| Objective: To explore the etiology and clinical significance of axialsymptoms after posterior operative procedures for Ossification of PosteriorLongitudinal Ligament by analyzing the incidence of axial symptomsfollowed laminectomy, single open-door laminoplasty and laminectomy withlateral mass screw fixation. Long-term neck and shoulder pain, muscle spasmand limitation of cervical motion, obvious tenderness and muscle cramps inphysical examination, which is defined as axial symptoms, is a commonsymptom in routine work. Many influencing factors are reported to be withassociation with the incidence of axial symptoms, such as age, the severity ofpreoperative axial symptoms, choice of surgery, intra-operative blood loss,surgery time, postoperative treatment and so on. But there in no consensus onthe exact causes of the disease, so its corresponding treatment and preventionstrategy remains to be further analyzed. In this study, we divided axialsymptoms into early and late stages based on the duration of the axialsymptoms. We tried to explore the etiology and its corresponding treatmentand prevention strategy of axial symptoms by studying incidence of axialsymptoms and its associated influencing factors followed laminectomy, singleopen-door laminoplasty and laminectomy with lateral mass screw fixation.Methods: From Feb2005to Feb2010,76patients with Ossification ofPosterior Longitudinal Ligament treated in the third hospital of hebei medicaluniversity were retrospectively reviewed. Pre-operative CT confirmed thepatients experienced three or three above segments of posterior longitudinalligament ossification (continuous or hybrid) and the surgery segments weredetermined by the compression of the spinal cord in CT and MRI. In thisstudy.19patients underwent traditional laminectomy,7M and12F, with ageof49to68y(the mean age of58.0y);33patients received single open-door laminoplasty,15M and18F, with age of51to66y(the mean age of57.2y);24patients underwent laminectomy with lateral mass screw fixation,15Mand9F, with age of53to74(the mean age of61.7y). we evaluated thechanges of cervical curvature in preoperative, postoperative and follow upwith help of Cervical Curvature Index(CCI), we evaluated the changes ofneurologic status in preoperative, postoperative and follow up with help ofJapanese Orthopaedic Association Scores (JOA), we evaluated the severity ofaxial symptom to three degrees according to the treatment choice, severe pain:requiring regular oral medication or injection of anesthetic;2. median pain:always need physical therapy, such as hyperthermia;3. mild pain: neck orshoulder pain but no treatment needed. We defined early AS as median orsevere pain at3-month follow up and defined late AS as median or severe painat12-month follow up. All data were analyzed by Statistical Product andService Solutions version13.0software (SPSS13.0), The incidence of earlyand late AS among three groups were compared using χ2-test; recovery rateof JOA score, age, duration, operation time, blood loss, CCI were comparedusing Analysis of Variance (ANOVA), Tukey’s multiple comparison test wasused for post hoc analysis, Probability values less than0.05were consideredsignificant difference in this study.Results: All patients were followed up and the final follow-up rangefrom14to35months.(with the average of21±5.2months). Age, duration,operation time, amount of bleeding was of no significant difference amongthree groups (p>0.05), In the three month follow up, Loss of cervical curvatureindex was (0.2±0.1)%in group laminectomy,(0.4±0.2)%in grouplaminoplasty and (0.4±0.1)%in group laminectomy with lateral mass screwfixation, there was no significant difference among the three groups(p>0.05).The average JOA recovery rate was29.2%for group laminectomy，30.0%forgroup laminoplasty and30.2%for group laminectomy with lateral mass screwfixation, there was no significant difference in JOA recovery rate among thethree groups(p>0.05). The rate of early evident axial symptoms was36.8%ingroup laminectomy,30.3%in group laminoplasty and33.3%in group laminectomy with lateral mass screw fixation, there was no significantdifference among the three groups(p>0.05). In the one year follow up, Lossof cervical curvature index was (4.2±1.7)%in group laminectomy,(2.9±2.2)%in group laminoplasty and (2.3±1.9)%in group laminectomy withlateral mass screw fixation, there was significant difference among the threegroups(F=117.5, p＜0.01). There was no significant difference betweenlaminectomy with lateral mass screw fixation and laminoplasty, but being ofsignificant difference between laminectomy and laminoplasty (q=2.94,p<0.01), between laminectomy and laminectomy with lateral mass screwfixation (q=4.23, p<0.01). The average JOA recovery rate was58.3%in grouplaminectomy，64.3%in group laminoplasty and66.7%in group laminectomywith lateral mass screw fixation, there was no significant difference in JOArecovery rate among the three groups(p>0.05). The incidence of late evidentaxial symptoms was26.3%in group laminectomy,12.1%in grouplaminoplasty and8.3%in group laminectomy with lateral mass screw fixation,the difference was not significant between group laminoplasty andlaminectomy with lateral mass screw fixation (p>0.05). but of statisticaldifference between group laminectomy and laminoplasty(X2=6.368，p <0.01),group laminectomy and laminectomy with lateral mass screw fixation(X2=11.481，p<0.01). There was no cerebrospinal fluid leakage or spinalhematoma occurred in all the patients. Cervical five paralysis of zero inlaminectomy, one in laminoplasty, two in laminectomy with lateral massscrew fixation, with administration of neurotrophic drugs, all of five patientsrecovered as strength of deltoid muscle reached almost degree four in thetwelve month follow up. No kyphotic deformity in the group laminectomy, No"Close Door" phenomenon in group laminoplasty and No internal failure ingroup laminectomy with lateral mass screw fixation.Conclusion: The incidence of early axial symptoms is of no significantdifference among the three groups, which may be associated with thesimilarity of postoperative edema and muscle adhesion in the three groups.The incidence of late axial symptoms are higher in the laminectomy than other groups, which may be associated with loss of cervical lordosis caused bydestroy of surgery to the spine and the increase of posterior stress, accelerateddegeneration of the muscles, ligaments and joints. |
PDF Full Text Request