Summary
The authors reviewed 85 patients who had undergone anterior decompression and cervical fusion for myeloradiculopathy due to ossification of the posterior longitudinal ligament. There were 72 males and 13 females; the average follow up was for 8.3 years. Sixteen patients (group I) underwent one vertebra subtotal spondylectomy with fusion, 58 (group II) two vertebra subtotal spondylectomy, and 11 (group III) three vertebra subtotal spondylectomy. Neurological recovery was assessed on the grading system of the Japanese Orthopaedic Association. The patients in group I had an average improvement of 75%, in group II 72% and in group III 23%. The severity of compromise of the spinal cord did not affect the post-operative improvement. Duration of disease, previous injury and advanced neurological symptoms all affected neurological recovery. Spondylectomy of at most two vertebrae, with fusion, is recommended for ossification of the posterior longitudinal ligament. If there is more extensive involvement laminoplasty may be indicated.
Résumé
Les auteurs ont revu 85 patients qui ont bénéficié d'une décompression antérieure et d'une arthrodèse cervicale pour myéloradiculopathie consécutive à une ossification du ligament longitudinal postérieur et ils ont étudié les facteurs en relation avec la récupération neurologique. Il s'agissait de 72 hommes et de 13 femmes qui ont été suivis pendant 8.3 ans en moyenne. Seize patients (Groupe I) ont subi une spondylectomie subtotale d'une vertèbre avec arthrodèse, 58 (Groupe II) une spondylectomie subtotale de deux vertèbres et 11 (Groupe III) de trois vertèbres. La récupération neurologique a été évaluée selon la cotation en 17 points du Comité standard de l'Association orthopédique japonaise. Les patients du Groupe I ont obtenu un taux d'amélioration de 75%, ceux du Groupe II de 72% et ceux du Groupe III de 23%, ce qui est significativement moins bon. La sévérité de l'atteinte du canal vertébral par l'ossification n'a pas affecté directement le taux d'amélioration postopératoire. La durée de la maladie, un traumatisme cervical préalable, des symptômes neurologiques marqués ont influencé défavorablement le résultat neurologique. Le type d'intervention recommandé en cas d'ossification du ligament longitudinal postérieur est une spondylectomie portant sur deux vertèbres au plus, chez des patients n'ayant pas de symptômes importants. Lorsque plus de trois vertèbres sont impliquées, une autre opération telle qu'une laminoplastie peut être envisagée.
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Baba, H., Furusawa, N., Tanaka, Y. et al. Anterior decompression and fusion for cervical myeloradiculopathy secondary to ossification of the posterior ligament. International Orthopaedics 18, 204–209 (1994). https://doi.org/10.1007/BF00188323
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DOI: https://doi.org/10.1007/BF00188323