| ObjectiveTo explore the efficacy of anterior and posterior surgery in the treatment of mixed posterior longitudinal ligament ossification,and analyze the risk factors that affect the treatment effect.MethodsA retrospective analysis of the data of 26 patients with mixed cervical posterior longitudinal ligament ossification(12 cases in the anterior surgery group and 14 cases in the posterior surgery group)who were surgically treated in our department from February 2016 to February 2019 was retrospectively analyzed.The anterior approach group was designated as group A,and the posterior approach group was designated as group B.The general information,intraoperative conditions and hospital stay of the two groups were compared.After at least 2 years of follow-up,the patients were collected postoperative cervical curvature,JOA neurological function score,Nurick classification,VAS score,neurological improvement rate(IR)and the occurrence of complications.SPSS 21.0 software was used for statistical analysis.According to different data types,paired t test or Wilcoxon signed rank test was used for intra-group comparison.The two independent sample t test or Mann-Whitney U rank sum test was used for comparison between the two groups.Fisher’s exact probability method is used to compare count data.Finally,the two groups of cases were combined to analyze the related factors that caused the poor prognosis of the patients.Then subjected to single-factor regression analysis,and then the significant independent variables were incorporated into the multiple linear regression analysis through the stepwise method.P<0.05 was considered statistically significant.ResultsThere was no statistically significant difference in the preoperative general data of the two groups of patients(P>0.05).The average operation time of group A was longer than that of group B,while the amount of blood loss and hospitalization time during operation were less than that of group B,the difference was significant(P<0.05).Comparison within the postoperative group:The cervical curvature,JOA score,Nurick classification and VAS score of group A at 1 week and 2 years after operation were significantly different from those before operation(P<0.05);group B was 1 week after operation.The JOA score,Nurick grading and VAS score of the week and 2 years after the operation were significantly different from those before the operation(P<0.05),but the difference in cervical spine curvature was not statistically significant(P>0.05).Comparison between groups after operation:The change in cervical curvature,VAS score,IR and JOA score at 1 week after operation were significantly different at different time nodes after operation(P<0.05).Among them,IR was higher in group B than group A in the early stage.Long-term group A is higher than group B.There was no significant difference between the Nurick grading at different time points after the operation and the JOA score at 2 years after the operation(P>0.05).The patient’s age of onset,preoperative course of disease,spinal canal occupancy rate≥50%,and diabetes mellitus are negatively correlated with prognostic efficacy.In group A,there were 2 cases of dural tear during the operation,and 1 case of dysphagia and coughing symptoms,and recovered spontaneously one week after the operation.There were 4 cases of axial pain in group B,of which 3 cases gradually improved,and 1 case still had axial symptoms during the 2-year follow-up.Conclusion1.For patients with mixed cervical spine OPLL,both anterior and posterior surgery can effectively improve the symptoms of patients.The posterior group has a significant early effect,while the long-term effect is better in the anterior group.In addition,anterior surgery can effectively restore the physiological curvature of the cervical spine and improve axial symptoms.2.Important risk factors affecting the prognosis of patients with mixed cervical OPLL are age,preoperative course of disease,spinal canal occupying rate≥50%,and diabetes... |
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