一期前后联合手术治疗严重颈椎后纵韧带骨化症

目的　评价一期前后联合手术治疗严重颈椎后纵韧带骨化症的疗效和可行性。方法　采用一期前后联合手术减压内固定治疗颈椎OPLL 12例 ,连续型 6例 ,节段型 2例 ,混合型 4例。合并发育性椎管狭窄 10例 ,OPLL累及节段为 2～ 5节 ,平均 3.5节。前路采用Orion带锁钢板 6例 ,Zephir带锁钢板 6例 ,前路减压后采用自体骨移植 5例 ,采用钛网加自体骨移植 7例 ,后路均采用Axis钛板螺钉 ,其中采用侧块螺钉 4例 ,颈椎椎弓根螺钉 8例。结果　疗效按JOA评分标准评定。 10例患者术后第 2天诉双上肢痛感明显好转 ,手握力增加 ,术后 1周四肢肌力和肌张力均有不同程度改善 ,膝踝阵挛明显减轻 ,评分提高 3～ 6分。术后脊髓功能平均改善率为 5 5 .6 % ,1例术后出现双上肢肌力减弱 ,3周后肌力增强并超过术前水平 ,另 1例术后出现右上肢C5,6神经不全瘫 ,随访 2年恢复 ,2例术后伤口感染 ,经二次清创换药愈合。随访 3月～ 3年 ,脊髓功能平均改善率为 75 .6 %。无钢板松动 ,植骨块脱出并发症 ,经椎弓根螺钉固定者术后经斜位及CT检查发现 1例颈7椎弓根螺钉位置稍差 ,但无神经血管并发症。部分患者术后做了MRI检查 ,显示颈椎管截面积显著扩大 ,脊髓或硬膜前、后方均得到充分减压。结论　一期前后联合手术内固定治疗颈椎OPLL是一较好

Single-stage anterior-posterior decompression and stabilization for severe cervical myelopathy caused by ossification of the posterior longitudinal ligament

Objective To evaluate the applicability and safety of single-stage anterior-posterior decompression combined with the fusion and internal fixation for the severe cervical myelopathy caused by the ossification of the posterior longitudinal ligament (OPLL). Methods 12 patients involving OPLL were treated by single-stage anterior-posterior decompression and stabilization. All patients were undergone two- or three-level procedures within the range of two to five levels, and undergone the anterior cervical corpectomies, in which the allograft bone or mesh cage and plates were implanted. While undergoing the posterior approach, the lateral mass plating with autograft fusion (morselized iliac crest) was accepted in four patients and the pedicle screw plating was accepted in eight patients; the same anesthetic agent was still in effect in all patients. Results On the follow-up from three months to three years after operation,the fusion was determined to be successful in all 12 patients (100%). Clinically, there was no significant hardware complication occurred, neither the occurrence of strutting graft or mesh cage extrusion or the fracture of anterior plate or screw.Conclusions The combined single-stage anterior-posterior decompression, reconstruction, and instrumentation procedure represents a viable option in the treatment of cervical myelo-pathy caused by the ossification of the posterior longitudinal ligament. The technique provides immediate rigid stabilization of the cervical spine, preventing failure of the anterior plate or strut graft extrusion, and eliminating the needs of external immobilization after operation. Furthermore, a high rate of fusion can be achieved with this combined approach than only with the anterior approach or the posterior approach alone.