversy remains regarding surgical options. Between January 2004 and December 2007, a total of 164 patients with ossification of the posterior longitudinal ligament in the cervical spine who underwent surgical treatment at the authors' institution were included in this study. The choice of surgical option was based on pathological extent and cervical alignment. Short-segment pathology was treated via the anterior approach and long-segment pathology via the posterior approach. When the posterior approach was selected, laminoplasty was performed for the patients with cervical lordosis and laminectomy with fusion for those with cervical kyphosis. Consequently, anterior corpectomy and fusion was performed in 91 patients, laminoplasty in 41 patients, and laminectomy and instrumented fusion in 32 patients. The Japanese Orthopedic Association scoring system was used to evaluate patients' neurological status, and related complications were also recorded. Clinical results between different approaches and techniques were compared at mid-term follow-up.Based on the results of this study and a review of previous literature, no significant differences existed between different approaches and techniques for patients with mild ossification of the posterior longitudinal ligament, but anterior corpectomy and fusion had significantly better results in patients with severe ossification of the posterior longitudinal ligament. With respect to the posterior approach, laminectomy and instrumented fusion improved the surgical results of patients with cervical kyphosis, but a high incidence of C5 palsy existed simultaneously.