Early Clinical Effect Of Resecting Posterior Longitudinal Ligament In Anterior Approach For Cervical Spondylotic Myelopathy With Sympathetic Symptoms

Objective: To investigate the effect of two kinds of operations oncervical spondylotic myelopathy(CSM) with sympathetic symptoms,namely cervical artificial disc replacement and anterior cervicaldecompression and fusion (ACDF), and to examine whether resectingposterior longitudinal ligament (PLL) play a key role on the clinical outcome.Method: From January2008to December2011， fifty patients withCSM combined with symptoms were included,who were under the treatmentoperation from January2008to December2011in our department. They weredivided into two groups(Group A and Group B).18Patients underwent cervicalartificial disc replacement in group A, and32ACDF in group B. Each groupwas divided into two subgroups according to whether the OPLL wasresected.In group A,11cases resected, and7nonresected; in group B，21cases resected,11nonresected. Each case was evaluated through clinical andradialogic conditions preoperatively,9days,3months,6months and12months after surgery. The20-point system was used to evaluate thesympathetic symptoms, and the Japanese Orthopedic Association (JOA) scorewere applied on clinical outcomes.Results: In all the patients who underwent cervical artificial discreplacement and the PLL was resected during the operation，the20-pointsystem scores were: pre-operation:7.6±2.4;9days post-operation:1.4±1.0;3months post-operation:2.2±1.8;6months post-operation:2.4±1.3;12months post-operation:2.4±1.4; and the JOA scores were: pre-operation:10.8±1.6;9days post-operation:14.5±2.0;3months post-operation:15.1±1.3;6months post-operation:16.8±2.0;12months post-operation:17.2±1.1； in the patients who underwent the operation of anterior cervical decompression and fusion (ACDF) and the PLL was resected during theoperation, the20-point system scores were: pre-operation:7.4±1.1;9dayspost-operation:1.5±1.6;3months post-operation:2.2±1.0;6monthspost-operation:2.4±1.5;12months post-operation:2.5±1.2; the JOA scoreswere: pre-operation:11.2±1.4;9days post-operation:13.8±2.0;3monthspost-operation:14.7±2.2;6months post-operation:16.2±2.0;12monthspost-operation:17.0±1.6；in the patients who underwent the operation ofanterior cervical decompression and fusion (ACDF) and the PLL wasmaintained during the operation, the20-point system scores were:pre-operation:7.5±1.2;9days post-operation:2.4±1.0;3monthspost-operation:2.9±1.7;6months post-operation:3.2±1.3;12monthspost-operation:3.6±1.7; and the JOA scores were: pre-operation:11.5±1.3;9days post-operation:12.5±2.0;3months post-operation:13.4±1.8;6months post-operation:14.0±1.2;12months post-operation:14.7±1.0； allthe statistics were significantly improved in all patients after surgery, and nomatter group A and group B, the clinical outcomes in resecting group werebetter than those in nonresecting group, No loosening and displacement ofprosthesis occurred.Conclusion: In cervical artificial disc replacement or ACDF for cervicalspondylotic myelopathy with sympathetic symptoms, the choice of two kindsof operative methods on CSM with sympathetic symptoms is not closelyrelative to the clinical outcomes. Whether resecting the PLL or not determinesthe early outcomes. Compared to the patients with PLL nonresected, resectingthe PLL can better relieve the symptoms and improve the clinical curativeeffect.