1
|
Wu Z, Wang W, Zhou F, Xiang P, Li Y, Yang H, Chu G. Comparative analysis of risk factors associated with degeneration of adjacent segments: zero-profile anchored spacer vs. anterior cervical plate and cage construct. Front Med (Lausanne) 2024; 11:1375554. [PMID: 38887670 PMCID: PMC11182449 DOI: 10.3389/fmed.2024.1375554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/18/2024] [Indexed: 06/20/2024] Open
Abstract
Objective Anterior cervical discectomy and fusion (ACDF) is an established treatment for cervical degenerative disc disease, but cervical spine surgery may affect sagittal alignment parameters and induce adjacent segment degeneration (ASD). This study aimed to determine the risk factors for developing ASD following anterior cervical plate and cage (ACPC) compared with the use of zero-profile anchored spacer (ROI-C). Methods A retrospective contrastive study included 105 patients who underwent ACPC or ROI-C between January 2014 and October 2019 at our treatment centre. There were 50 cases in the ROI-C group and 55 patients in the ACPC group. Clinical and radiological results and the incidence of ASD were assessed after surgery. All patients were further divided into the ASD and non-ASD groups for subgroup analysis. Results At each follow-up time, there was no statistically significant in radiographic parameters between the two groups. The overall ASD rate was higher in the ACPC group than in the ROI-C group (65.5% vs. 44.0%, p = 0.027). The low preoperative Cobb angle, low preoperative segment angle (SA), and loss of Cobb (ΔCobb) were significantly correlated with ASD. However, clinical outcomes were not associated with ASD at any postoperative follow-up visit. Conclusion Equally good therapeutic effects were achieved with both the ROI-C and ACPC. The occurrence of ASD was considerably higher in the ACPC group than in the ROI-C group. The preoperative Cobb angle, preoperative SA, and ΔCobb were the most associated with an increase in the risk of ASD.
Collapse
Affiliation(s)
- Zhikai Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wenhao Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Feng Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Pan Xiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Orthopaedic Institute, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yangfeng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Orthopaedic Institute, Suzhou Medical College, Soochow University, Suzhou, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Orthopaedic Institute, Suzhou Medical College, Soochow University, Suzhou, China
| |
Collapse
|
2
|
Kang JH, Im SB, Jeong JH, Lee SJ, Cho SH, Hossain M. Effectiveness of nasotracheal intubation in anterior cervical surgery including C3 lesions. Br J Neurosurg 2024; 38:111-115. [PMID: 35016576 DOI: 10.1080/02688697.2021.2024504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/27/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Anterior approach cervical surgery is widely used for accessing C3 lesions. When operating with an anterior approach, the surgical field is obstructed by mandible. Neck extension is popular method to secure better surgical field but risk devastating neurological damage. To overcome this limited surgical field without neck extension, we adopted nasotracheal intubation and evaluated its efficiency. METHODS We retrospectively analyzed 16 patients who underwent anterior cervical discectomy or corpectomy of C3 lesions via nasotracheal intubation. We enrolled an additional 29 patients who underwent anterior cervical discectomy or corpectomy of C3 lesions via orotracheal intubation as a control group. All patients had been diagnosed with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. We measured the mandibular-cervical angle, which is the angle between the lower mandibular line and anterior vertebral line. RESULTS The mandibular-cervical angle was increased by 7.3 with nasotracheal intubation compared to orotracheal intubation. CONCLUSIONS Nasotracheal intubation is an effective surgical option for securing the surgical field without neck extension in anterior cervical surgery including C3 lesions.
Collapse
Affiliation(s)
- Jung Hoon Kang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Soo Bin Im
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Seong-Jong Lee
- Department of Neurosurgery, Wooridul spine Hospital, Seoul, Republic of Korea
| | - Sung-Hwan Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Mosharraf Hossain
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| |
Collapse
|
3
|
Zhang Q, Guo R, Fang S, Tong S, Fan Y, Wang J. The clinical efficacy of laminectomy fusion fixation and posterior single open-door laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL): a retrospective study. BMC Surg 2023; 23:380. [PMID: 38093252 PMCID: PMC10720063 DOI: 10.1186/s12893-023-02289-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND To compared the clinical efficacy of two surgical methods, posterior laminectomy fusion fixation, and posterior single open-door laminoplasty, in treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL). METHODS The study retrospectively included 102 patients treated between December 2016 and December 2020. The patients were included into an observation group (56 cases) treated with total laminectomy and lateral screw fixation, and a control group (46 cases) treated with single open-door laminoplasty. RESULTS After 24 months, both groups showed significant improvement in Japanese Orthopaedic Association (JOA) scores and Visual Analogue Scale (VAS) scores, indicating better clinical symptoms and functional recovery. There was no significant difference in preoperative JOA and VAS scores between the two groups (P > 0.05). At 24 months after surgery, there was no significant difference in JOA and VAS scores between the two groups (P > 0.05). However, the observation group had a significantly higher cervical curvature index (CCI) and lower range of motion (ROM) of the cervical spine compared to the control group (P < 0.05). The CCI in control group was lower than before surgery, while the CCI in observation group was higher than before surgery, and CCI in the control group was considerably lower than that in the observation group (P < 0.05). The complication rate was lower in the control group, with fewer cases of axial symptoms, fifth cervical nerve root palsy, and overall complications. The overall complication rate was 25.0% (14/56) in the observation group and 10.8% (5/46) in the control group (P < 0.05). CONCLUSIONS Both posterior laminectomy fusion fixation and posterior single open-door laminoplasty yield positive outcomes in improving clinical neurological function, cervical curvature, range of motion of the cervical spine, and cervical sagittal balance. Although open-door laminoplasty is less effective than total laminectomy in maintaining CCI and sagittal balance, it excels in preserving cervical range of motion, less surgical trauma and complications. Thus, open-door laminoplasty may be a suitable first-choice treatment for multi-segmental cervical OPLL, especially for patients with lordotic cervical spine physiological curvature.
