Anterior or posterior approaches for cervical ossification of posterior longitudinal ligament: a mid-term follow-up

English Keywords:Ossification of the posterior longitudinal ligament  Cervical surgery  Canal stenosis ratio  Mid-term follow-up

English Abstract:

  【Abstract】 Objectives: To observe the mid-term clinical outcomes and radiological parameters of anterior cervical corpectomy and fusion(ACCF) and posterior single-door laminoplasty in cervical ossification of posterior longitudinal ligament(OPLL). Methods: All 33 cervical OPLL cases(17 males, 16 females; mean age, 58.6±8.8 years; range, 41 to 78 years) treated in our department between January 2010 and December 2012 were analyzed retrospectively. 16 cases with less than 2 segments involved were treated by ACCF(group A). 17 cases with more than 2 segments involved were treated by the posterior single-door laminoplasty(group B). All patients included in the study had preoperative, postoperative cervical X-rays, CTs and MRIs. Japanese Or?鄄thopaedic Association(JOA) score was used to evaluate the clinical outcomes of the two groups. Curvature angle and canal stenosis rate before surgery and at the follow-up were analyzed. The clinical and radiographic differences between the two groups were compared by using the paired t-test. Results: The mean follow-up time in group A and B was 48.56±8.02 and 52.59±8.88 months, respectively. One case presented postoperative dysphagia in group A and recovered by self in the follow-up. One case occured cerebrospinal fluid leakage and one case occured postoperative wound infection in group B, they recovered by delayed drainage and placing drainage-tube respectively. The postoperative JOA score was significantly higher than the preoperative(P<0.05). Cervical curvature showed no significant difference(P>0.05) before surgery, at post operation immediately and the last follow-up. At the last follow-up, ossified mass area was significantly higher than the postoperative in group A(P<0.05), but not in group B(P>0.05). Conclusions: For cervical OPLL, the ACCF and posterior single-door laminoplasty appear to be efficient and safer approaches. Posterior single-door laminoplasty is able to enlarge the canal and relieve compression, and the canal stenosis rate can maintain stable through mid-term follow-up. ACCF surgery can decompress cervical canal stenosis better by removing ossified mass. And the clinical outcomes of two procedures are satisfying in early and middle term.