Compare The Efficacy Of Minimally Invasive Release And Open Surgery In The Treatment Of Nuchal Ligament Ossification

Background:Long-term chronic injury to the ligamentum nuchae(LN)leads to collagen and elastic fiber rupture and calcium salt deposition,resulting in ossification of the nuchal ligament(ONL).Patients with ONL often experience pain and stiffness in the neck,head,upper arm,or upper back,which have an impact on their work and life.Studies have shown that ONL may be a calcified disease of the spinal ligament,often occurs in middle-aged and elderly people,coexists with other cervical degenerative diseases or a risk factor,and is closely related to the development and progression of cervical radiculopathy(CR).For the treatment of ONL,the current clinical treatment is mainly symptomatic,often without satisfactory results,and cannot delay the development of ONL.Calcified foci resection has achieved some efficacy,but it is often difficult for patients to accept because of the large trauma,slow recovery,and high risk of infection and bleeding.Tenosynovial and deep fascia release is often used clinically to treat the disease through acupuncture techniques,we use it as a minimally invasive treatment method to extensively release and peel away the diseased tissue,and compare the efficacy with open calcified foci resection,observe the clinical significance.Objective:In this study,we compared the efficacy and differences between the calcified foci resection and minimally invasive release surgery in the treatment of ONL and investigated the new method of procedure for the treatment of ONL.Methods:Patients with ONL were prospectively collected from September 2020 to September 2022 at the First Affiliated Hospital of Henan University,and 60 cases were finally included according to the inclusion and exclusion criteria.The patients were grouped according to the procedure: 28 cases in the control group,who underwent calcified foci resection,and 32 cases in the observation group,who underwent minimally invasive release surgery.The patients were followed up for at least 6 months after surgery.The changes in the cross-sectional area(CSA)of the calcified foci,cervical physiological curvature,visual analog pain scale(VAS),range of motion(ROM),and neck disability index(NDI)before and after surgery were recorded in both groups.Postoperative patient satisfaction and the occurrence of adverse events such as severe pain,ecchymosis,subcutaneous hematoma,and infection.A combined assessment of the efficacy of both approaches in the treatment of ONL.SPSS 26.0 software was used for data analysis.Results:1.Patient age,gender,disease duration,shape,and location of the calcified foci had no influence on the choice of surgery.2.The calcified foci were completely removed from the ligamentum nuchae in the calcified foci resection group,and no new calcified foci were created during the follow-up period.In the minimally invasive release group,the CSA of the calcified foci decreased after surgery compared with that before surgery,but the difference in the area before and after surgery was not statistically significant.3.Postoperative cervical physiological curvature,VAS,ROM,and NDI improved in both groups compared to the preoperative period.Comparison of treatment results between the two groups,no difference in cervical spine physiological curvature,ROM,or NDI after treatment.Late postoperative VAS,change in CSA of calcified foci,and healing rate were better in the calcified foci resection group;early postoperative VAS and patient satisfaction were better in the minimally invasive release group.4.In the control group,there were 6 adverse events: 2 cases of pain,2 cases of ecchymosis,1case of subcutaneous hematoma,and 1 case of deterioration,with an incidence rate of 21.4%.In the observation group,there were 2 cases of adverse events: 1 case of pain and 1 case of ecchymosis,and the incidence of adverse events was 6.3%,and there was no difference between them.Conclusions:1.Both calcified foci resection and minimally invasive release surgery can treat ONL,and both have improved VAS,ROM,cervical physiological curvature,and NDI after surgery.2.Compared with calcified foci resection,minimally invasive release surgery is a simple,less damaged,safe,and effective treatment with high patient acceptance and satisfaction,and is more recommended for the treatment of ossification of the nuchal ligament.