| Objective:The purpose of this retrospective study is to explore the feasibility and clinical value of intraoperative ultrasound(IOUS)in the process of cervical posterior longitudinal ligament ossification(OPLL)in the treatment of cervical posterior longitudinal ligament ossification(OPLL).Background:In the treatment of cervical posterior longitudinal ligament ossification(OPLL),the use of posterior cervical surgery,especially the posterior cervical laminoplasty,is very extensive.The spinal surgeons are widely used in clinical practice because of their fewer surgical complications,better spinal nerve function recovery,short operation time,simple anatomical structure,and so on.However,posterior cervical laminoplasty can only observe the structure of the spinal dorsal side of the spina)cord.It is difficult to observe the overall compression of the spinal cord and the relationship between the ventral spinal cord and the posterior longitudinal ligament.Experts point out that in the process of posterior cervical laminoplasty(Laminoplasty),the spinal dorsal and lateral dural pulsation can be observed at this time after the vertebral lamina is opened and fixed,in order to indirectly determine the degree of spinal dorsum floating and decompression,but this method is difficult to form a quantitative evaluation criterion because of the difference of the operator.The different methods and angles of each operator will bring large errors and seriously affect the accuracy of the results,so there is a highly controversial method which has not been used in the clinical cervical posterior laminoplasty.(1)Intraoperative ultrasound(IOUS)has small space and low cost for its use;(2)easy to use,easy to learn,easy to be accepted by clinicians,and(3)to observe the changes of the dural sac in real time,dynamically and intuitively during the operation,especially when the ventral dural sac is affected.When the pressure of the front pressure is pressed,it can clearly show the extent and extent of compression of the spinal cord.Since the 80s of last century,it has been widely used in the treatment and diagnosis of spinal cord intraspinal tumors and in the process of pedicle screw placement.In recent years,ultrasound technology has made great progress,so some scholars have applied the intraoperative ultrasound(IOUS)to the cervical posterior laminoplasty,and put forward the use of intraoperative ultrasound(IOUS)to detect the bone in the operation.The thickness of the posterior longitudinal ligament is used to determine whether the spinal cord is sufficiently decompressed.However,there are many problems in this method,such as the intraoperative ultrasound technique is not suitable for measuring ossification tissue,and it is difficult to observe the boundary between the longitudinal ligament and the posterior edge of the vertebral body after ossification.There is a large error in the measurement results,and the thickness of the longitudinal ligament after ossification can be judged by the CT results before operation without any intraoperative examination.Therefore,this kind of observation index is not widely used.The use of intraoperative ultrasound(IOUS)in the posterior cervical laminoplasty is a new technique,so the reference material is still less.Methods:According to the inclusion and exclusion criteria,a total of 48 patients with cervical-ossification of the posterior longitudinal ligament(OPLL)with cervical posterior longitudinal ligament(OPLL)were included in this retrospective study,including 31 males and 17 females.During the period from January 2015 to December 2016,these patients were all caused by cervical spine.The longitudinal ligament ossification(OPLL)was admitted to the second hospital of Shandong University for spinal surgery and accepted the treatment of the posterior cervical laminoplasty in our department,and the specific laminoplasty is a double open door laminectomy for the posterior approach of the neck.Plasty.The average age of the 48 patients was(58.38 + 10.36)years(37-81 years),and the mean duration of symptoms was(21.73 + 22.22)months(1-96 months).According to the preoperative medical records and postoperative follow-up data,the JOA recovery rate was calculated and recorded.According to the results of intraoperative ultrasound images,the spinal cord compression ratio of each patient was calculated and recorded in detail.According to the ultrasonic image results of the patients,the patients were divided into group A(decompression filling group)and group B(the group of decompression insufficiency),of which group A included I(cervical spinal ventral dural contact with posterior longitudinal ligament),II type(with epidural pulsation,ventral dura)and posterior longitudinal ligament contact immediately after contact),and B group including the III type(cervical pulp abdomen).The lateral dura is constantly in contact with the posterior longitudinal ligament without separation from the dural pulsation.According to the JOA recovery rate and spinal cord compression ratio,the rationality of-the group was verified.Finally,using a reasonable group and the spinal cord compression ratio,receiver operating characteristic curve(ROC)were drawn and the conclusion was finally concluded.The combined operation of the anterior approach should be accepted.Results:Intraoperative ultrasound(IOUS)can accurately display the extent and extent of the spinal ventral compression after laminoplasty,and measure the anterior and posterior diameter of the spinal cord and the left and right diameters.According to the intraoperative ultrasound images,the relationship between the dura pulsation and the ventral structure after spinal cord decompression was dynamically observed.According to these relationships,48 patients were divided into two groups,the first group was group A(decompression and filling group),including I type(n=10 cases)and Ⅱ(n=10 cases)and Ⅱ type(dural pulsation).Dura pulsation was separated from the ventral structure(n=27),and the second group was group B(less decompression group),including type Ⅲ(dura pulsation,inseparable with the ventral structure)(n=11).The age,sex and preoperative symptom duration of group A(decompression group)were not significantly different from those of group B(decompression insufficiency group).The improvement rate of JOA cervical spine score in A group was(90.37 + 10.33)%(70%-100%),obviously higher than that in group B(49.55 +17.98)(13.33%-69.23%)(T=9.5849,P<0.001).The spinal cord decompression effect of A group(decompression filling group)was better than that of group B(less decompression group),P<0.001,poor.The difference has statistical significance.The compression rate of spinal cord(spinal cord compression ratio)was(0.52 ＋0.038)%(0.492-0.634)in the A group(0.41 + 0.08)(0.314~0.532)(T=4.2474,P<0.001)in the B group(T=4.2474,P<0.001),indicating that the compression degree of the spinal cord in the B group was less than that in the decompression group.But the A group(decompression group)had less spinal cord compression or had been exposed to compression.P<0.001,the difference was statistically significant.The above data prove the rationality of group A(decompression group)and group B(decompression insufficiency group).Then we use this group to assume that the degree of decompression of the spinal cord in the group A(decompression filling group)is sufficient and the degree of decompression in the patients in the group B(less decompression group)is insufficient.The spinal compression rate(spinal cord compression ratio)was taken into 48 patients,and receiver operating characteristic curve were drawn(ROC).The truncation point was 0.480 with the receiver operating characteristic curve,ROC curve,and the sensitivity was 0.784 and the specificity was 1.It was proved that when the intraoperative spinal cord compression ratio was 0.480,78.4%of all the patients with full decompression were from the A group(decompression filling group),and the remaining 21.6%were from the B group(the hypobaric group),and]00%of the patients were from the B group(the decompression group).Therefore,only in the group of B(spinal cord compression ratio)less than 0.480 of the intraoperative B group(less decompression group),a combined anterior cervical operation is required.Conclusions:1.Intraoperative ultrasound technique,in the process of cervical posterior longitudinal ligament ossification,can evaluate cervical posterior laminoplasty efficiently and intuitively.The decompression of spinal nerve in the operation can guide the range of decompression and evaluate the prognosis of the operation.2.When the compression ratio of spinal cord is less than 0.480,the possibility of spinal cord decompression is not enough.Intraoperative decompression should be combined with anterior approach. |
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