Comparative study on the surgical effect of cervical OPLL and intervertebral disc herniation combined with cervical spinal cord injury without fracture and dislocation

English Keywords:Cervical spinal cord injury  Ossification of cervical posterior longitudinal ligament  Cervical disc herniation  Laminoplasty

English Abstract:

  【Abstract】 Objectives： To investigate the clinical characteristics and surgical effects of ossification of posterior longitudinal ligament(OPLL) of cervical spine and disc herniation combined with spinal cord injury without fracture and dislocation. Methods： Retrospective analysis of patients with cervical spinal cord injury without fracture and dislocation treated with posterior laminoplasty in our department from January 2017 to December 2019, 35 patients with cervical spinal cord injury without fracture and dislocation who were treated surgically were selected for this study. There were 19 males and 16 females. According to the imaging characteristics by MRI and CT, the patients were divided into cervical posterior longitudinal ligament ossification group (group A, 18 cases) and cervical disc herniation group (group B, 17 cases). The mJOA score and itsimprovement rate, as well as the ASIA score and ASIA score improvement value were recorded before operation, at 1 week, 3 months, and 6 months after operation. Results: In group A and group B respectively, the operation time was 95±12min and 95±15min, the intraoperative blood loss was 450±55ml and 440±60ml, and the length of hospital stay was 10.5±1.3d and 10.2±1.4d. The follow-up time nodes were 1 week, 3 months and more than 6 months after operation. There were no serious complications in both groups. At pre-operation, 1 week, 3 months, and 6 months after operation, the mJOA scores of group A were 5.2±5.6, 7.1±4.3, 8.6±3.7, and 12.9±3.8 respectively, and those in group B were 4.8±3.8, 6.7±4.1, 7.0±3.8, and 9.3±3.6 respectively. There was no significant difference between the two groups(P>0.05). One week after operation, the mJOA scores were 7.1±4.3 in group A and 6.7±4.1 in group B, and the improvement rates of mJOA scoreswere 16.2% and 14.1% respectively, and the improvement values of ASIA were 1.2 and 1.0 respectively. There was no significant difference between the two groups(P>0.05). At 3 months after operation, the mJOA scores of group A and group B were 8.6±3.7 and 7.0±3.8, and the improvement rates of mJOA scores were 26.5% and 16.5% respectively, and the improvement values of ASIA were 2.3 and 1.5 respectively. There was significant difference between the two groups (P<0.05). At 6 months after operation, the mJOA scores of group A and group B were 12.9±3.8 and 9.3±3.6 respectively. The improvement rates of mJOA scores were 62.3% and 33.6% respectively, and the improvement values of ASIA scores were 2.6 and 1.8 respectively. There was significant difference between the two groups(P<0.05). Conclusion: Posterior laminoplasty can achieve satisfactory results in the treatment of cervical spinal cord injury without fracture and dislocation. The improvement of neurological recovery in patients with cervical spinal cord injury combined with ossification of cervical posterior longitudinal ligament is better than that patients who combined with cervical disc herniation at 3 and 6 months after operation.