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| LU Shijin,PAN Hansheng,LIU Ruzhuan.Analysis on surgical treatment for elderly patients with severe cervical segmental ossification of the posterior longitudinal ligament[J].Chinese Journal of Spine and Spinal Cord,2013,(4):352-358. |
| Analysis on surgical treatment for elderly patients with severe cervical segmental ossification of the posterior longitudinal ligament |
| Received:August 24, 2012 Revised:February 09, 2013 |
| English Keywords:Ossification of the posterior longitudinal ligament Cervical The elderly Surgery Efficacy |
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| English Abstract: |
| 【Abstract】 Objectives： To analyze the efficacy of different surgical procedures for elderly patients with severe segmental cervical ossification of the posterior longitudinal ligament(OPLL). Methods: 48 elderly patients severe legmental cervical OPLL were analyzed retrospectively. The patients underwent surgical treatment, including 33 males, 15 females; with an average age of 71.33±8.46 years(rang, 60-86 years); with an average course of duration of 6.61±1.26 years(rang, 4-16 years). The rang of lesion segments was 1 to 2; the mean cervical lordosis, spinalstenosis rate and JOA score was 3.88°±5.14°, (58.77±4.32)% and 8.42±1.23, repectively. According to the patient′s condition before surgery all patients were divided into three groups. Group A(poor tolerance to surgery) included 11 cases, 8 males, 3 females, which was used the simple posteriorlaminectomy decompression lateral mass screw fixation; group B[(without high-signal intensity zone(HIZ) on MRI)] included 18 cases, 13 males and 5 females who had no intramedullary HIZ on MRI and no obvious hypertrophy of ligamentum flavum, which was applied the simple anterior corpectomy decompression and interbody fusion and titanium screw-plate fixation; group C(with HIZ on MRI) included 19 cases, 12 males and 7 females who had significantly intramedullary HIZ found on MRI, or accompanied by obvious hypertrophy of ligamentum flavum, formed "clamp" oppression to the cervical spinal cord which was adopted the posterior and anterior corpectomy decompression and titanium mesh interbody fusion titanium screw-plate fixation. The change of cervical curvature, spinal stenosis rate, JOA score at pre- and post-operation and 1-year follow-up were compared. Occurrence of complications was analyzed. SPSS 16.0 software was used to compare and analyze the clinical efficacy. Results: All patients were successfully operated in three groups. Axial neck pain occurred gradually in 2 cases in group A, but the symptoms gradually ease after being treated by non-steroidal anti-inflammatory drugs. In group B, there were 2 cases suffered from CSF leakage, which 1 case resolved by self-healing, other 1 case resolved by lumbar puncture and drainage processing. 3 cases suffered from postoperative neurological deterioration who were resolved gradually to preoperative levels in postoperative 7-22 days and continued to improve by hormones and neurotrophic treatment. In group C, 1 case suffered from incision redness, but no abscess formation, and healed after antibiotic treatment. There was a significant improvement of cervical curvature and JOA score at postoperation and 1-year follow-up respectively, which showed statistical significance compared with preoperative ones(P<0.05). The JOA score improving rate in group A, B and C at 1-year follow-up was (41.00±10.58)%, (55.20±10.66)% and (67.42±9.41)%, respectively. But the cervical curvature at 1-year follow-up showed no significant difference compared with postoperative one(P>0.05). Conclusions: For elderly patients with severe OPLL, the surgical approach should be considered based on the individual conditions, which can ensure effective improvement of neurological function. |
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