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SHI Lei,SUN Jingchuan,YUAN Xiaoqiu.Comparative study of the clinical outcomes and incidence rates of postoperative neurological deterioration between two anterior surgical procedures in the treatment of severe cervical ossification of the posterior longitudinal ligament[J].Chinese Journal of Spine and Spinal Cord,2022,(10):872-879, 887. |
Comparative study of the clinical outcomes and incidence rates of postoperative neurological deterioration between two anterior surgical procedures in the treatment of severe cervical ossification of the posterior longitudinal ligament |
Received:February 09, 2022 Revised:July 08, 2022 |
English Keywords:Ossification of the posterior longditudinal ligament Anterior controllable antedisplacement and fusion Anterior cervical corpectomy and fusion Clinical outcomes Neurological deterioration |
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English Abstract: |
【Abstract】 Objectives: To compare the clinical outcomes and incidence rates(IR) of postoperative neurological deterioration between anterior controllable antedisplacement and fusion(ACAF) and anterior cervical corpectomy and fusion(ACCF) in the treatment of severe cervical ossification of the posterior longitudinal ligament(OPLL). Methods: We retrospectively analyzed 72 cases who underwent anterior surgery for severe cervical OPLL(occupying rate≥50%) in our department from March 2018 to March 2019. Among them, 35 cases were treated with ACAF(ACAF group), and the other 37 cases were treated with ACCF(ACCF group). The patients were followed up for 6-12 months. Data of the two groups of patients were collected, including age at surgery, gender, follow-up time, and incidence of neurological deterioration within 2 weeks after operation and the cause and prognosis. JOA score was used to assess the neurologic function before operation, within 2 weeks after operation, and at the final follow-up, and meanwhile, the types of ossification were observed and the occupying rate, decompression width at the narrowest part of spinal canal, spinal canal area, and anteroposterior(AP) diameter of the spinal cord were measured on cervical CT and MRIs before operation and at final follow-up. Results: There was no significant difference in the age at surgery, gender ratio, follow-up time, ossification type, preoperative occupying rate, spinal canal area, AP diameter of the spinal cord, and JOA score between the two groups(P>0.05). A total of 10 cases in ACCF group suffered neurological deterioration within 2 weeks after surgery(IR=27.0%), including 6 cases of intraoperative spinal cord injury, 2 cases of epidural hematoma compressing spinal cord, and 2 cases of residual ossification mass. In contrast, there were only 2 cases in ACAF group occurred neurological deterioration due to residual ossification mass(IR=5.7%). There was significant difference in the incidence rate of neurological deterioration between the two groups(P<0.05). At final follow-up, the decompression width was larger in ACAF group than that in ACCF group(18.5±2.5mm vs 16.9±1.9mm), with significant difference(P<0.05); There was no significant difference in the spinal canal area and AP diameter of the spinal cord between the two groups(144.9±31.2mm2 vs 142.1±22.3mm2, P>0.05; 5.5±0.5mm vs 5.2±1.4mm, P>0.05). The JOA scores of both groups significantly improved after surgery, and ACAF group achieved higher improvement rate of JOA scores than did ACCF group[(79.5±8.7)% vs (68.9±20.3)%, P<0.05]. Conclusions: Comparing with ACCF, ACAF can achieve better clinical outcomes and reduce the incidence rate of postoperative neurological deterioration in the treatment of severe cervical OPLL. However, there is still a potential risk of postoperative neurological deterioration in the early practice of ACAF. |
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