62 - A comparative study of three surgical methods for the treatment of long-segment OPLL of the cervical spine

Objective: To compare the effectiveness of three surgical methods in the treatment of long-segment OPLL.

Methods: A total of 58 patients with long-segment OPLL admitted to our hospital from January 2018 to August 2021 were selected, and the general data (including gender, age, etc.) of the selected patients were collected. The subjects were divided into the spinal endoscopy group, the posterior cervical open-door surgery group, and the posterior cervical laminectomy group.Preoperative cervical X-ray, CT, and MRI examination showed 3 segments cervical spinal cord compression and 3 segments requiring surgical treatment. The operation time, intraoperative blood loss and hospitalization time were recorded and compared among the three groups. The JOA score, NDI score, cervical curvature index (CCI), and range of motion (ROM) before and after the operation were recorded.

Results: 1. 13 patients in the endoscopic group, aged (62.92±11.59) years old; There were 30 patients in the open-door group, aged (62.17±20.14) years. There were 15 cases in the posterior cervical laminectomy group, aged (63.47±9.82) years.
2. The average operation time of the endoscopic group (233.12±77.82) min was significantly longer than that of the open-door group (127.79±45.18) and the posterior cervical laminectomy group (138.24±31.38).
The average blood loss was 66.67±15.17 ml in the endoscopic group. The average hospital stay was (6.17±1.85) days. The average intraoperative blood loss was (170.29 ±80.28) ml and the average hospital stay was (8.71 ± 2.14) days in the open-door group. The average intraoperative blood loss was (220.29 ±105.58) ml and the average hospitalization time was (10.43 ± 3.45) days in the posterior cervical laminectomy group. The comparison of the three groups was as follows: spinal endoscopy group < posterior cervical open-door group < posterior cervical laminectomy group (P < 0.05).
3. The preoperative JOA scores were 9.25±3.91, 10.32±2.17, and 10.12±2.30 in the endoscopic group, open-door group, and posterior cervical laminectomy group, respectively. Postoperative JOA scores were 14.77±2.13, 15.23±1.66, and 14.45±0.74, respectively. The preoperative NDI scores were 26.61±12.88, 28.16±6.17 and 27.43 ±4.33, and the postoperative NDI scores were 11.12±10.85, 11.25±11.25 and 11.45, respectively There was no significant difference in JOA and NDI scores among the three groups at the same time (P > 0.05), but not in different time. The JOA scores at the last follow-up after the operation were significantly higher than those before the operation, and the NDI scores were significantly lower than those before the operation.
4. The ROM at the last follow-up was lost when compared with that before the operation in the three groups, and the loss degree of the three groups was as follows: endoscopy group < posterior cervical open-door group < posterior cervical laminectomy group (P < 0.05). The CCI of the three groups was lower than that before the operation (P < 0.05.

Conclusion: The three surgical procedures have some differences in the treatment of long-segment OPLL, but the short - and mid-term clinical outcomes are similar.