课件：颈椎后纵韧带骨化.pptVIP

A full analysis of the advantages and disadvantages between laminoplasty compared with laminectomy and fusion has been discussed elsewhere Our preference is to use laminectomy and fusion for OPLL because the retained cervical motion with laminoplasty may allow disease progression,and the risk for progression to kyphosis at the affected levels is eliminated with fusion For severe disease, recovery rates after posterior decompression appear to be lower than those following anterior decompression, but with a lower complication rate Iwasaki et al retrospectively compared the results of anterior decompression and fusion with those of laminoplasty; they reported better outcomes after anterior surgery in patients with an OPLL mass occupying ＞60% of the canal; however,it results in a reoperation rate of 26% versus 2% in the laminoplasty group. With＜60% canal occupancy,recovery rates were equivalent. A prospective comparison of anterior decompression and fusion versus laminoplasty found similar results. Patients with ＞50% canal occupancy had superior recovery rates with anterior surgery but equivalentrates with ＜50% involvement Patients with ＜5°of cervical lordosis also had significantly worse outcomes from laminoplasty, and 50% lost lordosis versus none in the fusion group.Half of the laminoplasty patients experienced OPLL progression versusonly one after anterior surgery However, surgical complications heavily favored laminoplasty, with a 23% complication rate and a 14% reoperation rate in the anterior group and none in the laminoplasty patients Only one study to date has examined the results of laminectomy and fusion for OPLL. Chen et al reported a mean recovery rate of 62% at 5 years among 83 patients who underwent instrumented laminectomy and fusion from C2 or C3 to C7. Patients with a good outcome had significantly more postoperative lordosis (16.1° versus10.4°). No other factors, including occupying ratio, were significant between groups. The reoperation rate was 4%