Analysis of the Effect and Risk of One-Stage Posterior Spinal Canal Enlargement and Decompression in the Treatment of Multi-Segmental Ossification of Cervical Posterior Longitudinal Ligament
Objective:To explore the changes of cervical sagittal parameters and risk factors of imbalance in the treatment of cervical multi-segmental ossification of posterior longitudinal ligament(OPLL)by one-stage posterior spinal canal enlargement and decompression.Methods:The clinical data of 96 patients with multi-segmental cervical vertebra OPLL treated from January 2020 to September 2022 were collected retrospectively.Japanese orthopaedic association(JOA)score,neck disability index(NDI)and visual analogue scale(VAS)score were evaluated before operation and 12 months after operation.The anterior and lateral cervical X-ray films were collected before operation,immediately after operation and 12 months after operation,and the related parameters of cervical sagittal position were measured.According to the me-dian of C2-7 SVA 12 months after operation,96 patients were divided into balanced group(C2-7 SVA≤41.2 mm)and un-balanced group(C2-7 SVA＞41.2 mm).The general clinical data and imaging sagittal parameters of the two groups were compared.Bayesian Cox proportional hazard regression was used to determine the influencing factors of cervical sagittal imbalance after operation.Results:96 patients were followed up for 12 months.Immediately after operation and 12 months after operation,T1 slope(T1S),thoracic inlet angle(TIA)and C2-7 Cobb angle were significantly increased,while C2-7 SVA at C2-7 sag-ittal position was significantly decreased compared with those before operation.The changes before operation,12 months after operation and before and after operation showed that T1S,TIA and C2-7 Cobb angle were positively correlated with each other,while C2-7 SVA was negatively correlated with T1S,TIA and C2-7 Cobb angle.12 months after operation,15 patients had cervical sagittal imbalance(imbalance group),and the other 81 patients remained normal(balance group).The results of Cox regression multivariate analysis showed that preoperative high C2-7 SVA(hazard ratio=1.05,95％CI=1.03-1.08),mixed OPLL(hazard ratio=1.26,95％CI=1.10-1.75),high preoperative NDI(hazard ratio=13.20,95％CI=6.01-29.85),and low preoperative JOA score(hazard ratio=0.08,95％CI=0.03-0.12)were risk factors for postoperative sagittal imbalance of cervical vertebra(P＜0.05).Conclusion:One-stage posterior spinal canal surgery can effectively improve the spinal cord nerve function and cervical vertebra function,reduce the pain of patients,and has obvious curative effect on OPLL patients.The related parameters of cervical sagittal position are related to the risk of postoperative cervical sagittal imbalance.
cervical vertebraossification of posterior longitudinal ligamentone-stage posterior spinal canalimaging eval-uationsagittal position of cervical vertebra
万方数据
维普
