Comparison Of The Efficacy Of Posterior Single-door Laminoplasty And Total Laminectomy For The Treatment Of Ossification Of The Posterior Longitudinal Ligament

BackgroundOssification of the posterior longitudinal cervical ligament is a type of heterotopic ossification that causes significant chronic pressure on the spinal cord,resulting in spinal cord compression and neuro degeneration,including changes in gait or balance,loss of fine motor control,and weakness,numbness,or paresthesia of the upper extremities.OPLL is one of the important causes of cervical spondylotic myelopathy.Because OPLL is a disease caused by a variety of factors,it usually leads to the deterioration of nerve function,and conservative treatment is not effective,so ossification of the posterior longitudinal ligament of the cervical spine often requires surgical treatment.Both anterior and posterior surgeries can achieve good clinical results.For multi-segmental cervical OPLL,it is difficult and risky to directly remove ossified bone by anterior surgery for decompression,and posterior surgery is safer than anterior surgery through indirect decompression.In view of the significant complication rates of the anterior surgery,this leds to the study of posterior surgery,single-door laminoplasty,and laminectomy with decompression and fusion became the main surgical single-door laminoplasty for multi-segment OPLL.The cervical single-door laminoplasty has been advocated for small trauma,and procedures have their unique advantages and limitations.Most of the current literatures are the study of single-door laminoplasty,laminectomy with decompression and fusion.Most of the studies lack comparison group or long-term follow-up in this study.We have caused the treatment of OPLL by single-door laminoplasty,laminectomy with decompression and fusion.The clinical effects and complications of cervical spondylotic myelopathy were systematically reviewed in order to find the most suitable surgical method for ossification of the posterior longitudinal ligament of the multi-segment cervical spine.ObjectiveTo explore the clinical efficacy of posterior cervical single-door laminoplasty and laminectomy with decompression and fusion for the treatment of multiple segments of posterior longitudinal ligament ossification of the cervical spine.MethodClinical data of two kinds of surgeries for the ossification of multi-segmental posterior longitudinal ligament of cervical spine in the First Affiliated Hospital of Xinxiang Medical University from January 2014 to July 2016 were collected,According to the inclusion and exclusion criteria,66 cases were finally selected for study and analysis,including 36 patients who underwent single-door laminoplasty and 30 patients who underwent total laminectomy with decompression and fusion.Among them,36 patients in the single door group received single-door laminoplasty(titanium plate method),and 30 patients in the laminar decompression and fusion group received total laminectomy with decompression and fusion(lateral mass screw method).After 24 months of follow-up,The Cervical Curvature Index(CCI),Cervical 2 to 7 vertebral bodies Sagittal Vertical Axis(C2-7 Sagittal Vertical Axis,C2-7 SVA)and the range of motion of cervical spine(ROM)were calculated by measuring the cervical lateral position and overextension and flexion X-ray at the time of preoperative and postoperative follow-up,The patients were counted with postoperative incision infection,cerebrospinal fluid leakage,axial symptoms,and incidence of C5 nerve root palsy.Results1.There was no significant difference between the two groups in general data such as the gender,age,medical history and basic diseases(P>0.05).2.The postoperative JOA score and VAS score of the two groups were significantly improved compared with those before the operation(P<0.05),while the postoperative JOA score and VAS score of the two groups were not significantly different(P>0.05).3.The cervical vertebral activity(ROM)of the last follow-up visit after surgery in both groups was higher than that before surgery(P<0.05),but the cervical range of motion(ROM)of the laminar decompression and fusion group was higher than that of the single-door group(P<0.05).4.At the last follow-up,the CCI of the two groups was significantly lower.The CCI of the single-door group was lower than the laminar decompression and fusion group(P<0.05),There was no significant difference in CCI loss between the two groups(P>0.05);At the last follow-up,the C2-7SVA of the single-door group was higher than the laminar decompression and fusion group(P<0.05).The increase of C2-7SVA in the single-door group was higher than that in the laminar decompression and fusion guoup.5.In the laminar decompression and fusion group,6 cases(20.0%)had axial symptoms,7 cases(23.3%)had C5 nerve root palsy,and the overall incidence of complications was 60.0%(18/30).Postoperative axial symptoms were observed in 1 case(2.8%)and C5 nerve root palsy in 2 cases(5.6%).The total incidence of complications was 25.0%(9/36).The total incidence of postoperative axial symptom C5 nerve root paralysis and complications in the single door group was lower than that in the laminar decompression and fusion group,and the difference was statistically significant(P<0.05).ConclusionPosterior cervical single-door laminoplasty and total laminectomy for the treatment of OPLL can achieve satisfying clinical effect.Total laminectomy is better than Single-door laminoplasty in maintaining cervical curvature and sagittal position,but posterior single-door laminoplasty have greater mobility after surgery,and low complication rate.