Analysis Of Surgical Treatment Of Ossification Of Posterior Longitudinal Ligament With Whiplash

Objectives: To evaluate the therapeutic efficacy of surgical treatments of ossification of the posterior longitudinal ligament(OPLL)with whiplash.Methods: We retrospectively analyzed 21 male and 6 female patients(average age 55.9,range 36–79 years)who presented with OPLL with whiplash between August 2013 and July 2016.There were nine traumatic cases due to violent forces,which were due to falls from a high altitude and traffic accidents.There were18 traumatic cases due to slight forces,primarily falling down.All patients were diagnosed by conventional radiographs,computed tomography(CT),and magnetic resonance imaging(MRI).For the purposes of this study,ossification types were categorized into segmental(8 cases),continuous(11 cases),local(5 cases),and mixed(3 cases)styles.Eight patients underwent surgery by the anterior approach.In the anterior group,six patients underwent anterior cervical corpectomy and fusion(ACCF),while the others underwent anterior cervical discectomy and fusion(ACDF).Fifteen patients underwent the posterior approach: 12 patients underwent double-door cervical laminoplasty and two patients underwent laminectomy and lateral mass screw fixation.One patient underwent double-door cervical laminoplasty combined with laminectomy and lateral mass screw fixation.Four patients were treated by a combined anterior–posterior approach.Two patients were treated by double-door cervical laminoplasty combined with ACDF.The remaining patients were treated by laminectomy and lateral mass screw fixation combined with ACDF.Clinical outcomes were assessed using Japanese Orthopaedic Association(JOA)scores.The thickness of the ossification block and the stenosis rate of the spinal canal were measured at the narrowest position of the spinal canal.The Student's t test was applied for data analysis using SPSS version 20.0 statistical software.A p-value of less than 0.05 was considered statistically significant.Comparisons of JOA scores between preoperative and postoperative parameters were made with paired t or nonparametric tests.The differences in postoperative JOA recovery rates and forces between groups were assessed by the independent-samples t test or nonparametric test.The correlation between spinal stenosis and JOA recovery rates was assessed using bivariate correlation analysis.Results: The mean follow up period was 17.4(range 3–39)months.One patient developed a C5 palsy and one developed cerebrospinal fluid leakage(posterior approach).Postoperative JOA scores of all patients significantly improved compared to preoperative scores(p<0.01).The difference in postoperative JOA recovery between the anterior and posterior groups was statistically significant(53.51±13.04% vs.35.01±18.28%,p<0.05).There was also a significant difference in postoperative JOA recovery rates between slight force and violent force(49.22±15.83% vs.23.73±14.19%,p<0.05).There was a significant correlation between preoperative JOA scores and JOA recovery rates(p<0.01).However,there was no significant correlation between spinal stenosis and JOA recovery rates.Conclusions: OPLL with whiplash was significantly improved after operation,and the JOA recovery rate of the anterior group was better than that of the posterior group.If there are neurologic symptoms in patients with OPLL,surgery is the good choice in order to prevent irreversible cervical spinal cord injury.