A Comparison Of The Curative Effect Of One-stage Posterior Anterior Combined Operation And Staged Operation In The Treatment Of Cervical Ossification Of The Posterior Longitudinal Ligament

Background Ossification of the posterior longitudinal ligament of cervical spine is an ectopic ossification disease in which ossification mass compresses the spinal cord and/or nerve roots,causing a series of neurological symptoms.Conservative treatment is recommended for mild or asymptomatic patients,and surgical intervention is recommended for ossification patients with severe spinal symptoms or spinal stenosis.Many scholars have carried out relevant studies on anterior and posterior approaches.However,few studies on the clinical efficacy of anterior and posterior combined approaches have been compared.In this study,we conducted a systematic review of the clinical efficacy of a single-stage combined anterior and posterior surgery approach and staged surgery for cervical OPLL,in order to compare the efficacy of the two methods in the treatment of cervical OPLL and provide reference for the clinical treatment of this disease.Objective To compare the clinical efficacy of one-stage posterior anterior combined surgery and staged surgery for cervical ossification of the posterior longitudinal ligament（OPLL）.Method From June 2016 to June 2019,the clinical data were collected of patients with cervical OPLL who received combined surgical treatment in the Department of Orthopaedics of the First Affiliated Hospital of Xinxiang Medical College.According to inclusion and exclusion criteria,58 eligible patients with cervical OPLL were selected and divided into two groups according to surgical methods.The one-stage group was enrolled into 28 patients for one-stage combined posterior anterior surgery,30 patients in the staged group was enrolled as staged combined posterior anterior surgery,the clinical data of the two groups of patients in terms of gender,age,and course of disease were not statistically significant（P>0.05）.They were comparable,and all operations were operated by the same surgical team.The review data of all enrolled patients within 24 months after operation were analyzed,the JOA scores and VAS scores of the two groups of patients before and after operation were recorded and compared.Compared the two groups of patients early and late complications.Two groups of patients underwent X-ray examinations of the anteroposterior and lateral position of cervical spine,3 and 6 months after operation to observe the changes in cervical curvature and spinal cord decompression and evaluate the clinical efficacy.Results1.There were statistically significant differences in JOA and VAS scores between 2groups 6,12 and 24 months after surgery compared with those before surgery（P<0.05）.2.Three months after surgery,CCI in the two groups was significantly lower than that before surgery,and the staged group was significantly lower than the one-stagel group,with statistical significance（P<0.05）.3.Three months after surgery,C_2-7SVA in the two groups was significantly increased compared with that before surgery,and the staged group was significantly higher than the one-stage group,with statistical significance（P<0.05）.4.The total number of C5 nerve root palsy in theone-stage group was lower than that in the staged group,and the difference was statistically significant（X~2=4.757,P<0.05）.Conclusion One-stage and staged combined surgery for multilevel cervical OPLL can improve symptoms,and one-stage surgery was better than staged operation in maintaining early cervical stability and physiological curvature,and the incidence of C5 nerve root palsy after one-stage combined surgery was significantly lower than that of staged surgery.