Clinical observation of anterior cervical V-osteotomy Y-decompression and fusion for ossification of posterior longitudinal ligament

English Keywords:Ossification of the posterior longitudinal ligament  Anterior cervical V-osteotomy Y-decompression and fusion  Anterior cervical corpectomy decompression and fusion  Implant subsidence  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To observe the clinical efficacy of anterior cervical V-osteotomy Y-decompression and fusion(ACVYF) for treating ossification of posterior longitudinal ligament(OPLL) in cervical spine. Methods: The clinical data of 60 patients with single-segment vertebral level OPLL who underwent surgical treatment in Luoyang Orthopedic Traumatological Hospital of He′nan Province from June 2018 to October 2022 were retrospectively analyzed. Among them, 30 cases were treated with ACVYF operation(ACVYF group), including 18 men and 12 women, aged 47-65 years(61.0±6.4 years), with a body mass index(BMI) of 16.8-28.1kg/m2(23.67±2.86kg/m2) and a disease duration of 10-80 months(37.5±20.1 months), whose surgical segments fell in C3 in 2 cases, C4 in 5 cases, C5 in 13 cases, C6 in 10 cases. The other 30 cases were treated with anterior cervical corpectomy decompression and fusion(ACCF) operation(ACCF group), including 19 men and 11 women, aged 44-68 years(59.5±6.8 years), with a BMI of 16.6-26.4kg/m2(23.30±2.56kg/m2) and a disease duration of 13-72 months(35.8±18.8 months), whose surgical segments fell in C3 in 3 cases, C4 in 6 cases, C5 in 12 cases, C6 in 9 cases. The two groups were comparable in gender, age, BMI, disease duration, surgical section and other general information with no statistical difference(P>0.05). The operation time, intraoperative bleeding, and complications of the two groups were compared; The cervical Japanese Orthopaedic Association(JOA) scores were recorded before operation, at 1 week, and 3, 6 and 12 months after operation, and the JOA score improvement rate was calculated at postoperative 12 months; The height of the fusion area and C2-7 Cobb angle were measured on X-ray films at pre-operation, 1 week, 3 months, 6 months and 12 months after operation. The fusion condition of implants were observed and evaluated on X-ray film or CT image at 3 months, 6 months and 12 months after operation. Results: The operation was completed smoothly in both groups. The operation time and intraoperative bleeding were 88.2±19.7min and 133.3±24.4mL respectively in the ACVYF group, which were 91.5+24.1min and 137.7±29.4mL in the ACCF group, and there was no statistical difference between the two groups(P>0.05). Three cases of dysphagia occurred in both groups after surgery, which resolved spontaneously after 1-2 weeks. No complications occurred during the follow-up period, and there was no statistically significant difference in the complication rates between the two groups(P>0.05). The JOA scores of both groups at all time points after surgery showed significant improvement compared with those before surgery(P<0.05), and there was no statistically significant difference between the two groups at the same time points(P>0.05); The height of the fusion zone and C2-7 Cobb angle after operation were statistically different from those before operation(P<0.05), and no significant difference was found between the two groups at preoperation, postoperative 1 week and 3 months(P>0.05), while those of ACVYF group were bigger than ACCF group at postoperative 6 and 12 months(P<0.05). The improvement rate of cervical JOA score at 12-month follow-up was (72.39±10.54)% in the ACVYF group and (75.92±10.39)% in the ACCF group, and there was no statistically significant difference between the two groups(P>0.05). The rate of implant fusion was better in the ACVYF group at 3-month and 6-month follow-ups(70.0% and 93.3%) than in the ACCF group(40.0% and 73.3%)(P<0.05), and both groups had osseous fusion at 12 months postoperatively(P>0.05). Conclusions: ACVYF can effectively relieve the compression of the posterior longitudinal ligament on the spinal cord at the vertebral level and improve the neurological function of the patients; Comparing with ACCF, ACVYF can better maintain the physiological curvature of the cervical vertebrae and speed up the fusion of the implants.