Collapse
Affiliation(s)
- Qian Zhang
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
| | - Rudan Guo
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China.
| | - Sanhua Fang
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
| | - Shunyi Tong
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
| | - Yuan Fan
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
| | - Jun Wang
- Department of Orthopedics, Lanxi People's Hospital, No.1359 Xishan Road, Lanxi City, Jinhua City, 321000, Zhejiang Province, China
| |
Collapse
|
4
|
Morishita S, Yoshii T, Inose H, Hirai T, Yuasa M, Matsukura Y, Ogawa T, Fushimi K, Katayanagi J, Jinno T, Okawa A, Fujiwara T. Perioperative Complications of Laminoplasty in Degenerative Cervical Myelopathy -A Comparative Study Between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database. Global Spine J 2023; 13:1956-1963. [PMID: 34920676 PMCID: PMC10556883 DOI: 10.1177/21925682211063867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Laminoplasty (LAMP) is one of the effective methods to successfully achieve surgical decompression in patients with degenerative cervical myelopathy (DCM). However, little evidence exists regarding the perioperative complications in LAMP for patients with ossification of the longitudinal ligament (OPLL) compared with cervical spondylotic myelopathy (CSM). We aimed to investigate the perioperative complication rates and medical costs of DCM, including OPLL and CSM patients who underwent LAMP using a large national inpatient database. METHODS This study identified patients who underwent LAMP for OPLL and CSM from 2010 to 2016 using the Japanese Diagnosis Procedure Combination database. We compared the incidence of perioperative complications (systemic and local), reoperation rates, medical costs during hospitalization, and mortality were between the OPLL and CSM groups after propensity score matching. RESULTS This study included 22,714 patients (OPLL: 7485 patients, CSM: 15,229 patients). Consequently, 7169 pairs were matched. More perioperative systemic complications were detected in the OPLL group (one complication: 9.1% vs 7.7%; P = .002), especially for pneumonia (.5% vs .2%; P = .001) and dysphagia (.5% vs .2%; P = .004). The local complication rate was also higher in the OPLL group (paralysis: 1.1% vs .6%, P = .006; spinal fluid leakage: .4% vs .1%, P = .002). The hospitalization costs were approximately $2300 higher ($19,024 vs $16,770; P < .001) in the OPLL group. CONCLUSIONS More perioperative complications and higher medical costs were noted in patients with OPLL than in patients with CSM who underwent LAMP.
Collapse
Affiliation(s)
- Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Junya Katayanagi
- Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Tetsuya Jinno
- Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Xue HH, Tang D, Zhao WH, Chen L, Liao Z, Xue JL. Static mechanical analysis of the vertebral body after modified anterior cervical discectomy and fusion (partial vertebral osteotomy): a finite element model. J Orthop Surg Res 2023; 18:554. [PMID: 37528421 PMCID: PMC10391851 DOI: 10.1186/s13018-023-04033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Modified anterior cervical discectomy and fusion (Mod ACDF) can effectively address ossification of the posterior longitudinal ligament (OPLL), which is difficult to remove directly from the posterior edge of the vertebral body, with considerably lesser damage as compared to anterior cervical corpectomy and fusion (ACCF). We compared the static mechanics of different anterior approaches by using an ideal finite element model. METHODS A complete finite element model was established and classified into the following three surgical models according to different model cutting operations: ACDF, ACCF, and Mod ACDF. Three different bone volume situations (normal bone mineral density, osteopenia, and osteoporosis) were simulated. After fixing the lower surface of C5 or C6, a load was applied to the upper surface of C4, and the stress distribution and displacement of the upper surface of C5 or C6 were observed and the related values were recorded. RESULTS The average Von Mises Stress and displacement levels of Mod ACDF were between those of ACDF and ACCF; with the peak Von Mises Stress occurring on the posterior side of the vertebral body (Points 1-4). The change in Von Mises Stress of the vertebral body is not significant during bone loss. However, the degree of displacement of the vertebral body surface and risk of vertebral collapse are increased (100 N: 13.91 vs. 19.47 vs. 21.62 μm; 150 N: 19.60 vs. 29.30 vs. 31.64 μm; 200 N: 28.53 vs. 38.65 vs. 44.83 μm). CONCLUSIONS The static biomechanical effects caused by Mod ACDF are intermediate between ACDF and ACCF, and the risk of vertebral body collapse is lower than that by ACCF. Therefore, Mod ACDF may be an effective solution when targeting OPLL with poorly positioned posterior vertebral body edges.
