Abstract:Objective To explore the clinical effect and safety of square hook knife in the resection of the longitudinal ligament after anterior decompression surgery of cervical spondylosis.Methods The clinical data of 43 cases of cervical spondylosis with square hook knife assisted cervical longitudinal ligament resection in the Department of Orthopedics of Luoyang Orthopedic Hospital of Henan Province from September 2015 to June 2017 were analyzed retrospectively. There were 23 males and 20 females with an age of 38-69 (54.2±8.3) years. According to the classification of cervical spondylosis, there were 13 patients of nerve root type, 21 patients of spinal cord type and 9 patients of mixed type. The safety, postoperative efficacy and complications of this method were also analyzed. The operative time, intraoperative blood loss, postoperative hospital stay and postoperative complications were observed. According to the Japanese Orthopaedic Association(JOA) score at the last follow-up, the improvement rate of cervical spinal cord function was calculated to evaluate the clinical efficacy.Results All patients have a smooth operation and 2 patients with cerebrospinal fluid leakage were recovered after conservative treatment. The operative time was 67-170 (102.4±20.7) minutes, the intraoperative blood loss was 50-280(160.6±51.2) mL, and the postoperative hospital stay was 5-11 (7.8±1.3) days. Of the 43 patients, 38 were followed up for 8-17 (10.5±2.1) months. No postoperative hoarseness, hematoma, infection, failure of internal fixation and other complications occurred. The preoperative JOA scores were 6-11(8.7±1.3)points, and the JOA scores were 10-17 (15.6±1.1) points at the end of follow-up. The improvement rates of cervical spinal cord function were 65.8%-93.6%(83.1%±6.8%). The curative effects were excellent in 8 patients, good in 24 patients, common in 5 patients and poor in 1 case, with an excellent rate of 84.2%.Conclusions It is safe and reliable to remove the posterior longitudinal ligament with square hook knife in anterior cervical approach, which is beneficial to the recovery of spinal cord shape and nerve function, and the clinical effect is satisfactory.
Wu D, Liu CZ, Yang H, et al. Surgical interventions for cervical spondylosis due to ossification of posterior longitudinal ligament[J]. Medicine (Baltimore), 2017, 96(33): e7590. DOI:10.1097/md.0000000000007590
[2]
Nakashima H, Tetreault L, Nagoshi N, et al. Comparison of outcomes of surgical treatment for ossification of the posterior longitudinal ligament versus other forms of degenerative cervical myelopathy: results from the prospective, multicenter AOSpine CSM-International study of 479 patients[J]. J Bone Joint Surg Am, 2016, 98(5): 370-378. DOI:10.2106/JBJS.O.00397
Du YQ, Duan WR, Chen Z, et al. Risk factors and management of dural defects in anterior surgery for cervical ossification of the posterior longitudinal ligament[J]. World Neurosurg, 2018, 111: e527-e538. DOI:10.1016/j.wneu.2017.12.113
[6]
Odate S, Shikata J, Soeda T, et al. Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament[J]. J Neurosurg Spine, 2017, 26(4): 466-473. DOI:10.3171/2016.9.SPINE16430
Avila MJ, Skoch J, Sattarov K, et al. Posterior longitudinal ligament resection or preservation in anterior cervical decompression surgery[J]. J Clin Neurosci, 2015, 22(7): 1088-1090. DOI:10.1016/j.jocn.2015.01.021
[10]
Bai C, Li K, Guo A, et al. Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy[J]. Medicine (Baltimore), 2017, 96(23): e7043. DOI:10.1097/MD.0000000000007043
[11]
Chin KR, Ghiselli G, Cumming V, et al. Postoperative magnetic resonance imaging assessment for potential compressive effects of retained posterior longitudinal ligament after anterior cervical fusions: a cross-sectional study[J]. Spine (Phila Pa 1976), 2013, 38(3): 253-256. DOI:10.1097/BRS.0b013e3182796e9c