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  • Title: [Comparison of three different posterior cervical approaches for treating cervical spine trauma with ossification of posterior longitudinal ligament].
    Author: Qi M, Chen HJ, Xu C, Yuan W.
    Journal: Zhonghua Wai Ke Za Zhi; 2019 Mar 01; 57(3):176-181. PubMed ID: 30861645.
    Abstract:
    Objective: To investigate the clinical application value of using laminoplasty combine with short-segment pedicle screw fixation in the treatment of cervical spine trauma patients with ossification of posterior longitudinal ligament (OPLL). Methods: Fifty-four cervical spine trauma patients with OPLL from June 2014 to June 2016 were retrospectively analyzed of Department of Spine Surgery, Changzheng Hospital, Naval Military Medical University. There were 31 males and 23 females, aging (68.4±4.3) years (rang: 46 to 82 years). All patients had a history of cervical spine trauma, confirmed by imaging examination of OPLL, and there are signs and symptoms related to cervical spinal cord compression. Eighteen patients underwent one-stage laminoplasty combine with short-segment pedicle screw fixation(group A), and 15 patients underwent posterior cervical laminectomy and pedicle screw fixation (group B). Twenty-one patients underwent posterior laminoplasty (C group). According to the range of OPLL and the compression of the spinal cord, the range of laminoplasty was selected. MRI scan was used to evaluated the compression condition of cervical spine and the injury condition of anterior longitudinal ligament injury and other factors that can cause local instability of the cervical spine. Posterior unilateral pedicle screw fixation (two pedicles) were performed in the instability segment. The neurological function of the patients was assessed by the Japanese Orthopedic Association (JOA) Score before surgery, the second day after surgery, 3 months, 1 year and the last follow-up. The cervical spine X-ray films were used to evaluate cervical curvature, cervical spine activity and internal fixation-related complications. Results: The average follow-up time was 18 months (6-30 months). Satisfactory neurological improvement was achieved in all three groups, and no internal fixation-related complications occurred during follow-up. The range of laminoplasty was 22 cases in 4 segments (C(3)-C(6), C(4)-C(7)) and 17 cases in 5 segments (C(3)-C(7)). Unilateral pedicle screw fixation was performed in 11 patients with C(3-4) fixation and 7 patients with C(4-5) fixation. Cervical curvature was basically the same in the three groups after operation and at the last follow-up. No significant changes in cervical curvature and kyphosis were observed during the follow-up period. The overall cervical mobility (C(2)-C(7)) in group A and group C had no significant difference compared with preoperative (P=0.077). The overall mobility of cervical vertebrae in group B was significantly lower than that before surgery (P=0.013). Conclusions: For cervical spine trauma patients with OPLL, laminoplasty combined short-segment pedicle screw fixation can increase cervical segmental stability while extensive decompression of cervical spinal cord compression. At the same time, to some extent, the complications of postoperative axial symptoms caused by posterior cervical laminectomy and pedicle screw fixation were avoided. 目的： 探讨颈后路椎管扩大成形术中联合应用短节段椎弓根螺钉固定在治疗颈椎外伤合并后纵韧带骨化（OPLL）患者中的临床应用价值。 方法： 对海军军医大学长征医院脊柱外科2014年6月至2016年6月收治的54例颈椎外伤合并OPLL患者的临床资料进行回顾性分析。男性31例，女性23例，年龄（68.4±4.3）岁（范围：46~82岁）。所有纳入研究的患者均存在颈椎外伤病史，经影像学检查证实存在OPLL，且存在颈脊髓压迫相关症状体征。54例患者中，18例患者行一期颈后路椎管扩大成形术联合短节段椎弓根螺钉固定（A组），15例患者行颈后路椎板切除椎弓根螺钉固定术（B组），21例患者行单纯颈后路椎管扩大成形术（C组）。根据患者颈椎OPLL的范围及脊髓受压情况选择单开门椎管扩大成形的范围。根据术前MRI判断可能存在前纵韧带损伤等因素可引起颈椎局部不稳的位置进行后路单侧椎弓根螺钉固定一个节段（2个椎弓根）。术前行颈椎MRI平扫评估患者颈脊髓压迫情况及颈椎过伸伤引起的前纵韧带等前方结构损伤情况。分别于术前和术后第2天、3个月、6个月、1年及末次随访时采用日本矫形外科学会评分对患者的神经功能情况进行评估；拍摄颈椎正侧位及动力位X线片评价颈椎曲度、颈椎活动情况及内固定相关并发症。3组之间均值比较采用单因素方差分析，两两之间比较采用LSD-t检验法。 结果： 本组病例随访时间18个月（范围：6~30个月）。3组患者均取得了满意的神经功能改善，随访期间未出现内固定相关并发症。单开门椎管扩大成形术范围分别为4个节段（C(3)~C(6)、C(4)~C(7)）22例，5个节段（C(3)~C(7)）17例。单侧椎弓根螺钉固定情况为C(3~4)固定11例，C(4~5)固定7例。3组患者术后及末次随访时颈椎曲度与术前相比基本一致，随访期间未发现颈椎曲度明显改变、后凸等情况。术后A组和C组患者颈椎整体活动度（C(2)~C(7)）与术前差异无统计学意义（P=0.077）；B组患者术后颈椎整体活动度较术前明显降低，差异有统计学意义（P=0.013）。 结论： 对于颈椎外伤合并OPLL的患者，联合短节段椎弓根螺钉固定的颈后路椎管成形术可以在广泛减压颈脊髓压迫的同时增加颈椎的节段稳定性，同时在一定程度上避免了颈后路椎板切除椎弓根螺钉固定术所带来的术后轴性症状等并发症的出现。.
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