Collapse
Affiliation(s)
- Huo-huo Xue
- Department of Spine Surgery, Fuzhou Second Hospital, 350007 Fuzhou, China
| | - Dian Tang
- Department of Spine Surgery, Fuzhou Second Hospital, 350007 Fuzhou, China
| | - Wen-han Zhao
- Fujian Medical University Union Hospital, Fuzhou, 350100 China
| | - Liang Chen
- Fujian Medical University Union Hospital, Fuzhou, 350100 China
| | - Zhong Liao
- Department of Spine Surgery, Fuzhou Second Hospital, 350007 Fuzhou, China
| | - Jing-lai Xue
- Department of Spine Surgery, Fuzhou Second Hospital, 350007 Fuzhou, China
| |
Collapse
|
6
|
Koike Y, Takahata M, Nakajima M, Otomo N, Suetsugu H, Liu X, Endo T, Imagama S, Kobayashi K, Kaito T, Kato S, Kawaguchi Y, Kanayama M, Sakai H, Tsuji T, Miyamoto T, Inose H, Yoshii T, Kashii M, Nakashima H, Ando K, Taniguchi Y, Takeuchi K, Ito S, Tomizuka K, Hikino K, Iwasaki Y, Kamatani Y, Maeda S, Nakajima H, Mori K, Seichi A, Fujibayashi S, Kanchiku T, Watanabe K, Tanaka T, Kida K, Kobayashi S, Takahashi M, Yamada K, Takuwa H, Lu HF, Niida S, Ozaki K, Momozawa Y, Yamazaki M, Okawa A, Matsumoto M, Iwasaki N, Terao C, Ikegawa S. Genetic insights into ossification of the posterior longitudinal ligament of the spine. eLife 2023; 12:e86514. [PMID: 37461309 DOI: 10.7554/elife.86514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/22/2023] [Indexed: 07/20/2023] Open
Abstract
Ossification of the posterior longitudinal ligament of the spine (OPLL) is an intractable disease leading to severe neurological deficits. Its etiology and pathogenesis are primarily unknown. The relationship between OPLL and comorbidities, especially type 2 diabetes (T2D) and high body mass index (BMI), has been the focus of attention; however, no trait has been proven to have a causal relationship. We conducted a meta-analysis of genome-wide association studies (GWASs) using 22,016 Japanese individuals and identified 14 significant loci, 8 of which were previously unreported. We then conducted a gene-based association analysis and a transcriptome-wide Mendelian randomization approach and identified three candidate genes for each. Partitioning heritability enrichment analyses observed significant enrichment of the polygenic signals in the active enhancers of the connective/bone cell group, especially H3K27ac in chondrogenic differentiation cells, as well as the immune/hematopoietic cell group. Single-cell RNA sequencing of Achilles tendon cells from a mouse Achilles tendon ossification model confirmed the expression of genes in GWAS and post-GWAS analyses in mesenchymal and immune cells. Genetic correlations with 96 complex traits showed positive correlations with T2D and BMI and a negative correlation with cerebral aneurysm. Mendelian randomization analysis demonstrated a significant causal effect of increased BMI and high bone mineral density on OPLL. We evaluated the clinical images in detail and classified OPLL into cervical, thoracic, and the other types. GWAS subanalyses identified subtype-specific signals. A polygenic risk score for BMI demonstrated that the effect of BMI was particularly strong in thoracic OPLL. Our study provides genetic insight into the etiology and pathogenesis of OPLL and is expected to serve as a basis for future treatment development.
Collapse
Affiliation(s)
- Yoshinao Koike
- Laboratory for Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, Tokyo, Japan
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masahiko Takahata
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masahiro Nakajima
- Laboratory for Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, Tokyo, Japan
| | - Nao Otomo
- Laboratory for Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, Tokyo, Japan
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
- Department of Orthopedic Surgery, Keio University School of Medicine, Nagoya, Japan
| | - Hiroyuki Suetsugu
- Laboratory for Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, Tokyo, Japan
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Xiaoxi Liu
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Tsutomu Endo
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shiro Imagama
- Department of Orthopedics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | | | - Masahiro Kanayama
- Department of Orthopedics, Hakodate Central General Hospital, Hakodate, Japan
| | - Hiroaki Sakai
- Department of Orthopaedic Surgery, Spinal Injuries Center, Iizuka, Japan
| | - Takashi Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Nagoya, Japan
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Nagoya, Japan
- Department of Orthopedic Surgery, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Inose
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masafumi Kashii
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroaki Nakashima
- Department of Orthopedics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Takeuchi
- Department of Orthopaedic Surgery, National Okayama Medical Center, Okayama, Japan
| | - Shuji Ito
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
- Department of Orthopedic Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kohei Tomizuka
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Keiko Hikino
- Laboratory for Pharmacogenomics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Yusuke Iwasaki
- Laboratory for Genotyping Development, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Shingo Maeda
- Department of Bone and Joint Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Atsushi Seichi
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, Nankoku, Japan
| | - Toshihiro Tanaka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazunobu Kida
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Sho Kobayashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masahito Takahashi
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Kei Yamada
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Obu, Japan
| | - Hiroshi Takuwa
- Laboratory for Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, Tokyo, Japan
- Department of Orthopedic Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Hsing-Fang Lu
- Laboratory for Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, Tokyo, Japan
- Million-Person Precision Medicine Initiative, China Medical University Hospital, Taichung, Taiwan
| | - Shumpei Niida
- Core Facility Administration, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kouichi Ozaki
- Medical Genome Center, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Nagoya, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, Center for Integrative Medical Sciences, RIKEN, Tokyo, Japan
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
7
|
