Ten-Year Follow-up of Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-09-04 Epub Date: 2024-08-05 DOI:10.2106/JBJS.23.01475

Sadayuki Ito, Hiroaki Nakashima, Naoki Segi, Jun Ouchida, Ryotaro Oishi, Ippei Yamauchi, Yuichi Miyairi, Yoshinori Morita, Yukihito Ode, Shiro Imagama

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引用次数: 0

Abstract

Background: We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL).

Methods: We retrospectively evaluated 51 patients followed for ≥10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression.

Results: A significant improvement was observed in the JOA score from preoperatively (3.7) to 2 years postoperatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 preoperatively to 0.68 at 10 years postoperatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from preoperatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after 2 years. Fourteen (27.5%) of the patients experienced postoperative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade.

Conclusions: Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years.

Level of evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

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胸椎后纵韧带骨化的后方减压和融合手术十年随访》（Posterior Decompression and Fusion Surgery for Thoracic Ossification of Posterior Longitudinal Ligament）。

背景：我们评估了胸椎后纵韧带骨化（T-OPLL）手术治疗的临床、功能和生活质量（QoL）：我们评估了胸椎后纵韧带骨化症（T-OPLL）手术治疗的临床、功能和生活质量（QoL）结果：我们对 51 名 T-OPLL 后路减压和矫正融合手术后随访≥10 年的患者进行了回顾性评估。收集的数据包括人口统计学、合并症、术前和术后症状。日本骨科协会（JOA）评分、腰腿痛数字评分量表（NRS）和欧洲量表（EQ-5D-5L）用于评估神经功能、疼痛和生活质量。此外，还进行了影像学评估，以评估畸形角的变化和骨化进展：从术前（3.7）到术后两年（7.9），JOA评分有了明显改善（P < 0.05）；此后评分保持稳定。EQ-5D-5L 平均得分从术前的 0.53 提高到术后 10 年的 0.68（p < 0.001）。背部和腿部疼痛的 NRS 评分分别从术前的 5.4 分降至 3.5 分和 4.0 分降至 3.0 分（均 p < 0.001）。影像学结果显示，畸形角度和骨化区域发生了变化，2年后无明显进展。14名患者（27.5%）出现了术后并发症。其中，8 例（15.7%）需要再次手术，6 例（11.8%）在围手术期，2 例（3.9%）在术后。有 4 名患者（7.8%）因腰椎管狭窄和颈椎 OPLL 等疾病接受了额外手术。尽管如此，所有出现术后并发症或接受额外手术的病例的身体功能在这十年间都保持稳定：结论：T-OPLL 的手术治疗能有效改善神经功能、生活质量并长期控制疼痛。T-OPLL手术的长期疗效表明，虽然颈椎和腰椎病变导致了再次手术，但并不影响生活质量，而且即使在10年后，相对改善仍能保持：证据级别：治疗四级。有关证据级别的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.