Effect of in situ decompression during anterior controllable antedisplacement fusion for treatment of the cervical ossification of posterior longitudinal ligament

English Keywords:Anterior controllable antedisplacement fusion  In situ decompression  Ossification of the posterior longitudinal ligament  C5 nerve palsy

English Abstract:

  【Abstract】 Objectives: To investigate the clinical effect of in situ decompression during anterior controllable antedisplacement fusion(ACAF) in treatment of cervicalossification of the posterior longitudinal ligament(OPLL). Methods: The demographic information, imaging data and postoperative indicators(age, sex, duration of symptom, occupying rate, and number of ossified vertebrae) from 78 patients diagnosed with OPLL were analyzed retrospectively. All patients were admitted from June 2017 to December 2018. 42 cases were treated with ACAF and 36 cases with open-door laminoplasty(LAM). The average follow-up time was 21.7±4.0(12-30) months. The JOA score, area of spinal cord, Cobb angle, Kang′s grade, and the incidences of C5 nerve palsy, cerebrospinal fluid leakage and dysphagia were compared between the two groups before operation and at final follow-up. Results: At final follow-up, compared with LAM group, ACAF group had advantages in JOA score(14.17±0.81 vs 13.81±1.12, P<0.05), area of spinal cord(74.12±4.48mm2 vs 70.36±5.60mm2, P<0.05), Cobb angle(20.07°±1.28° vs 9.99°±0.65°, P<0.05) and Kang′s grade(0.93±1.40 vs 2.00±0.89, P<0.05). The postoperative complications of ACAF and LAM group demonstrated C5 nerve palsy(4.8％ vs 11.1％), cerebrospinal fluid leakage(2.4％ vs 2.8％) and dysphagia(9.5％ vs 0％), there was no statistical difference between two groups. In ACAF group, 2 patients with C5 palsy failed to complete in situ decompression. Conclusions: ACAF can achieve in situ decompression to spinal cord by restoring the volume and shape of spinal canal, and the effect of decompression is significant. As to the recovery of cervical curvature and shape of spinal cord, ACAF is better than LAM.