28. 颈椎OPLL手术后的矛盾结果：分析神经恢复与持续疼痛的原因

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100722

Sunjoon Yoo MD

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引用次数: 0

摘要

背景背景/目的后纵韧带骨化（OPLL）手术广泛采用前路、后路或联合入路。OPLL手术的主要目的是对受压的脊髓进行减压，从而改善麻痹和麻木等神经系统症状。虽然这些手术通常会改善神经系统的预后，如日本骨科协会（JOA）评分等指标所反映的那样，但一些患者在术后继续经历持续或恶化的颈部或手臂疼痛。本研究旨在分析颈椎OPLL手术后尽管神经预后改善，但疼痛持续或恶化的潜在原因。研究设计/设置：回顾性队列研究。患者SAMPLEA回顾性队列分析了242例在我院接受手术治疗的颈椎OPLL患者。根据术后疼痛结果将患者分为两组：1组（n = 208，改善视觉模拟量表（VAS）评分）和2组（n = 34，VAS评分不变或恶化）。分析的变量包括人口统计学因素（年龄、性别）、临床特征（骨密度、体重指数、症状持续时间、合并症）、手术参数(手术技术：前路融合、椎板成形术、后路融合；手术水平、手术时间、出血量)和放射学因素（OPLL类型、k线分类、占位率和其他放射学特征）。对连续变量使用t检验，对分类变量使用卡方检验进行统计分析，并使用逻辑回归来确定持续或恶化的术后疼痛的独立预测因素。结果在242例患者中，第2组与女性（p = 0.0009）、后路融合作为手术技术（p = 0.00003）、术前VAS评分较高（p = 0.0295）相关。Logistic回归确定女性性别(OR = 2.1,95% CI: 1.3-3.4, p <；0.01)，后路融合(OR = 3.8,95% CI: 2.1-7.0, p <；0.001)和术前VAS评分（OR = 1.1 /单位增加，95% CI: 1.02-1.15, p = 0.03）作为持续或恶化疼痛的独立预测因子。结论OPLL患者术后VAS评分持续或恶化与女性、后路融合及术前VAS评分较高相关。这些发现表明，量身定制的手术策略和术前咨询可能是改善该亚组疼痛结局的必要条件。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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28. Paradoxical outcomes after cervical OPLL surgery: analyzing the causes of neurological recovery with persistent pain

BACKGROUND CONTEXT

N/A

PURPOSE

Cervical ossification of posterior longitudinal ligament (OPLL) surgery is widely performed using anterior, posterior, or combined approaches. The primary goal of OPLL surgery is to decompress the spinal cord, which is under compression, thereby improving neurological symptoms such as paralysis and numbness. While these surgeries often result in improved neurological outcomes, as reflected by measures like the Japanese Orthopedic Association (JOA) score, some patients continue to experience persistent or worsening pain in the neck or arms postoperatively. This study aims to analyze the underlying causes of persistent or worsening pain despite improved neurological outcomes following cervical OPLL surgery.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

A retrospective cohort analysis was conducted on 242 patients with cervical OPLL who underwent surgical intervention at our institution.

OUTCOME MEASURES

N/A

METHODS

Patients were categorized into two groups based on postoperative pain outcomes: Group 1 (n = 208, improved visual analog scale (VAS) scores) and Group 2 (n = 34, unchanged or worsened VAS scores). The variables analyzed included demographic factors (age, sex), clinical characteristics (bone mineral density [BMD], body mass index [BMI], symptom duration, comorbid diseases), surgical parameters (surgical technique: anterior fusion, laminoplasty, posterior fusion; number of surgical levels, operative time, blood loss), and radiological factors (OPLL type, K-line classification, occupying ratio, and other radiological characteristics). Statistical analyses were performed using t-tests for continuous variables and chi-squared tests for categorical variables, with logistic regression employed to identify independent predictors of persistent or worsening postoperative pain.

RESULTS

Among the 242 patients analyzed, Group 2 was significantly associated with female sex (p = 0.0009), posterior fusion as the surgical technique (p = 0.00003), and higher preoperative VAS scores (p = 0.0295). Logistic regression identified female sex (OR = 2.1, 95% CI: 1.3–3.4, p < 0.01), posterior fusion (OR = 3.8, 95% CI: 2.1–7.0, p < 0.001), and preoperative VAS scores (OR = 1.1 per unit increase, 95% CI: 1.02–1.15, p = 0.03) as independent predictors of persistent or worsening pain.

CONCLUSIONS

Persistent or worsening postoperative VAS scores in OPLL patients are significantly associated with female sex, posterior fusion and higher preoperative VAS scores. These findings suggest that tailored surgical strategies and preoperative counseling may be necessary to improve pain outcomes in this subgroup.