Objective To investigate the effect of the opening side selection in unilateral open-door laminoplasty (UODL) on postoperative outcomes for patients with cervical ossification of the posterior longitudinal ligament (OPLL) presenting with symptom-ossification mismatch. Methods A retrospective analysis was conducted on 89 patients with multilevel cervical OPLL presenting with symptom-ossification mismatch treated between January 2020 and January 2024. According to the opening side, 41 patients underwent laminoplasty with the opening toward the side with more severe ossification (ipsilateral group), and 48 patients toward the side with more severe symptoms and signs (contralateral group). There was no significant difference in the baseline data between groups (P>0.05), including gender, age, body mass index, disease duration, comorbidities, number and type of affected segment, and preoperative visual analogue scale (VAS) score, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, ossification length, ossification area, sagittal and coronal canal diameter, Pavlov ratio, C2-7 Cobb angle, and spinal cord diameter ratio. Perioperative parameters, changes in VAS score, NDI and JOA score, radiological parameters, and postoperative complications were analyzed. Results There was no significant difference between groups in operation time, intraoperative blood loss, or length of hospital stay (P>0.05). All patients were followed up 11-30 months (mean, 19.3 months). At last follow-up, VAS score and NDI significantly decreased and JOA score significantly increased when compared with preoperative values in both groups (P<0.05), while the changes in these clinical scores were not significantly different between the two groups (P>0.05). Radiological evaluation showed that there was no significant difference between groups in the changes of ossification length and C2-7 Cobb angle, nor in postoperative opening width and opening angle (P>0.05). However, the change in spinal cord diameter ratio differed significantly between groups (P<0.05). At last follow-up, the spinal cord posterior shift distance in the ipsilateral group was significantly more than that in the contralateral group (P<0.05). There was no significant difference between groups in the incidences of C5 nerve root palsy, axial symptoms, or the overall complications (P>0.05). Conclusion For patients with multilevel cervical OPLL with symptom-ossification mismatch, UODL provides similar improvement in clinical symptoms regardless of whether the opening side is directed toward the side with more severe ossification or toward the more symptomatic side. However, opening toward the side with more severe ossification may lead to more pronounced spinal cord morphological recovery and posterior shift, although the impact of this radiological advantage on long-term clinical outcomes requires further investigation.
Objective To compare the clinical and radiological outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and minimally invasive tubular TLIF (MT-TLIF) in treatment of lumbar degenerative diseases. Methods A clinical data of 75 patients with lumbar degenerative diseases, who met the selection criteria between August 2019 and August 2020, was retrospectively analyzed, including 35 patients in the UBE- TLIF group and 40 patients in the MT-TLIF group. There was no significant difference in general data such as gender, age, body mass index, disease type and duration, and surgical segment between the two groups (P>0.05), which was comparable. The operation time, intraoperative blood loss, hemoglobin (Hb) before operation and at 1 day after operation, the length of hospital stay, incidence of complications, and visual analogue scale (VAS) score of low back and leg pain, Oswestry Disability Index (ODI), Short-Form 36 Health Survey Scale (SF-36 scale), intervertebral disc height (IDH), sagittal Cobb angle, lumbar lordosis (LL), and the intervertebral fusion were compared between the two groups. Results Compared with MT-TLIF group, UBE-TLIF group had significantly longer operation time but less intraoperative blood loss and shorter length of hospital stay (P<0.05). The Hb levels in both groups decreased at 1 day after operation, but there was no significant difference in the difference before and after operation between the two groups (P>0.05). All patients were followed up, and the follow-up time was (14.7±2.5) months in the UBE-TLIF group and (15.0±3.4) months in the MT-TLIF group, with no significant difference (t=0.406, P=0.686). In both groups, the VAS score of low back pain, VAS score of leg pain, SF-36 scale, and ODI after operation significantly improved when compared with those before operation (P<0.05). There was no significant difference between 1 month after operation and last follow-up (P>0.05). There was no significant difference in the VAS score of low back pain, VAS score of leg pain, and SF-36 scale between the two groups before and after operation (P>0.05). At 1 month after operation, the ODI in the UBE-TLIF group was significantly better than that in the MT-TLIF group (P<0.05). At 1 month after operation, IDH, Cobb angle, and LL in both groups recovered when compared with those before operation (P<0.05), and were maintained until last follow-up (P>0.05). There was no significant difference in the IDH, Cobb angle, and LL between the two groups at each time point (P>0.05). Thirty-three cases (89.2%) in the UBE-TLIF group and 35 cases (87.5%) in the MT-TLIF group achieved fusion, and the difference was not significant (χ2=0.015, P=0.901). In the UBE-TLIF group, 1 case of intraoperative dural tear and 1 case of postoperative epidural hematoma occurred, with an incidence of 5.7%. In the MT-TLIF group, 1 case of intraoperative dural tear, 1 case of postoperative epidural hematoma, and 1 case of superficial infection of the surgical incision occurred, with an incidence of 7.5%. There was no significant difference in the incidence of complications between the two groups (χ2=1.234, P=1.000). Conclusion Compared with MT-TLIF, UBE-TILF can achieve similar interbody fusion in the treatment of lumbar degenerative diseases, and has the advantages of smaller incision, less bleeding, and shorter length of hospital stay.