Lee NJ, Boddapati V, Mathew J, Fields M, Vulapalli M, Kim JS, Lombardi JM, Sardar ZM, Lehman RA, Riew KD. What Is the Impact of Surgical Approach in the Treatment of Degenerative Cervical Myelopathy in Patients With OPLL? A Propensity-Score Matched, Multi-Center Analysis on Inpatient and Post-Discharge 90-Day Outcomes. Global Spine J 2023; 13:324-333. [PMID: 33601898 PMCID: PMC9972269 DOI: 10.1177/2192568221994797] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE Provide a comparison of surgical approach in the treatment of degenerative cervical myelopathy in patients with OPLL. METHODS A national database was queried to identify adult (≥18 years) patients with OPLL, who underwent at least a 2-level cervical decompression and fusion for cervical myelopathy from 2012-2014. A propensity-score-matching algorithm was employed to compare outcomes by surgical approach. RESULTS After propensity-score matching, 627 patients remained. An anterior approach was found to be an independent predictor for higher inpatient surgical complications(OR 5.9), which included dysphagia:14%[anterior]vs.1.1%[posterior] P-value < 0.001, wound hematoma:1.7%[anterior]vs.0%[posterior] P-value = 0.02, and dural tear:9.4%[anterior]vs.3.2%[posterior] P-value = 0.001. A posterior approach was an predictor for longer hospital length of stay by nearly 3 days(OR 3.4; 6.8 days[posterior]vs.4.0 days[anterior] P-value < 0.001). The reasons for readmission/reoperation did not vary by approach for 2-3-level fusions; however, for >3-level fusions, patients with an anterior approach more often had respiratory complications requiring mechanical ventilation(P-value = 0.038) and required revision fusion surgery(P-value = 0.015). CONCLUSIONS The national estimates for inpatient complications(25%), readmissions(9.9%), and reoperations(3.5%) are substantial after the surgical treatment of multi-level OPLL. An anterior approach resulted in significantly higher inpatient surgical complications, but this did not result in a longer hospital length of stay and the overall 90-day complication rates requiring readmission or reoperation was similar to those seen after a posterior approach. For patients requiring >3-level fusion, an anterior approach is associated with significantly higher risk for respiratory complications requiring mechanical ventilation and revision fusion surgery. Precise neurological complications and functional outcomes were not included in this database, and should be further assessed in future studies.
Collapse
Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA,Nathan J. Lee, MD, Columbia University
Medical Center, Fort Washington Avenue, New York, NY 10032, USA.
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA
| | - Justin Mathew
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA
| | - Michael Fields
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA
| | - Meghana Vulapalli
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA
| | - Jun S. Kim
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA
| | - Joseph M. Lombardi
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA
| | - Zeeshan M. Sardar
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA
| | - K. Daniel Riew
- Department of Orthopaedics, Columbia
University Medical Center, The Och Spine Hospital at New York-Presbyterian, New
York, NY, USA
| |
Collapse
|
8
|
Ng BW, Tan JA, Sabri S, Baharuddin A, Muhamad Ariffin MH. Surgical Management of Cervical Ossification of Posterior Longitudinal Ligament: The Treatment Algorithm and Outcome. Cureus 2023; 15:e36517. [PMID: 37090402 PMCID: PMC10121251 DOI: 10.7759/cureus.36517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Managing patients who present with symptoms of cervical myelopathy secondary to cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. Various factors such as the number of levels involved with OPLL, types of OPLL, canal occupying ratio, K-line characteristics, and C2-C7 lordosis angle were found to guide decision-making and surgical approaches in managing this condition. However, no clear treatment algorithm has been published. This study aims to investigate the outcome of the management of cervical OPLL using a treatment algorithm used in a tertiary university hospital. Methods This is a retrospective cross-sectional study. Patients with cervical myelopathy secondary to cervical OPLL who were treated surgically in our center from 2014 to 2020 were included in this study. Demographic data and preoperative parameters that determined the treatment given according to our treatment algorithm were analyzed. Result A total of 24 patients fit the inclusion and exclusion criteria of the study. The mean recovery rate for all groups is 61.8[Formula: see text]21.9% and the mean postoperative neck disability index (NDI) is 17.83[Formula: see text]16.67%. There was a statistically significant difference between preoperative and postoperative Japanese Orthopaedic Association (JOA) scores for both anterior and posterior surgery subgroups. Conclusion We believe that the treatment algorithm used in our center could benefit other surgeons as a guide in managing patients who suffer from cervical myelopathy secondary to cervical OPLL. Further study including newer techniques would increase the surgeon's arsenal in providing the best outcome in managing this condition.
Collapse
Affiliation(s)
- Bing Wui Ng
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, MYS
- Orthopaedics and Traumatology, Hospital Pakar Kanak-Kanak Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, MYS
| | - Jin Aun Tan
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, MYS
| | - Suffian Sabri
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, MYS
| | - Azmi Baharuddin
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, MYS
| | | |
Collapse
|
9
|
Zhang YH, Liu HT, Zhou FC, Song J, Shao J. Single-Stage Posterior Approach for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament With K-line (-) Using Thick Cervical Pedicle Screw System: A Technical Note and Preliminary Results. Global Spine J 2023; 13:416-424. [PMID: 33733889 PMCID: PMC9972262 DOI: 10.1177/2192568221997078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Technical note, retrospective case series. OBJECTIVE The optimal surgical strategy for multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with a negative kyphosis line (K-line (-)) remains controversial. We present a novel single-stage posterior approach that converts the K-line from negative to positive in patients with multilevel cervical OPLL, using a posterior thick cervical pedicle screw (CPS) system and report the procedure's outcomes and feasibility. METHODS Twelve consecutive patients with multilevel cervical OPLL and K-line (-) underwent single-stage posterior thick CPS fixation, with laminectomy and foraminal decompression. A pre-bent rod was installed to convert the K-line from negative to positive. Radiographic parameters, including the extent and occupying ratio of OPLL and the C2-C7 angle, were examined. CPS accuracy was assessed using computed tomography. The Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores were analyzed. Quality of life was assessed using the Neck Disability Index (NDI). The mean OPLL extent was 5 vertebral body levels, and posterior decompression was performed on 4.2 segments. RESULTS The average C2-C7 angle and the occupying ratio of OPLL improved from -9.0° to 14.3° and from 63% to 33%, respectively. The preoperative JOA, VAS, and NDI scores significantly improved from 8.4 to 13.3, from 7.1 to 2.2, and from 21.9 to 9.3, respectively. The K-line was converted from negative to positive in all cases. No severe complications were identified. CONCLUSION Single-stage posterior surgery with a thick CPS system may be a reliable and effective treatment for multilevel cervical OPLL and K-line (-).
