Title : The clinical and radiological improvement comparison between anterior cervical corpectomy and fusion (ACCF) and posterior single-door laminoplasty in the treatment of cervical ossification of posterior longitudinal ligament (OPLL)
Abstract:
Objectives: To observe the mid-term clinical outcomes and radiological parameters of anterior cervical corpectomy and fusion(ACCF) and posterior single-door laminoplasty in cervical ossification of posterior longitudinal ligament(OPLL).
Methods: All 35 cervical OPLL cases(19 males, 16 females; mean age, 61.5±7.9 years; range, 53 to 72 years) treated in our department between January 2018 and December 2020 were analyzed retrospectively. 17 cases with less than 2 segments involved were treated by ACCF (group A). 18 cases with more than 2 segments involved were treated by the posterior single-door laminoplasty (group B). All patients included in the study underwent preoperative, postoperative cervical X-rays, CT and MRI examinations. Japanese Orthopaedic Association (JOA) score was used to evaluate the clinical outcomes of the two groups. Angle and canal stenosis rate before surgery and at the follow-up were analyzed. The clinical and radiographic differences between the two groups were compared using the paired t-test.
Results: The mean follow-up time in group A and B was 50.16±6.58 and 52.33±6.82 months, respectively. One case presented postoperative dysphagia in group A and recovered by self in the follow-up. One case occurred cerebrospinal fluid leakage and one case occurred postoperative wound infection in group B, they recovered by delayed drainage and placing drainage-tube respectively. The postoperative JOA score was significantly higher than the preoperative (P<0.05) in both group but showed no significant difference (P>0.05) between groups. The cervical ROM at the last follow-up decreased significantly (P<0.05) in group A but maintained in group B (P>0.05). At the last follow-up, ossified mass area was significantly higher than the postoperative in group A (P<0.05), but not in group B (P>0.05). The canal stenosis rate at the last follow-up was significantly less than the preoperative (P<0.05) in both group, and it was 12.53±4.39 in group A, significantly better than 19.45±6.18 in group B (P<0.05).
Conclusions: For cervical OPLL, the ACCF and posterior single-door laminoplasty appear to be comparably efficient and safe approaches. Posterior single-door laminoplasty is able to enlarge the canal and maintain the cervical ROM. ACCF surgery can decompress cervical canal stenosis better by removing ossified mass.
Keywords: Ossification of the posterior longitudinal ligament; Cervical surgery; Canal stenosis ratio; anterior cervical corpectomy and fusion; posterior single-door laminoplasty
