| Background: Ossification of the posterior longitudinal ligament(OPLL)has been recognized as one of the most common causes of severe cervical myelopathy in Asian countries.As OPLL is a multifactorial disease and no conservative treatment has been confirmed to be effective,surgical treatment is usually required.Some authors reported that anterior corpectomy and fusion was more appropriate for the patients with OPLL.However,when OPLL occupies too much area of the canal or involves multilevels,the technical requirements of anterior surgery are high,dissection is difficult,and the risks of cerebrospinal fluid leakage,neurological deterioration,graft and instrumentation extrusion,subsidence and pseudoarthrosis are also high.Thus for a long period of time,the major surgical treatment for multilevel OPLL is still via posterior approach.Posterior approach is a relatively safe method and indirect decompression in the cases of severe spinal cord compression over 3 or more of segments expecting posterior migration effects.Open-door laminoplasty(OL)and laminectomy and fusion(LF)are two main surgical procedures used in the treatment of multilevel OPLL.While favorable neurologic recovery has demonstrated after laminectomy with fusion and laminoplasty in patients with OPLL,both two procedures were also associated with unique limitations and complications.In addition,the progression of OPLL is worthy of paying attention to.Essentially,there is a paucity of strong data in the literature to support one of these procedures over the other in treating multilevel OPLL.Objective: The purpose of the study was to make a decision to select a proper procedure between Open-door laminoplasty and Laminectomy and fusion in the future treatment of multilevel cervical OPLL by prospective and randomised trial comparing.Methods: We analyzed the clinical records of total 80 patients who were surgically treated with Open-door laminoplasty(40)and Laminectomy and fusion(40)from 2011.01 to 2013.01 by the same surgeon.Patients who had 1 to 2-level OPLL or significant kyphosis or OLF or non-OPLL diseases were excluded.The associate data of changes in sagittal alignment and anterior-posterior diameter of the spinal cord,subjective functional improvement,rate of major complications,incidence of postoprative kyphosis and progession of OPLL were recorded and analyzed.End points included the Visual Analog Scale,Japanese Orthopedic Association,Nurick score,Short Form-36 questionnaire and radiographic measures.Results: A total of 80 patients were enrolled in the comparative study,40 underwent open-door laminoplasty(the following abbreviated in laminoplasty)and 40 underwent laminectomy combined lateral mass screw fixation and fusion(the following abbreviated in laminectomy and fusion),respectively.No significantly statistical difference was observed in JOA improvement rate and Nurick score improvement values between the two groups(p>0.05).Postoperative improvement value on VAS score and SF-36 score of laminoplasty group was significantly higher than that of laminectomy and fusion group(p<0.05).The postoperative spinal cord expansion rate was obviously greater in laminectomy and fusion group than laminoplasty group(p < 0.05),no significant difference was seen in lateral dimension change rate between the two groups(p > 0.05).Lanmioplasty was observed to maintain significantly lager range of postoperative ROM than laminectomy and fusion group(p<0.05).In lanimoplasty group,C5 palsy was visible in 4 patients,axial symptom in 5 patients and kyphosis in 3 patients,the number of above complications in laminectomy and fusion group was 14,14 and 2,espectively.The postoperative apparent rate of C5 palsy and axial symptom were significantly lower than that in laminectomy and fusion group(p < 0.05).No significantly statistical difference was observed between the two groups in postoperative value loss of cervical alignment,changing value of cervical sagittal balance and rate of OPLL progression(p>0.05).No neurological deterioration happened in two groups during the follow-up period.Conclusion: The study demonstrated that both laminoplasty and laminectomy and fusion treating cervical multilevel OPLL could obtain comfortable clinical outcomes,which were maintained well during the follow-up period.Despite of significant greater increase of spinal cord AP dimension laminectomy and fusion group obtained than laminoplasty,no superiority demonstrated.Without fusion,patients who underwent laminoplasty got well maintained postoperative cervical ROM,earlier cervical exercise,lower degree of neck pain and stiffness and better quality of life than laminectomy and fusion group.The cervical sagittal alignment was generally well maintained in both groups during the follow-up period.The progression of OPLL occured in part of patients in both groups,however,laminectomy and fusion procedure did not have the priority in slowing down OPLL progression,forward progression situation needs further follow-up.The preserved ROM resulting in uneven train distribution in laminoplasty may be associated with one of important risks for OPLL progression.Ultimately,laminoplasty may be the better opotion for the treatment of multilevel cervical OPLL for it’s better clinilcal outcome,lower rate of C5 palsy,simplicity,less blood loss and less influence on life quality. |
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