Collapse
Affiliation(s)
- Yue-Hui Zhang
- Spine Center, Xin Hua Hospital, Affiliated to Shanghai
Jiao Tong University School of Medicine, Shanghai, China
| | - Hai-Tao Liu
- Spine Center, Xin Hua Hospital, Affiliated to Shanghai
Jiao Tong University School of Medicine, Shanghai, China
| | - Fu-Chao Zhou
- Spine Center, Xin Hua Hospital, Affiliated to Shanghai
Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Song
- Spine Center, Xin Hua Hospital, Affiliated to Shanghai
Jiao Tong University School of Medicine, Shanghai, China
- Jia Song and Jiang Shao Spine Center, Xinhua
Hospital, 1665 Kongjiang Road, Shanghai 200092, China. Emails:
;
| | - Jiang Shao
- Spine Center, Xin Hua Hospital, Affiliated to Shanghai
Jiao Tong University School of Medicine, Shanghai, China
- Jia Song and Jiang Shao Spine Center, Xinhua
Hospital, 1665 Kongjiang Road, Shanghai 200092, China. Emails:
;
| |
Collapse
|
10
|
Ossification of the Posterior Longitudinal Ligament: Pathophysiology, Diagnosis, and Management. J Am Acad Orthop Surg 2022; 30:820-830. [PMID: 35587949 DOI: 10.5435/jaaos-d-22-00049] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/10/2022] [Indexed: 02/01/2023] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) occurs as heterotopic bone forms in the posterior longitudinal ligament, resulting in neural compression, myelopathy, and radiculopathy. OPLL is most commonly observed in East Asian populations, with prevalence rates of 1.9% to 4.3% reported in Japan. OPLL rates are lower in North American and European patients, with reported prevalence of 0.1% to 1.7%. Patients typically develop symptoms due to OPLL in their cervical spines. The etiology of OPLL is multifactorial, including genetic, metabolic, and anatomic factors. Asymptomatic or symptomatic patients with OPLL can be managed nonsurgically, whereas patients with neurologic symptoms may require surgical decompression from an anterior, posterior, or combined approach. Surgical treatment can provide notable improvement in neurologic function. Surgical decision making accounts for multiple factors, including patient comorbidities, neurologic status, disease morphology, radiographic findings, and procedure complication profiles. In this study, we review OPLL epidemiology and pathophysiology, clinical features, radiographic evaluation, management, and complications.
Collapse
|
11
|
Comparative Effectiveness and Functional Outcome of C2 Dome-like Expansive Versus C2 Expansive Open-door Laminoplasty for Upper Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Cohort Study. Spine (Phila Pa 1976) 2022; 47:E448-E455. [PMID: 34524271 DOI: 10.1097/brs.0000000000004221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES This study compared the function and radiographical outcomes of the patients who underwent C2 dome-like expansive laminoplasty to those C2 expansive open-door laminoplasty for the treatment of OPLL with C2 involved. SUMMARY OF BACKGROUND DATA There are few comparative studies of these two surgical methods. C2 dome-like and C2 expansive open-door laminoplasty are posterior approaches for posterior longitudinal ligament ossification with C2 level and above. METHODS This study performed a retrospective cohort analysis of 59 patients with OPLL up to C2 which cause compression symptoms. 31 patients underwent C2 dome-like expansive laminoplasty with C3-7 expansive open-door laminoplasty (Group Dom) and 28 underwent C2-7 expansive open-door laminoplasty (Group Exp). The preoperative and postoperative space available for cord (SAC) of C2 segment, cervical curvature index of C2-7, C2-7 range of motion, Japanese orthopedic association (JOA) score, visual analog scale (VAS) score, and neck disability index (NDI) were used to assess clinical out-comes and statistically analyzed. RESULTS The cervical curvature index, JOA score, and NDI significantly changed at the final follow-up in two groups with no significant intergroup differences. There were no significant differences in preoperative SAC and VAS between the two groups. At the final follow-up, the SAC of C2/3 in Group Exp was significantly larger than Group Dom, while the VAS and range of motion of Group Dom became significantly better than Group Exp. CONCLUSION The C2 dome-like expansive laminoplasty can reduce postoperative neck pain more obviously and achieve better cervical curvature. C2 expansive open-door laminoplasty can get more adequate decompression in the spinal canal, which may be recommend to the patients with OPLL occupying more than 50% of the vertebral canal at C2/3, or with developmental spinal stenosis. LEVEL OF EVIDENCE 3.
Collapse
|
12
|
Lee DH, Park S, Cho JH, Hwang CJ, Lee CS. Vertebral Body Rotational Osteotomy for Decompressing an Eccentrically Protruded Ossification of the Posterior Longitudinal Ligament: A Technical Note. Clin Spine Surg 2022; 35:111-117. [PMID: 33605610 DOI: 10.1097/bsd.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
Vertebral body sliding osteotomy has been reported as a technique to manage cervical myelopathy caused by ossification of the posterior longitudinal ligament. It involves mobilization and anteriorly translating the vertebral body and ossified mass as a whole. The main advantage of the procedure is decreased rate of complication such as dural tear, implant dislodgement, and pseudarthrosis, which demonstrates high rate in anterior cervical corpectomy and fusion. Vertebral body rotational osteotomy is a modification of vertebral body sliding osteotomy. It is indicated for laterally deviated ossified mass to achieve further decompression. This is a technical note describing the procedures of vertebral body rotational osteotomy.
