| Part one Influence of K-line on intraoperative and hidden blood loss in patients with ossification of the posterior longitudinal ligament when undergoing unilateral open door laminoplastyObjective : The K-line is a virtual straight line that connects the midpoints of the anteroposterior spinal canal diameter from C2 to C7 on a cervical lateral X-ray film.Patients with cervical ossification of the posterior longitudinal ligament(OPLL),in which the peak of the OPLL exceeds the K-line(K-line [-]),are less likely to experience sufficient decompression after laminoplasty compared with patients for whom the OPLL does not exceed the K-line(K-line [+]).This retrospective study investigated the influence of K-line position relative to the OPLL on intraoperative and hidden blood loss during unilateral open-door laminoplasty for OPLL.Methods:Data were retrospectively analysed of 108 patients with OPLL who underwent unilateral open-door laminoplasty between April 2015 and March 2018.Patient cases were categorized as K-line(+)or(-).The evaluated perioperative parameters were: haematocrit,hemoglobin,intraoperative and hidden blood loss,surgical time,postoperative drainage,and complications.Radiological parameters included ossification occupancy ratio and C2-7lordosis.Results : The K-line(+)and K-line(-)groups were statistically comparable with regard to age,gender,body mass index,OPLL classification,medication history,C2-7 lordosis,postoperative hemoglobin and haematocrit,postoperative drainage,hidden blood loss,and complications.The occupying ratio of the K-line(-)group was significantly greater than that of the K-line(+)group(49.5 ± 15.3% cf.42.3 ± 10.1%;P = 0.006),and the intraoperative blood loss was also significantly higher(286 ± 110.5 m L cf.205.5 ± 98.3L,P = 0.003).The hidden blood loss of the K-line(-)group was higher than that of the K-line(+),but not significantly(295.5 ± 112.6 m L cf.265.6 ±103.8 m L;P = 0.072).Conclusion : Intraoperative and hidden blood loss associated with unilateral open-door laminoplasty can be predicted by the spatial relationship of the K-line and osteophyte.This relationship is a simple and practical index that may help surgeons determine the appropriate surgical strategy for patients with OPLL.Part two Study on blood loss and clinical effect of single open door surgery with different open side in treatment of lateral cervical OPLLObjective:Posterior cervical open-door surgery is a common operation for the treatment of OPLL,which is generally considered to be the open-door side from the side with severe symptoms or compression.The purpose of this study was to investigate the effects of the choice of lateral opening door with severe compression and the choice of lateral opening door with less compression on the surgical outcome and blood loss in patients with lateral OPLL.Methods:Retrospective analysis was performed on 59 patients who received unilateral open-door surgery in our hospital from January 2017 to December 2019,including 30 patients with severe compression(control group)and 29 patients with mild compression(experimental group).The mean follow-up time was 24 months.We compared two groups of the general situation,evaluation of two groups of preoperative and postoperative hemoglobin,red blood cells deposited,and calculate the intraoperative blood loss and hidden blood loss,postoperative flow,operation time,the Japanese Orthopaedic Association scoring(Japanese Orthopaedic Association Scores,JOA score),and postoperative period,cervical dysfunction index(neck disability index,NDI)and postoperative visual analog scale(visual analogue score,VAS),Spinal canal enlargement rate,spinal cord area(SCA),range of motion(ROM),changes in C2-7Cobb Angle,and neurological complications,such as infection,dural rupture,axial symptoms,C5 root paralysis,were analyzed statistically.Results:There was no significant difference in general data between the two groups.The total intraoperative blood loss in the experimental group(380.5±100.5ml)was significantly less than that in the control group(450.8±120.9ml),P= 0.019.The intraoperative blood loss in the experimental group(120.5± 80.5ml)was significantly less than that in the control group(175.0± 90.3ml),P=0.018.There was no statistical difference in the postoperative drainage volume and latent blood loss between the two groups.The operation time of the experimental group(90.5±30.5min)was shorter than that of the control group(110.0 ± 45.8min),P=0.060,and there was no statistical significance.SCA in the experimental group was higher than that in the control group(P < 0.001).Dural rupture(1 case)in the experimental group was less than that in the control group(2 cases).Axial pain and C5 nerve root paralysis(1 case in each group)were not statistically significant.At the last follow-up,there was no statistical significance in postoperative JOA score,JOA improvement rate,VAS score,NDI index,cervical ROM,C2-7 cob Angle changes,SCA and spinal canal enlargement rate between the two groups.Conclusion:It is feasible to decompress OPLL with less compression on the side door.The operation and the door is the same technology,but seriously reduce the perioperative blood loss,has the advantages in improving spinal cord compression,can get the same postoperative clinical effect,although the operation time and postoperative complications is not significant,but the average less than conventional surgery,may be related to the size of the sample size.Part three Comparison of blood loss and clinical effect of open door laminoplasty and laminectomy combined with internal fixation in the treatment of cervical OPLL with straight curvatureObjective:Comparison of blood loss analysis and efficacy of posterior single-door laminoplasty and laminectomy with lateral mass screw for straightening cervical curvature and/or K-line negative ossification of the posterior longitudinal ligament(OPLL).Methods:Retrospective analysis was conducted on a total of 59 patients diagnosed with cervical OPLL and meeting the inclusion criteria who were admitted to the Department of Cervical Spine of the Third Hospital of Hebei Medical University from January 2017 to December 2018.According to different surgical methods,they were divided into the laminoplasty group(the open-door laminoplasty group,n = 28)and the laminectomy and fusion internal fixation group(the laminectomy group,n =31).The mean follow-up time was 24 months.The general conditions of the two groups were compared.Collect preoperative and postoperative Hb and Hct,calculate the total blood loss,intraoperative blood loss,postoperative and recessive drain blood loss,compared two groups of operation time,JOA score,JOA period,cervical vertebra of motion(ROM),VAS score,neck dysfunction index(NDI),cervical vertebra and C2-7 cobb Angle,cerical Sagittal vertical axis(SVA)and cervical curvature index(CCI),and postoperative complications,evaluate the clinical efficacy.Results:There was no significant difference in general data between 2groups(P > 0.05).The total blood loss,intraoperative blood loss,latent blood loss and operation time in the open-door group were significantly lower than those in the laminar decompression and fusion group.At the last postoperative follow-up,JOA score,JOA improvement rate,VAS score and neck dysfunction index(NDI)were significantly improved in both groups compared with those before surgery(P < 0.05),and there was no statistically significant difference in JOA score between groups.VAS score,NDI index and incidence of axial pain in the open-door group were significantly lower than those in the laminectomy group,and the difference was statistically significant.Compared with the laminectomy group,there was obvious difference in ROM of cervical vertebra.Cervical lordosis was significantly decreased in the single door group,and increased in the laminectomy group.SVA was significantly increased in the single door group,but remained unchanged in the laminectomy group.At the last follow-up,CCI in the open-door group was significantly lower than that in the laminectomy group,with statistical significance.Although there was no significant difference in the rate of neurologic improvement between the two groups,the incidence of cervical kyphosis and the rate of cervical kyphosis change were significantly higher in the open-door group than in the laminectomy group.Conclusion:For patients with cervical OPLL with straightened cervical curvature and/or K-negative cervical curvature,symptom remission after both procedures was significantly improved compared with preoperative symptoms.Compared with laminectomy and internal fixation,the open-door approach resulted in less perioperative blood loss,less axial pain,and more retained neck motion.But in the maintenance of cervical curvature is poor. |
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