Clinical outcome of selective cervical posterior single open-door laminoplasty in the treatment of isolated cervical ossification of the posterior longitudinal ligament

English Keywords:Ossification of the posterior longitudinal ligament  Isolated  Selective cervical posterior single open-door laminoplasty  Anterior cervical corpectomy and fusion  Clinical outcome

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical effect of selective cervical posterior single open-door laminoplasty in the treatment of isolated cervical ossification of the posterior longitudinal ligament(OPLL), and compare it with the clinical outcome of anterior cervical corpectomy and fusion(ACCF). Methods: A retrospective study was performed on 40 isolated cervical OPLL patients receiving surgery from January 2017 to January 2019. 22 patients underwent ACCF surgery as the ACCF group, and 18 patients underwent selective cervical posterior single open-door laminoplasty as the LP group. All patients were followed up for 12 to 24 months. The follow-up time was 18.50±4.20 months in the ACCF group and 18.60±4.50 months in the LP group. The JOA scores and neck pain VAS scores were compared between the patients of the two groups at preoperative, 3 months postoperative and final follow-up. The neurological improvement rate(IR) at final follow-up was compared between the patients of both groups. The cervical curvature change and cervical range of motion(ROM) at preoperative and final follow-up were compared between the two groups. The differences of intraoperative blood loss, operative time, length of postoperative hospital stay and postoperative complication rate between the two groups were compared. Results: The operation time, the intraoperative blood loss and length of postoperative hospital stay of ACCF group and LP group were 142.50±7.52min, 379.32±65.14ml, 8.77±1.51d, and 129.06±10.58min, 240.00±53.69ml, 7.83±1.34d respectively, with that of LP group significantly less than ACCF group(P<0.05). Both groups saw a significantly higher JOA score at 3 months after surgery and final follow-up than at preoperative(P<0.05), and a significantly lower VAS score at 3 months after surgery and final follow-up than at preoperative(P<0.05). Whereas, there was no significant difference in JOA score and VAS score between the two groups at preoperative, 3 months postoperative and final follow-up(P>0.05). The neurological IR in ACCF group at final follow-up was (65±9)%, and that in LP group was (61±15)%. There was no statistically significant difference in the neurological IR between the two groups at final follow-up(P>0.05). The cervical curvature in the ACCF group was 9.77°±1.23° before operation, and 11.05°±1.25° at final follow-up. The cervical curvature in LP group was 10.33°±1.33° before operation, and 11.44°±1.46° at final follow-up. There was no significant difference in the cervical curvature between the two groups(P>0.05). At final follow-up, the cervical curvature of the two groups was significantly improved compared with that before surgery, and the differences were statistically significant(P<0.05). In ACCF group, the cervical ROM at preoperative was 38.18°±2.26°, and at tfinal follow-up it was 29.05°±2.17°. The cervical ROM before surgery was 38.17°±2.09°, and at final follow-up it was 32.44°±2.15°. The comparison of cervical ROM before surgery between the two groups has no statistical significance(P>0.05), and that in ACCF group reduced more significantly at final follow-up(P<0.05). In final follow-up, the cervical ROM of the two groups was significantly reduced compared with that before surgery, and the differences were statistically significant(P<0.05). In LP group, 2 cases presented axial symptoms, 1 case presented left C5 nerve root paralysis, and 1 case presented mild kyphosis. In the ACCF group, there were 3 cases of titanium cage subsidence, 1 case of esophageal traction injury, 2 cases of recurrent laryngeal nerve paralysis, 1 case of epidural hematoma, 2 cases of dural leakage, and 3 cases of adjacent segment degeneration. The incidence of postoperative complications was 22.2% in the LP group and 54.5% in the ACCF group. The incidence of postoperative complications in the LP group was significantly lower than that in the ACCF group, with statistically significant difference(P<0.05). Conclusions: There was no significant difference in short-term prognosis in the treatment of isolated cervical OPLL between selective cervical posterior single open-door laminoplasty and ACCF; In terms of surgical bleeding volume, operative time, postoperative hospital stay, maintenance of cervical ROM, and postoperative complication rate, selective cervical posterior single open-door laminoplasty has more advantages than ACCF.