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.	刘云鹏, 刘沂. 骨与关节损伤和疾病的诊断分类及功能评定标准. 北京: 清华大学出版社, 2002: 243-244.
11.	周文超, 张浩, 陈元元, 等. 颈椎后纵韧带骨化症的三维椎管占比对前路手术预后的评估. 中国矫形外科杂志, 2017, 25(21): 1921-1926.
12.	贾连顺. 重视颈椎后纵韧带骨化症的个性化诊断, 探索外科治疗的改进与创新. 中华骨科杂志, 2018, 38(24): 1477-1479.
13.	张本, 侯铁胜, 沈洪兴, 等. 颈椎后纵韧带骨化症的手术治疗及前后路手术比较. 实用骨科杂志, 2013, 19(10): 865-869.
14.	王海波, 郭永飞, 史建刚, 等. 颈椎后纵韧带骨化症的外科治疗进展. 脊柱外科杂志, 2018, 16(6): 375-379.
15.	史建刚, 孙璟川, 郭永飞, 等. 颈椎后纵韧带骨化前路骨化物复合体前移技术及临床疗效分析. 中华骨科杂志, 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.	马远, 叶向阳, 王华磊, 等. 显微镜辅助下颈前路椎间盘切除植骨融合术治疗孤立型颈椎后纵韧带骨化症. 中医正骨, 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.	冉春枭, 芦健民. 显微镜下前路颈椎间盘摘除 cage 植骨融合钛板内固定治疗颈椎病: 108 例回顾性分析. 中国组织工程研究, 2017, 21(15): 2349-2354.
24.	刘鹏飞, 张文志, 贺瑞, 等. 显微镜辅助下颈前路精细化减压治疗脊髓型颈椎病的临床研究. 中华解剖与临床杂志, 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. 刘云鹏, 刘沂. 骨与关节损伤和疾病的诊断分类及功能评定标准. 北京: 清华大学出版社, 2002: 243-244.
11. 周文超, 张浩, 陈元元, 等. 颈椎后纵韧带骨化症的三维椎管占比对前路手术预后的评估. 中国矫形外科杂志, 2017, 25(21): 1921-1926.
12. 贾连顺. 重视颈椎后纵韧带骨化症的个性化诊断, 探索外科治疗的改进与创新. 中华骨科杂志, 2018, 38(24): 1477-1479.
13. 张本, 侯铁胜, 沈洪兴, 等. 颈椎后纵韧带骨化症的手术治疗及前后路手术比较. 实用骨科杂志, 2013, 19(10): 865-869.
14. 王海波, 郭永飞, 史建刚, 等. 颈椎后纵韧带骨化症的外科治疗进展. 脊柱外科杂志, 2018, 16(6): 375-379.
15. 史建刚, 孙璟川, 郭永飞, 等. 颈椎后纵韧带骨化前路骨化物复合体前移技术及临床疗效分析. 中华骨科杂志, 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. 马远, 叶向阳, 王华磊, 等. 显微镜辅助下颈前路椎间盘切除植骨融合术治疗孤立型颈椎后纵韧带骨化症. 中医正骨, 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. 冉春枭, 芦健民. 显微镜下前路颈椎间盘摘除 cage 植骨融合钛板内固定治疗颈椎病: 108 例回顾性分析. 中国组织工程研究, 2017, 21(15): 2349-2354.
24. 刘鹏飞, 张文志, 贺瑞, 等. 显微镜辅助下颈前路精细化减压治疗脊髓型颈椎病的临床研究. 中华解剖与临床杂志, 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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