Collapse
Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido Province, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| |
Collapse
|
13
|
Koo J, Hwang S, Yoon SH, Shin HJ, Cho BK. Progression of Ossification of Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion in Military Patients Exposed to Minor Trauma. Korean J Neurotrauma 2022; 18:254-267. [PMID: 36381449 PMCID: PMC9634320 DOI: 10.13004/kjnt.2022.18.e55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Ossification of the posterior longitudinal ligament (OPLL) can progress even after cervical spine surgery and may cause neurological injury as a result of minor trauma. The purpose of this study was to investigate the preventive factors associated with OPLL progression after anterior cervical discectomy and fusion (ACDF), a procedure commonly performed in clinical practice. Methods We retrospectively investigated 295 male soldiers who underwent ACDF surgery between 2012 and 2017. Patients who were followed up for >12 months using dynamic radiography and computed tomography (CT) were included in the study. Radiological parameters investigated included OPLL progression, C2-C7 angles on dynamic radiography, segmental angles, C2-C7 cervical sagittal vertical axis (C2-C7 SVA), and the T1 slope. These parameters were measured preoperatively and 1 year postoperatively. Results A total of 49 patients were enrolled, and 10 patients were confirmed to have OPLL progression. Comparison between the OPLL progression and non-progression groups showed no statistically significant differences in pre- and postoperative cervical range of motion. However, statistically significant differences were observed in the postoperative neutral C2-C7 angle (progression -3.9°±6.4° vs. non-progression -13.4°±7.9°, p=0.001) and the SVA change (progression 5.8±7.9 mm vs. non-progression -3.7±6.3 mm, p=0.00). The cutoff values were -8.01° for the postoperative neutral C2-C7 angle and 1.4 mm for SVA changes. Conclusion Increased SVA (>1.4 mm) and a small postoperative neutral C2-C7 angle (>-8.01°) 1 year after ACDF were associated with OPLL progression. It is important to be mindful of these factors during follow-up after ACDF, because additional surgical treatment may be necessary for OPLL progression due to neurological injury caused by minor trauma.
Collapse
Affiliation(s)
- Jungmyung Koo
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - SungHwan Hwang
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Hoon Yoon
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| |
Collapse
|
14
|
Is there any correlation between the recovery rate of JOA and the increasing of cervical spinal cord area after single-door cervical laminoplasty? Clin Neurol Neurosurg 2021; 213:107103. [PMID: 34959107 DOI: 10.1016/j.clineuro.2021.107103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/03/2021] [Accepted: 12/18/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of the study is to investigate the clinical and radiologic factors represented by the increasing of spinal cord area associated with the prognosis of the patients at long-term follow-up by multivariate analysis after single-door cervical laminoplasty (SDCL). METHODS A total of 115 patients who underwent cervical laminoplasty with miniplate fixation were included from November 2008 to June 2018. The average postoperative follow-up period was 17.3 months (range, 12-105 months). The prognosis of the patients following cervical laminoplasty was evaluated by the recovery rate of Japanese Orthopedic Association (JOA) at the final follow-up. The recovery rate of JOA ≤ 50% were classified as poor prognosis group (PP group) whose prognosis is relatively poor, and those> 50% were classified as good prognosis group (GP group) whose have a better prognosis. The clinical factors including gender, age, duration of symptoms, diagnosis type, blood loss, operative time, pre- and post-JOA score, etc. were recorded. The radiologic factors including sagittal canal diameter (SCD), the cervical curvature index (CCI), the range of motion (ROM), the spinal canal area and the increasing of cervical spinal cord area, etc. were collected before and after operation and measured by X-ray plain and computed tomography (CT) scan images. The univariate analysis and multivariate logistic regression analysis were performed. RESULTS There were 62 patients in PP group and 53 patients in GP group. The multivariate analysis showed that the preoperative (OR=6.875, P = 0.001) and postoperative JOA scores (OR=24.000, P = 0.001), preoperative spinal canal area (OR=2.464, P = 0.023) and the increasing of cervical spinal cord area (OR=5.438, P = 0.001) maybe related factors to the recovery rate of JOA at the final follow-up. CONCLUSIONS The preoperative spinal canal area, the increasing of cervical spinal cord area, preoperative and postoperative JOA scores play important roles in long-term prognosis after SDCL.
