颈椎病合并颈椎后纵韧带骨化症的前路手术治疗

Anterior decompression for the treatment of cervical spondylotic myelopathy associated with ossification of posterior longitudinal ligament

目的探讨颈椎病合并颈椎后纵韧带骨化症（OPLL）前路切除减压的方法及其临床效果。方法采用颈椎前路减压治疗颈椎病合并颈椎OPLL患者61例，其中男42例，女19例，平均57岁（45～74岁）。术前明确诊断颈椎病合并OPLL者49例，术中发现合并有OPLL者12例。OPLL椎管狭窄率32％～70％，平均52％。神经功能JOA评分术前4～14分，平均9．6分。手术在常规颈前路经椎间隙或椎体次全切除减压的基础上，切除骨化后纵韧带彻底减压。结果本组41例患者采用前路椎体次全切除减压，6例经椎间隙扩大减压，14例采用椎体次全切除结合经椎间隙减压的手术方式。所有患者随访6个月～3年，平均16个月。术后JOA评分8—16分，平均12．8分，神经功能恢复率25．0％～87．5％，平均65．2％。5例患者术后并发脑脊液漏，经保守治疗后均获得痊愈，无1例出现脊髓功能损害加重。结论颈椎病合并颈椎OPLL增加了手术难度和风险，在颈椎前路常规减压的基础上再将骨化的后纵韧带切除，保证了前路减压的彻底性，可提高手术治疗效果。

Objective To study the technique and effect of anterior decompression for the treatment of cervical spondylotic myelopathy associated with ossification of posterior longitudinal ligament （ OPLL ）. Method Sixty-one patients （42 male and 19 female, 45-74 years with mean age of 57 years old） underwent anterior decompression for the treatment of cervical spondylotic myelopathy associated with OPLL. Among them, OPLL was definitely diagnosed in 49 patients preoperatively, and was found during the operation in the other 12 patients. The occupying rate of OPLL ranged 32% -70% with an average of 52%. The preoperative JOA scores ranged 4-14 points with an average of 9.6 points. In additional to conventional decompression, the ossification was removed completely after discectomy and corpectomy. Results Corpectomy was performed in 41 cases, discectomy in 6 cases and combination of corpectomy and discectomy in 14 cases. The follow-up of all patients ranged from 6 to 36 months （mean 16 months）. The postoperative JOA scores ranged 8-16 points with an average of 12. 8 points. The neurological improvement rate ranged from 25.0% to 87.5% with an average of 65.2%. The transient leakage of cerebrospinal fluid （CSF） occurred in 5 cases, and stopped after conservational treatment. No neurological deterioration developed. Conclusions The difficulty and risk of anterior decompression are significantly increased in the patients with cervical spondylotic myelopathy associated with OPLL. Remove of ossification after corpectomy and discectomy could provide complete decompression and better results.