Clinical analysis of microscope-assisted anterior cervical decompression in the treatment of cervical spondylotic myelopathy with ossification of the posterior longitudinal ligament_West China Medical Journal

Authors：

LI Haibo , XU Shengxi , YANG Sheng , FU Bolin , CHE Zheng , GONG Dezhi ,  GOU Yongsheng

Department of Orthopedics, West China (Airport) Hospital Sichuan University, the First Peoples Hospital of Shuangliu District, Chengdu, Sichuan 610000, P. R. China;

Corresponding?author：

GOU Yongsheng, Email: 15002828117@163.com

Keywords：

Ossification of the posterior longitudinal ligament; anterior cervicaI surgery; cervical spondylosis myelopathy; microscope; surgical approach

DOI：

10.7507/1002-0179.202108282

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Objective To investigate the microscope-assisted anterior cervical surgery and traditional open surgery for the treatment of cervical myelopathy with ossification of the posterior longitudinal ligament (OPLL). Methods Retrospective selection of patients with OPLL who underwent microscope-assisted and traditional open anterior cervical surgery in West China (Airport) Hospital Sichuan University were selected between January 2016 and August 2020. The patients who underwent traditional open anterior cervical surgery between January 2016 and August 2018 were classified as the conventional group, and the patients who underwent microscope-assisted anterior cervical surgery between September 2018 and August 2020 were classified as the microscope group. The baseline characteristics, operative time, intraoperative blood loss, length of hospital stay, Visual Analogue Scale (VAS) of pain before and after surgery, and surgical complications were collected. Neurological function was assessed using the Japanese Orthopaedic Association (JOA) score. Result A total of 46 patients were included. There were 24 cases in the conventional group and 22 cases in the microscope group. There was no significant difference in baseline characteristics between the two groups (P>0.05). The operation time, intraoperative blood loss and length of hospital stay in the microscope group were lower than those in the conventional group (P<0.001). There was no significant difference in VSA score and JOA score between the two groups before operation (P>0.05). There were statistically significant differences in VAS score and JOA score between the two groups 18 months after operation (P<0.001). The comparison of VAS score and JOA score in the two groups before and after operation showed that there was a statistically significant difference between 18 months after operation and before operation (P<0.05). In the microscope group, the average improvement rate of neurological function [(79.90±16.67)% vs. (58.12±17.47)%, t=4.317, P<0.001], excellent and good rate [95.45% (21/22) vs. 66.67% (16/24), χ²=4.354, P=0.037] were higher than those in the conventional group. The total number of complications in the microscope group was lower than that in the conventional group (P=0.024). Conclusion Compared with the traditional open anterior cervical surgery, the microscope-assisted anterior cervical surgery for OPLL can reduce intraoperative blood loss and length of hospital stay, reduce the incidence of postoperative complications.

Citation： LI Haibo, XU Shengxi, YANG Sheng, FU Bolin, CHE Zheng, GONG Dezhi, GOU Yongsheng. Clinical analysis of microscope-assisted anterior cervical decompression in the treatment of cervical spondylotic myelopathy with ossification of the posterior longitudinal ligament. West China Medical Journal, 2022, 37(10): 1481-1486. doi: 10.7507/1002-0179.202108282 Copy

