Cervical Ossification Of The Posterior Longitudinal Ligament Anterior And Posterior The Comparative Analysis Of Surgical Treatment And Its Complications

Objective:Cervical ossification of the posterior longitudinal ligament( OPLL), mainly in the 50 to 60 years old, the incidence rate of the cervical disease 0.2% to 4% because of the high incidence of disease in the Japanese in itknown as the "Japanese disease."Cervical ossification of the posterior longitudinal ligament in cervical heterotopic ossification of the posterior longitudinal ligament is characterized by the formation of foci, has become a cause of cervical spinal cord of the important reasons.Patients because of the degree of nerve root or spinal cord compression can be expressed in different time and mild to severe symptoms of nerve damage may also be without neurological symptoms.Although the presence of clinical symptoms of severe nerve damage has become a common surgical treatment is required, but which one is most effective and safe surgical procedure is still a vexed issue.We examined the effects of two different surgical treatment of cervical ossification of posterior longitudinal ligament of the effect of surgery, the choice of surgical approach, and the cervical spinal cord MRI T2 high signal on the prognosis.Methods:Retrospective analysis of January 2008 ~ November 2010 in Shandong University of Traditional Chinese Medicine Hospital of surgical treatment for OPLL, and a complete follow-up data of 30 patients, including 20 males and 10 females, 15 with anterior surgerycases, posterior surgery in 15 cases.Determined according to the Japanese Orthopaedic Association scoring (JOA score standard), and preoperative JOA score of postoperative neurological function and surgical complications of Statistics.Also calculated rates of neurological function (nerve function improvement rate = (postoperative score - preoperative score) / (17 - preoperative score)×100%).Divided into four levels according to the improvement rate effect, excellent: more than 75% improvement, good: to improve the rate of 50% ~ 74%, can be: to improve the rate of 25% ~ 49%, poor: improving the rate of 25% or less.Statistics of patients before surgery, the end of l week and follow-up JOA score, postoperative improvement rate were calculated, statistical complications, analyze and compare two different procedures for the treatment; according to whether preoperativeMRI T2 high cervicalsignal will be divided into two groups, postoperative improvement rate between the two groups whether the differences, which determine the preoperative cervical spinal cord MRI T2 high signal on the prognosis.Result:Anterior preoperative JOA score was 9.80±1.08 minutes, after an average follow-up, 15.67±0.90 min; posterior surgery preoperative JOA score was 9.07±1.28 points, after an average follow-up, 15.00±1.41 points; two groups of patients were compared with the preoperative JOA score significantly improved, differences were statistically significant.The average improvement rate of anterior (81.68±11.10)%, the average improvement rate of posterior surgery (75.75±16.82)%, anterior surgery is not better than the posterior surgery, withoutdifference was not statistically significant; preoperative cervical spinal cord MRI T2 high signal group, the average improvement rate (70.22±13.37)%, no cervical spinal cord MRI T2 high signal group, the average improvement rate (85.96±11.54)%, a statistically significant difference; intraoperative anterior cerebrospinal fluid leakage in 1 case, recurrent laryngeal nerve injury in 1 case, 1 case of loosening of internal fixation; posterior axis of symptoms occurred in 1 case, C5 nerve root palsy1 case of hematoma formation in 1 case, 1 case of wound fat liquefaction.Conclusion:1.According to the specific circumstances of patients choose the appropriate surgical approach, two procedures are given a good effect; 2. Long-term follow-up to improve the rate of anterior and posterior surgical procedure no difference; 3. Adequate preoperative preparation, the correct and careful technique to operate and improve the postoperative care is to reduce complications and improve the efficacy of the important measures; 4. MRIT2 preoperative spinal cord high signal improvement rate after operation than those who have MRIT2 high signal spinal cord, spinal cord signal change on the prognosis has some value.