opll颈椎后纵韧带骨化ppt课件.ppt

Take Home Messages Thank You ! Exposure is provided by the standard Smith-Robinson approach, and diskectomy, hemicorpectomy,or subtotal corpectomy sufficient to allow exposure of the underlying OPLL mass is performed Corpectomies of up to five levels have been performed with success,but removal of three or more contiguous levels is associated with increased complication and reoperation rates Complications occur as part of the approach (eg, dysphagia, dysphonia), the decompression (eg, C5 palsy, dural tears), or the fusion (eg,graft subsidence, pseudarthrosis) Nerve root palsies occur in 4% to 17% of patients through either direct trauma or traction.Patients present with weakness, numbness,pain, or paresthesias, most commonly in the C5 distribution Dural tears occur in 4% to 20% of patients, often because of dural ossification or attenuation.Cerebrospinal fluid leakage may result in pseudomeningocele or fistula formation, leading to neural damage, airway compression,meningitis, or wound complications Tears recognized intraoperatively are treated by direct repair or by application of autogenous fascial or synthetic collagen grafts. Closure of pinhole defects or augmentation of repairs is done with thrombogenic sealants, such as fibrin glue or gelatin foam. Postoperatively, diverting lumbar drains and bed rest can be used In an effort to reduce dural tear rates, Yamaura et al introduced the“anterior floating method” for cervical decompression, consisting of subtotal vertebral body resection and thinning, but not removal, of the OPLL. The posterior vertebral body is not reconstructed, allowing the OPLL to “float” anteriorly and away from the spinal canal. At 5-year follow-up, the authors achieved a mean recovery rate of 68.5% and improvement in Japanese Orthopaedic Association scores from 8.3 to 14.2. No leaks of cerebrospinal fluid occurred, but 14% of patients were left with an inadequate decompression. In these patients,or with OPLL progression, the authors recommend