1.	Frediani B, Baraldi E, Cremonesi G. Effect of clodronate treatment on risk of fracture: a systematic review and meta-analysis. Calcif Tissue Int, 2014, 95(4): 295-307.
2.	Lei T, Shen Y, Wang LF, et al. Anterior longitudinal decompression in the management of severe ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics, 2014, 37: e465-e472.
3.	Kawaguchi Y, Nakano M, Yasuda T, et al. Anterior decompressive surgery after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament. Spine J, 2014, 14(6): 955-963.
4.	Liu H, Li Y, Chen Y, et al. Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament. Eur Spine J, 2013, 22(7): 1480-1488.
5.	Li H, Dai LY. A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament. Spine J, 2011, 11(11): 1049-1057.
6.	Chen LF, Tu TH, Chen YC, et al. Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study. Neurosurg Focus, 2016, 40(6): E4.
7.	Lee CK, Shin DA, Yi S, et al. Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament. J Neurosurg Spine, 2016, 24(1): 100-107.
8.	Sakai K, Okawa A, Takahashi M et al. Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty. Spine (Phila Pa 1976), 2012, 37(5): 367-376.
9.	Tani T, Ushida T, Ishida K, et al. Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament. Spine (Phila Pa 1976), 2002, 27(22): 2491-2498.
10.	劉云鵬, 劉沂. 骨與關節損傷和疾病的診斷分類及功能評定標準. 北京: 清華大學出版社, 2002: 243-244.
11.	周文超, 張浩, 陳元元, 等. 頸椎后縱韌帶骨化癥的三維椎管占比對前路手術預后的評估. 中國矯形外科雜志, 2017, 25(21): 1921-1926.
12.	賈連順. 重視頸椎后縱韌帶骨化癥的個性化診斷, 探索外科治療的改進與創新. 中華骨科雜志, 2018, 38(24): 1477-1479.
13.	張本, 侯鐵勝, 沈洪興, 等. 頸椎后縱韌帶骨化癥的手術治療及前后路手術比較. 實用骨科雜志, 2013, 19(10): 865-869.
14.	王海波, 郭永飛, 史建剛, 等. 頸椎后縱韌帶骨化癥的外科治療進展. 脊柱外科雜志, 2018, 16(6): 375-379.
15.	史建剛, 孫璟川, 郭永飛, 等. 頸椎后縱韌帶骨化前路骨化物復合體前移技術及臨床療效分析. 中華骨科雜志, 2018, 38(15): 919-926.
16.	Shin JH, Steinmetz MP, Benzel EC, et al. Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament: considerations for approach selection and review of surgical outcomes. Neurosurg Focus, 2011, 30(3): E8.
17.	Odate S, Shikata J, Kimura H, et al. Anterior corpectomy with fusion in combination with an anterior cervical plate in the management of ossification of the posterior longitudinal ligament. J Spinal Disord Tech, 2012, 25(3): 133-137.
18.	Sun M, Kong L, Jiang Z, et al. Microscope enhanced the efficacy and safety of anterior cervical surgery for managing cervical ossification of the posterior longitudinal ligament. Med Sci Monit, 2017, 23: 3088-3094.
19.	馬遠, 葉向陽, 王華磊, 等. 顯微鏡輔助下頸前路椎間盤切除植骨融合術治療孤立型頸椎后縱韌帶骨化癥. 中醫正骨, 2020, 32(2): 57-60.
20.	Kojima T, Waga S, Kubo Y, et al. Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament. Neurosurgery, 1989, 24(6): 864-872.
21.	Eleraky MA, Llanos C, Sonntag VK. Cervical corpectomy: report of 185 cases and review of the literature. J Neurosurg, 1999, 90 (Suppl 1): 35-41.
22.	Li H, Jiang LS, Dai LY. A review of prognostic factors for surgical outcome of ossification of the posterior longitudinal ligament of cervical spine. Eur Spine J, 2008, 17(10): 1277-1288.
23.	冉春梟, 蘆健民. 顯微鏡下前路頸椎間盤摘除 cage 植骨融合鈦板內固定治療頸椎病: 108 例回顧性分析. 中國組織工程研究, 2017, 21(15): 2349-2354.
24.	劉鵬飛, 張文志, 賀瑞, 等. 顯微鏡輔助下頸前路精細化減壓治療脊髓型頸椎病的臨床研究. 中華解剖與臨床雜志, 2018, 23(3): 203-208.

