Efficacy And Sagittal Parameters Of Severe Continuous Cervical Ossification Of Ossification Of The Posterior Longitudinal Ligament After Cervical Expansive Double-door Laminoplasty

Objective:To investigate the curative effect and cervical sagittal parameters of severe continuous cervical posterior longitudinal ligament slenderness(C-OPLL)underwent posterior cervical expansive double-door laminoplasty with artificial bone graft.Methods:Select 25 cases of severe continuous posterior longitudinal ligament ossification in our hospital from January 2014 to January 2017 in our hospital with double-posterior cervical spondyloplasty and artificial bone graft.Among them,14 were males and 11 were females;their ages ranged from 57 to 76 years(60 ± 5.6 years).Surgical scope: C2-C7 8cases,C2-C6 9 cases,C3-C7 8 cases.JOA score,pain visual analogue(VAS)score and JOA score improvement rate(IR)were recorded before and at the last follow-up to evaluate the neurological function.Preoperative and postoperative follow-up was performed on the posterior lateral X-ray,cervical CT and cervical MRI,and the cervical stenosis rate and the rate of cervical spinal canal stenosis,the total distance of spinal cord retraction(PCS),the preoperative and postoperative follow-upT1-Slope,C2-C7 Cobb angle,C2-C7 SVA,K-line,etc.The data of the preoperative and final follow-up were analyzed by t-test.Results:Three patients had transient C5 nerve root palsy postoperatively.Five patients had cervical axial pain increased compared with that before operation.No complications such as cerebrospinal fluid leakage and neurovascular injury occurred.All patients were followed up for 12-36 months with an average of 23 months.JOA score increased compared with preoperative,VAS scores of neck pain decreased compared with preoperative,with statistical significance(P <0.05).The postoperative neurological function improvement rate was excellent in 6 cases,good in9 cases,fair in 7 cases,poor in 3 cases.The excellent and good rate are60%.JOA score was 56.2 ± 14.7%,spinal stenosis rate was reduced from60.6 ± 18.7% to 31.2 ± 13.7%,P <0.05;25 cases were positive in K line before operation and 10 cases in K Line negative,JOA score was no significant difference between the two groups.At the last follow-up,the JOA score of K-line positive group was significantly higher than that of K-line negative line(P <0.05).There was no significant difference in the Cobb angle between the last follow-up and the preoperative(P> 0.05).The T1-Slope and C2-C7 SVA were significantly increased compared with those before operation(P <0.05)The cervical curvature was abnormal in 14 cases.There was no significant difference in preoperativeJOA score,preoperative spinal canal stenosis rate,spinal canal expansion rate,JOA score at the last follow-up and JOA improvement rate(P> 0.05).Double-door C2-C7 after each segment of the spinal cord were significantly displaced.Spinal canal enlargement rate,PCS in C3-C7 decompression segment and C2 segment no significant difference(P>0.05).Conclusion:Posterior cervical expansive double-door laminoplasty with artificial bone graft.surgery is effective,effective and safe operation.Postoperative T1-Slope,C2-C7 SVA increased compared with preoperative.The preoperative curvature of the cervical spine had no significant effect on the postoperative outcome,and the K line had a certain predictive effect on the postoperative outcome.For patients involved in C2 need to fully decompression,but need to pay attention to open the door angle.