The Mid-term Clinical Efficacy Evaluation Of Extending To C1,2 Posterior Cervical Open-door Laminoplasty For Patients Complicated With Upper Cervical Ossification Of The Posterior Longitudinal Ligament

Objective:To investigate the medium-term clinical and radiological outcome of extending to C1,2 spinal posterior cervical open-door laminoplasty for patients complicated with upper cervical ossification of the posterior longitudinal ligament(OPLL).Methods:From February 2013 to December 2015 in our hospital,32 patients of upper cervical OPLL were treated with extend to C1,2 spinal posterior cervical open-door laminoplasty(25 patients were completely followed up).There were 19 males and 6 females with an average age of 60.1 years old(range,48-76 years).Japanese Orthopaedic Association(JOA)spinal cord score was used to evaluated spinal cord function,and calculates the rate of improvement of neurological function.Neck disability index(NDI)was used to assess the patient’s quality of life.Visual analog scale(VAS)was used to assess axial symptoms and grade.Radiological outcomes such as C0-2 angle,C2-7 angle and ROM on radiographs to assess preoperative and last follow-up cervical curvature and cervical range of motion.Results:Twenty-five patients were completely followed up,for an average of 35.9months(26-64months).The JOA score significantly improved from 8.31 ± 1.62 preoperatively to 14.32±3.24(P<0.05)at final follow-up with an improving rate of(57.59±30.88)%.The NDI score significantly reduced from 12.62±2.34 preoperatively to 7.61±1.23(P<0.05)at final follow-up.The VAS score for axial symptoms decreased from 6.71± 0.92 preoperatively to 1.42 ± 0.78(P<0.05)at final follow-up.The preoperative C0-2angle was(26.04±6.28)°,the last follow-up was(24.92±5.51)°,the preoperative C2-7angle was(19.55±9.42)°,and the last follow-up was(17.97±8.80)°.Both of the last follow-up were slightly smaller than before surgery,and the decrease was similar,but the difference was not statistically significant.The ROM before operation was(35.31 ±12.24)° and last follow-up ROM was(32.23±9.65)°.The range of cervical motion at the last follow-up was slightly lower than before surgery,but the difference was not statistically significant(P=0.351).The decrease in the range of flexion was greater than the hyperextension,which was the main reason for ROM reduction.The progression of OPLL was observed in 11 cases at final follow-up.Conclusion:Extend to C1,2 spinal posterior cervical open-door laminoplasty for combine with upper cervical ossification of the posterior longitudinal ligament can achieve adequate decompression of the spinal cord and satisfactory neurological improvement,while no significant changes in postoperative cervical curvature and range of cervical motion,no significant increase in axial symptoms.The clinical efficacy is positive.