Collapse
|
15
|
Hirai T, Yoshii T, Sakai K, Inose H, Yuasa M, Yamada T, Matsukura Y, Ushio S, Morishita S, Egawa S, Onuma H, Kobayashi Y, Utagawa K, Hashimoto J, Kawabata A, Tanaka T, Motoyoshi T, Takahashi T, Hashimoto M, Sakaeda K, Kato T, Arai Y, Kawabata S, Okawa A. Anterior Cervical Corpectomy with Fusion versus Anterior Hybrid Fusion Surgery for Patients with Severe Ossification of the Posterior Longitudinal Ligament Involving Three or More Levels: A Retrospective Comparative Study. J Clin Med 2021; 10:jcm10225315. [PMID: 34830602 PMCID: PMC8624558 DOI: 10.3390/jcm10225315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 01/22/2023] Open
Abstract
Various studies have found a high incidence of early graft dislodgement after multilevel corpectomy. Although a hybrid fusion technique was developed to resolve implant failure, the hybrid and conventional techniques have not been clearly compared in terms of perioperative complications in patients with severe ossification of the posterior longitudinal ligament (OPLL) involving three or more levels. The purpose of this study was to compare clinical and radiologic outcomes between anterior cervical corpectomy with fusion (ACCF) and anterior hybrid fusion for the treatment of multilevel cervical OPLL. We therefore retrospectively reviewed the clinical and radiologic data of 53 consecutive patients who underwent anterior fusion to treat cervical OPLL: 30 underwent ACCF and 23 underwent anterior hybrid fusion. All patients completed 2 years of follow-ups. Implant migration was defined as subsidence > 3 mm. There were no significant differences in demographics or clinical characteristics between the ACCF and hybrid groups. Early implant failure occurred significantly more frequently in the ACCF group (5 cases, 16.7%) compared with the hybrid group (0 cases, 0%). The fusion rate was 80% in the ACCF group and 100% in the hybrid group. Although both procedures can achieve satisfactory neurologic outcomes for multilevel OPLL patients, hybrid fusion likely provides better biomechanical stability than the conventional ACCF technique.
Collapse
Affiliation(s)
- Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
- Correspondence: ; Tel.: +81-35803-5279
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saitamaken-Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchu, Kawaguchi City 332-8558, Japan; (K.S.); (Y.A.)
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Tsuyoshi Yamada
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Shuta Ushio
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Hiroaki Onuma
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Yutaka Kobayashi
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Kurando Utagawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Jun Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Atsuyuki Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Tomoyuki Tanaka
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Takayuki Motoyoshi
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Takuya Takahashi
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Motonori Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Kentaro Sakaeda
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Tsuyoshi Kato
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saitamaken-Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchu, Kawaguchi City 332-8558, Japan; (K.S.); (Y.A.)
| | - Shigenori Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.Y.); (H.I.); (M.Y.); (T.Y.); (Y.M.); (S.U.); (S.M.); (S.E.); (H.O.); (Y.K.); (K.U.); (J.H.); (A.K.); (T.T.); (T.M.); (T.T.); (M.H.); (K.S.); (T.K.); (S.K.); (A.O.)
| |
Collapse
|
16
|
Wang H, Yang R, Liu H, Meng Y, Hong Y. Comparison of Interventions for Cervical Ossification of Posterior Longitudinal Ligament: A Systematic Review and Network Meta-Analysis. World Neurosurg 2021; 155:1-12. [PMID: 34365049 DOI: 10.1016/j.wneu.2021.07.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To summarize the literature and systematically evaluate outcomes for ossification of posterior longitudinal ligament interventions including anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement and fusion (ACAF), laminoplasty (LP), and laminectomy with fusion (LF). METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Library from January 1990 to March 2021. Patient demographic data, Japanese Orthopaedic Association score, cervical lordosis and overall complications were analyzed. RESULTS We evaluated 30 studies involving 2038 patients. Patients undergoing ACCF had improved Japanese Orthopaedic Association scores compared with patients undergoing LP (weighted mean difference [WMD] 1.17, 95% confidence interval [CI] 0.49-1.85) and LF (WMD 1.21, 95% CI 0.17-2.24). Patients with ACAF had better cervical lordosis compared with patients with ACCF (WMD 7.00, 95% CI 0.72-13.27), LP (WMD 10.27, 95% CI 4.64-15.90), and LF (WMD 8.98, 95% CI 2.48-15.47). Additionally, ACAF (odds ratio 0.24, 95% CI 0.07-0.84) and LP (odds ratio 0.50, 95% CI 0.28-0.90) had a lower incidence of complications compared with ACCF. CONCLUSIONS Japanese Orthopaedic Association score outcomes indicated that ACCF was superior to LP and LF. ACAF had the largest cervical lordosis among all procedures. ACCF showed a higher incidence of overall complications compared with ACAF and LP.
Collapse
Affiliation(s)
- Han Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Runnan Yang
- Mental Health Center, West China Hospital, Sichuan University, Sichuan, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China.
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Ying Hong
- Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, Sichuan, China; West China School of Nursing, West China Hospital, Sichuan University, Sichuan, China
| |
Collapse
|
17
|
Su B, Shen J, Luo X, Quan Z, Jiang D, Peng X, Tang K. One-stage posterior laminectomy with instrumented fusion and foraminotomy for cervical ossification of posterior longitudinal ligament with radiculopathy pain. J Orthop Surg Res 2021; 16:277. [PMID: 33902662 PMCID: PMC8074402 DOI: 10.1186/s13018-021-02431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To explore the clinical efficacy of posterior LFF for cervical OPLL with radicular pain of upper limbs METHODS: Between January 2014 and January 2018, 48 OPLL patients with radicular pain symptoms of upper limbs who underwent a one-stage posterior laminectomy and instrumented fusion with/without foraminotomy were reviewed retrospectively and divided into two groups: LF group (laminectomy with instrumented fusion without foraminotomy) and LFF group (laminectomy with instrumented fusion and foraminotomy). Clinical data were assessed and compared between the two groups. The radicular pain of upper limbs and neck was measured using the visual analog scale (VAS). The neurological function was evaluated with the American Spinal Injury Association (ASIA) scale. Changes of sagittal alignment were investigated by postoperative plain x-ray or computed tomography (CT). Moreover, the decompression of the spinal cord was evaluated based on postoperative MRI. RESULTS All the 48 patients were followed up for 24-42 months with an average follow-up time of 31.1±5.3 months. A total of 56 cervical intervertebral foramens were enlarged in 48 patients, including 40 cases (83.3%) with 1 intervertebral foramen enlargement and 8 cases (16.7%) with 2 intervertebral foramen enlargements. There were no significant differences in intraoperative blood loss, postoperative drainage amount, Japanese Orthopaedic Association (JOA) scores, JOA recovery rates, VAS scores for neck pain, and ASIA grade between two groups. The mean operative time was shorter in the LF group compared with the LFF group. The VAS score for arm pain was significantly lower while the surgical duration was longer in group B. No statistical difference was observed between the two groups in terms of C2-C7 SVA, cervical lordosis, focal angulation at the foraminotomy segment, and local spinal cord angle. Compared with the LF group, there was no segmental kyphosis or instability where the additional posterior foraminotomy was performed in the LFF group. CONCLUSIONS One-stage posterior LFF can achieve satisfied clinical efficacy in improving neurological function and relieving the radicular pain of the upper limbs for OPLL patients with radiculopathy symptoms.
