| Objective: The surgical treatment for severe ossification of posteriorlongitudinal ligament （OPLL） of cervical spine has always been the bone ofcontention in the clinical work. There are many contentions on the selectionand efficacy between anterior and posterior approaches. Although the surgicalindications and technical requirements are different, many physicians inpractical work only pay attention to neural decompression effect, ignoring thecervical curvature and complications. The aim of this article is to discuss theefficacy and selection of two approaches in the treatment of severe OPLL ofthe cervical spine.Methods: From January2009to October2012,33patients with severeOPLL were retrospectively analyzed. Their stenosis rates were more than50%and the ossified focus were less than three segments. The average age was55.7years old（range,43～73）. Among them,18patients underwent anteriorcorpectomy and fusion（anterior approach group）, with11men and7women,and35patients underwent laminectomy and lateral mass screw fixation（posterior approach group）, with11men and4women. The operative time,amount of bleeding, cervical curvature, change of segmental curvature,complications were all recorded and compared between two groups. TheJapanese Orthopedic Association Score was used to evaluate the neuralfunction.Results: All patients were followed up for average15.3months. Bothgroups got solid fusion and no instrument failure. The differences of age, sex,scope of ossification and stenosis rate in the two groups were not statisticallysignificant （P>0.05）. The operative time was150.00（30.00）min in anteriorgroup, and was220.00（50.00）min in posterior group, the amount of bleeding was225.00（158.75）ml in anterior group, and was800.00（400.00）ml inposterior group, both of which showed statistically significant difference（P<0.05）. The preoperative JOA score in two groups had no statisticallysignificant differences（P>0.05）. The JOA score and the improvement rate atfinal follow-up showed statistically significant difference between two groups（P<0.05）. The postoperative change of segmental curvature was5.65°（1.70）°in anterior group and3.89°±1.65°in posterior group，whichshowed statistically significant difference（P<0.05）.The change of segmentalcurvature at final follow-up was-0.85°（0.50）°in anterior group and-0.40°（0.40）°in posterior group，which showed statistically significantdifference（P<0.05）. The preoperative cervical curvature between two groupsshowed no statistically significant difference（P>0.05）. But the cervicalcurvature postoperatively and at the final follow-up showed statisticallysignificant difference（P<0.05）. In the anterior approach group, four patientsdeveloped cerebrospinal fluid (CSF) leakage, and one patient had woundhematoma. In the posterior approach group, three patients developed C5palsy,and one patient occurred wound fat liquefaction. The rate of neck axialsymptom noted at final follow-up was16.67%in anterior group and60.00%in posterior group，which showed statistically significant difference（P<0.05）.Conclusion: In the treatment of severe OPLL of cervical spine, withscope of ossification in three segments, the anterior approach can take lessoperation time with less blood loss, remove compression directly, get a betterneurological recovery, provide cervical curvature recovery, decrease thepostoperative axial symptoms. But it requires high technology and the risk ofcerebrospinal fluid leakage is high. When the posterior laminectomy isselected, the lateral mass screw fixation should be adopted, which canmaintain the segmental curvature. But the risk of C5palsy and the neck axialsymptom are very common. Both the approaches can provide satisfyingshort-term outcomes. |
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