Abstract
ObjectivesThis study aimed to investigate the effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL.MethodsIn this study, 194 patients, who underwent open-door laminoplasty for cervical OPLL from January 2009 to January 2016, were retrospectively reviewed. The Patient Satisfaction Index (PSI) was collected at discharge, 6 months, 1 year, and the last follow-up. According to the PSI, patients were divided into satisfied group and dissatisfied group. The possible effect factors included demographic variables and surgery-related variables.ResultsAt discharge, 42 (21.6%) patients were in the dissatisfied group, as compared to the satisfied group, the hospitalization cost, hospital stay, postoperative depression, the axial neck pain, delayed wound healing, and VAS-neck had significant statistical differences. At 6-month follow-up, 25 (12.9%) patients were in the dissatisfied group. The axial neck pain and JOA score had significant statistical differences between the two groups, and no significant differences were found between the two groups in other items. At 1 year with 18 (9.3%) dissatisfied patients and last follow-up with 14 (7.2%) dissatisfied patients, the JOA score and symptom recurrence had significant statistical differences. For further analysis, the dissatisfied patients with axial neck pain at 6 months were significantly higher than that at other terms and the JOA score of the two groups increased gradually with prolonging of restoration years but compared with the dissatisfied group, the JOA scores were obviously better in the satisfied group at the last follow-up.ConclusionsOverall, to patients undergoing open-door laminoplasty for cervical OPLL, hospitalization cost and neck pain might be mainly associated with patient dissatisfaction at the early and middle recovery. Patient dissatisfaction at the long-term treatment outcome might be mainly associated with the low improvement rate of JOA score and symptom recurrence.
Highlights
Ossification of the posterior longitudinal ligament (OPLL) is a heterotropic ossification that occupies the spinal canal and causes myelopathy
While there were 42 (21.6%) patients that are still not comfortable with their short-term outcomes and 14 (7.2%) patients with their long-term outcomes according to the Patient Satisfaction Index (PSI) evaluation reminding that appropriate surgical indications and surgical timing associated with myelopathy symptoms remain to be clearly identified
The results of our study indicated that neck pain might be associated with patient dissatisfaction in the early and middle recovery
Summary
Ossification of the posterior longitudinal ligament (OPLL) is a heterotropic ossification that occupies the spinal canal and causes myelopathy. OPLL is a common cause of myelopathy in patients older than 55 years of age [1, 2]. For cases with cervical myelopathy due to OPLL, surgery treatment, including anterior cervical corpectomy and fusion (ACCF), anterior cervical discectomy and fusion (ACDF), laminoplasty (LP), and laminectomy arthrodesis with or without instrumentation, can provide direct ossification resection or indirect decompression [3,4,5]. Due to technically demanding and higher potential risk of complications such as nonunion, dislodgment of grafts, dural tears and neurological deterioration of anterior surgery, laminoplasty is still the most widely used procedure in the treatment of C-OPLL
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