1. Frediani B, Baraldi E, Cremonesi G. Effect of clodronate treatment on risk of fracture: a systematic review and meta-analysis. Calcif Tissue Int, 2014, 95(4): 295-307.
2. Lei T, Shen Y, Wang LF, et al. Anterior longitudinal decompression in the management of severe ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics, 2014, 37: e465-e472.
3. Kawaguchi Y, Nakano M, Yasuda T, et al. Anterior decompressive surgery after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament. Spine J, 2014, 14(6): 955-963.
4. Liu H, Li Y, Chen Y, et al. Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament. Eur Spine J, 2013, 22(7): 1480-1488.
5. Li H, Dai LY. A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament. Spine J, 2011, 11(11): 1049-1057.
6. Chen LF, Tu TH, Chen YC, et al. Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study. Neurosurg Focus, 2016, 40(6): E4.
7. Lee CK, Shin DA, Yi S, et al. Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament. J Neurosurg Spine, 2016, 24(1): 100-107.
8. Sakai K, Okawa A, Takahashi M et al. Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty. Spine (Phila Pa 1976), 2012, 37(5): 367-376.
9. Tani T, Ushida T, Ishida K, et al. Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament. Spine (Phila Pa 1976), 2002, 27(22): 2491-2498.
10. 劉云鵬, 劉沂. 骨與關節損傷和疾病的診斷分類及功能評定標準. 北京: 清華大學出版社, 2002: 243-244.
11. 周文超, 張浩, 陳元元, 等. 頸椎后縱韌帶骨化癥的三維椎管占比對前路手術預后的評估. 中國矯形外科雜志, 2017, 25(21): 1921-1926.
12. 賈連順. 重視頸椎后縱韌帶骨化癥的個性化診斷, 探索外科治療的改進與創新. 中華骨科雜志, 2018, 38(24): 1477-1479.
13. 張本, 侯鐵勝, 沈洪興, 等. 頸椎后縱韌帶骨化癥的手術治療及前后路手術比較. 實用骨科雜志, 2013, 19(10): 865-869.
14. 王海波, 郭永飛, 史建剛, 等. 頸椎后縱韌帶骨化癥的外科治療進展. 脊柱外科雜志, 2018, 16(6): 375-379.
15. 史建剛, 孫璟川, 郭永飛, 等. 頸椎后縱韌帶骨化前路骨化物復合體前移技術及臨床療效分析. 中華骨科雜志, 2018, 38(15): 919-926.
16. Shin JH, Steinmetz MP, Benzel EC, et al. Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament: considerations for approach selection and review of surgical outcomes. Neurosurg Focus, 2011, 30(3): E8.
17. Odate S, Shikata J, Kimura H, et al. Anterior corpectomy with fusion in combination with an anterior cervical plate in the management of ossification of the posterior longitudinal ligament. J Spinal Disord Tech, 2012, 25(3): 133-137.
18. Sun M, Kong L, Jiang Z, et al. Microscope enhanced the efficacy and safety of anterior cervical surgery for managing cervical ossification of the posterior longitudinal ligament. Med Sci Monit, 2017, 23: 3088-3094.
19. 馬遠, 葉向陽, 王華磊, 等. 顯微鏡輔助下頸前路椎間盤切除植骨融合術治療孤立型頸椎后縱韌帶骨化癥. 中醫正骨, 2020, 32(2): 57-60.
20. Kojima T, Waga S, Kubo Y, et al. Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament. Neurosurgery, 1989, 24(6): 864-872.
21. Eleraky MA, Llanos C, Sonntag VK. Cervical corpectomy: report of 185 cases and review of the literature. J Neurosurg, 1999, 90 (Suppl 1): 35-41.
22. Li H, Jiang LS, Dai LY. A review of prognostic factors for surgical outcome of ossification of the posterior longitudinal ligament of cervical spine. Eur Spine J, 2008, 17(10): 1277-1288.
23. 冉春梟, 蘆健民. 顯微鏡下前路頸椎間盤摘除 cage 植骨融合鈦板內固定治療頸椎病: 108 例回顧性分析. 中國組織工程研究, 2017, 21(15): 2349-2354.
24. 劉鵬飛, 張文志, 賀瑞, 等. 顯微鏡輔助下頸前路精細化減壓治療脊髓型頸椎病的臨床研究. 中華解剖與臨床雜志, 2018, 23(3): 203-208.

West China Medical Journal

Clinical analysis of microscope-assisted anterior cervical decompression in the treatment of cervical spondylotic myelopathy with ossification of the posterior longitudinal ligament

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