Application of the "Klotski Technique" in Cervical Ossification of the Posterior Longitudinal Ligament With En Bloc Type Dura Ossification.

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Neurospine Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI:10.14245/ns.2448086.043
Jian Guan, Kang Li, Chenghua Yuan, Wanru Duan, Kai Wang, Zhenlei Liu, Zuowei Wang, Xingwen Wang, Hao Wu, Fengzeng Jian, Zan Chen
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Abstract

Objective: The anterior controllable antedisplacement and fusion (ACAF) technique is a new procedure for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) that requires management of the disc adjacent to the ossification. This study describes a novel technique to reduce the number of fixed segments, namely, the "Klotski technique." The efficacy of ACAF using the Klotski technique was compared with that of anterior cervical corpectomy and fusion (ACCF) in the treatment of OPLL with en bloc type dural ossification (DO).

Methods: The clinical data of 25 patients with severe OPLL and en bloc type DO who were treated by the ACAF Klotski technique or ACCF at our hospital from January 2020 to January 2022 were retrospectively analyzed. In the Klotski technique, the number of segments fused within the OPLL is limited. The antedisplacement space was designed according to the shape of the vertebrae-OPLL-DO complex (VODC). Then, the entire VODC was antedisplaced as in Klotski. Neurological function and image examination were assessed preoperatively and postoperatively. Complications associated with surgery were recorded.

Results: Patients were followed up for 24-36 months. There were 11 patients who were treated with ACAF and 14 patients who were treated with ACCF. At 2 weeks after surgery, the incidence of neurological deterioration was 21.4% (3 of 14) in the ACCF group and 9.1% (1 of 11) in the ACAF group. The incidence of intraoperative cerebrospinal fluid leakage (CFL) was 35.7% (5 of 14) in the ACCF group and 9.1% (1 of 11) in the ACAF group. The postoperative follow-up JOA scores of the patients in both groups were significantly better than their preoperative JOA scores (p<0.05).

Conclusion: The Klotski technique for ACAF is a good option for the treatment of patients with en bloc type OPLL-DO, as it limits the number of fused segments, has a low incidence of CFL and neurologic deficits and is associated with good neurological recovery.

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克洛茨基技术 "在颈椎后纵韧带骨化伴硬膜外骨化中的应用
目的:前路可控反移位融合术(ACAF)是一种治疗颈椎后纵韧带骨化症(OPLL)的新方法,需要对骨化症邻近的椎间盘进行处理。本研究介绍了一种减少固定节段数量的新技术,即 "Klotski技术"。在治疗伴有整块型硬脑膜骨化(DO)的 OPLL 时,比较了采用 Klotski 技术的 ACAF 与前路颈椎椎间盘切除术和融合术(ACCF)的疗效:方法:回顾性分析2020年1月至2022年1月在我院接受ACAF Klotski技术或ACCF治疗的25例重度OPLL合并硬脑膜骨化(en bloc type DO)患者的临床资料。在Klotski技术中,OPLL内融合的节段数量是有限的。根据椎体-OPLL-DO复合体(VODC)的形状设计反移位空间。然后,按照 Klotski 的方法对整个 VODC 进行反移位。对术前和术后的神经功能和图像检查进行评估。记录与手术相关的并发症:对患者进行了 24-36 个月的随访。有11名患者接受了ACAF治疗,14名患者接受了ACCF治疗。术后2周,ACCF组神经功能恶化的发生率为21.4%(14例中有3例),ACAF组为9.1%(11例中有1例)。术中脑脊液漏(CFL)的发生率在ACCF组为35.7%(14例中的5例),在ACAF组为9.1%(11例中的1例)。两组患者术后随访的 JOA 评分均明显优于术前的 JOA 评分(pConclusion):Klotski技术的ACAF是治疗全局型OPLL-DO患者的良好选择,因为它限制了融合节段的数量,CFL和神经功能缺损的发生率低,且神经功能恢复良好。
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来源期刊
Neurospine
Neurospine Multiple-
CiteScore
5.80
自引率
18.80%
发文量
93
审稿时长
10 weeks
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