Clinical observation of posterior controllable antedisplacement, fixation and decompression of thoracic vertebrae-ossification of posterior longitudinal ligament complex in the treatment of multilevel continuous ossification of posterior longitudinal ligament of thoracic vertebrae

English Keywords:Thoracic vertebra  Ossification of the posterior longitudinal ligament  Vertebrae-OPLL complex  Antedisplacement  Curative effect

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy of posterior antedisplacement, fixation and decompression technique in the treatment of multi-segment continuous thoracic ossification of posterior longitudinal ligament(T-OPLL). Methods: From May 2018 to June 2020, 22 patients with multi-segment continuous T-OPLL who received this technique in the Spinal Surgery Department of Shanghai Changzheng Hospital were retrospectively analyzed. Preoperative and postoperative visual analogue scale(VAS) of pain, Japanese Orthopaedic Association (JOA) score, Frankel grading, CT and MRI were recorded to evaluate the surgical effect. At the same time, the general conditions of the operation was recorded, and the diseased segments, clinical manifestations, postoperative complications were counted. Results: The follow-up period was 13-17(14.95±1.33) months. The operative time was 200-310min(238.19±34.73min), and the blood loss was 900-1800ml(1345.45±230.38ml). VAS scores were 7.59±0.73 points, 3.50±0.51 points, 2.41±0.50 points, and 1.55±0.51 points before surgery, 3 months after surgery, 12 months after surgery, and at final follow-up, respectively. There were significant differences in VAS scores between preoperative and postoperative 3 months, 12 months and final follow-up(P<0.05). The JOA scores were 4.64±1.84 points, 5.73±1.78 points, 6.82±1.33 points, and 9.23±0.81 points before surgery, 3 months after surgery, 12 months after surgery, and at final follow-up, respectively. There were statistically significant differences between preoperative and postoperative JOA scores at 3 months, 12 months and at final follow-up(P<0.05), and the average improvement rate of JOA score at the final follow-up was (73.64±12.57)%. The Frankel classification of all patients showed 1-3 grade improvement(14 cases of grade B, 4 cases of grade C, and 4 cases of grade D preoperatively recovered to grade E), and there were no complications such as loosening of internal fixation, broken screw and broken rod during postoperative follow-up visit. Conclusions: Posterior controllable antedisplacement, fixation and decompression of thoracic vertebrae-ossification of posterior longitudinal ligament complex can controllably move the vertebral ossification complex to the ventral side with the help of screw and rod fixation system, and achieve in situ decompression of the spinal cord without the removal of the ossification. It is a safe and effective new surgical method which provides a new idea for the treatment of posterior longitudinal ligament ossification of the thoracic spine.