Collapse
Affiliation(s)
- Bao Su
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, People's Republic of China
| | - Jieliang Shen
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, People's Republic of China
| | - Xiaoji Luo
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, People's Republic of China
| | - Zhengxue Quan
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, People's Republic of China
| | - Dianming Jiang
- Department of Orthopaedics, The Third Affiliated Hospital of Chongqing Medical University, No 1 Shuanghu Road, Chongqing, 401120, People's Republic of China
| | - Xiaohua Peng
- Department of Rehabilitation, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, People's Republic of China.
| | - Ke Tang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, People's Republic of China.
| |
Collapse
|
18
|
Liu Y, Meng Y, Liu H, Ding C, Wang B, Hong Y. A Novel Anterior Cervical X-Shape-Corpectomy and Fusion for Cervical Spinal Stenosis at C4-C6 Level: A Technical Note. World Neurosurg 2021; 149:181-189. [PMID: 33662606 DOI: 10.1016/j.wneu.2021.02.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Anterior cervical corpectomy and fusion (ACCF) is employed in patients with localized cervical spinal stenosis (CSS). However, there are some disadvantages such as subsidence of the titanium mesh cage, slow fusion rates, breakage of the plate and screws, and donor-site complications. For patients with small posterior osteophytes, ossified or hypertrophy of the posterior longitudinal ligaments or ligamentum flavum, the range of decompression from the classic anterior cervical discectomy and fusion (ACDF) cannot meet the clinical requirements. However, employing ACCF is controversial. Therefore, it is necessary to seek a novel, safe and effective surgery that can combine the strengths of ACDF and ACCF. Our objective was to describe a novel anterior approach cervical surgery and investigate its clinical outcomes on segmental CSS at the C4-C6 levels 6 months postoperatively. METHODS A novel anterior cervical X-shape-corpectomy and fusion (ACXF) was performed to correct the CSS. RESULTS The patient's neurologic function and myodynamia of the extremities were improved significantly 3 and 6 months after surgery with good bony fusion. Neck pain also was relieved. Immediately postoperative and after 6-month images indicated no significant spinal stenosis. The patient's cervical curvature was improved after surgery without significant implant subsidence or loss of adjacent intervertebral height. There were no postoperative complications. CONCLUSIONS ACXF may be a safe and effective procedure for segmental CSS and an alternative for ACCF, as it has a wide operative field of view, sufficient decompression range, excellent transverse vertebral bony fusion, less internal fixation-related complications, and graft subsidence and no donor-site complications.
Collapse
Affiliation(s)
- Yang Liu
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China.
| | - Chen Ding
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China
| | - Beiyu Wang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Anesthesia and Operation Center/ West China School of Nursing, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
19
|
Xu P, Zhuang JS, Huang YS, Chen JT, Zhong ZM. Is anterior decompression and fusion superior to laminoplasty for cervical myelopathy due to ossification of posterior longitudinal ligament? A systematic review and meta-analysis. J Spinal Cord Med 2021; 44:169-183. [PMID: 30888255 PMCID: PMC7952055 DOI: 10.1080/10790268.2019.1579987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Context: Considerable controversy exists over surgical procedures for ossification of the posterior longitudinal ligament (OPLL).Objective: The purpose of the meta-analysis was to compare the clinical outcome of anterior decompression and fusion (ADF) with laminoplasty (LAMP) in treatment of cervical myelopathy due to OPLL.Methods: PubMed, EMBASE and the Cochrane Register of Controlled Trials database were searched to identify potential clinical studies compared ADF with LAMP for cervical myelopathy owing to OPLL. We also manually searched the reference lists of articles and reviews for possible relevant studies. Thirteen studies with 1120 patients were included in our analysis. Subgroup analyses were performed by the canal occupying ratio of OPLL.Results: Overall, the mean preoperative Japanese Orthopaedic Association (JOA) score was similar between two groups. Compared with LAMP group, ADF group was higher at the mean postoperative JOA scores and mean recovery rate, reoperation rate, and longer at mean operation time. There was not significantly different in mean blood loss and complication rate between two groups. In subgroup analysis, ADF had a higher mean postoperative JOA score and recovery rate than LAMP in cases of OPLL with occupying ratios ≥ 50%, while those difference were not found in cases of OPLL with occupying ratios < 50%.Conclusion: ADF achieves better neurological improvement compared with LAMP in treatment of cervical myelopathy due to OPLL, especially in cases of OPLL with occupying ratios ≥ 50%. Complication rate is similar between two groups, but ADF can increase the risk of reoperation.
Collapse
Affiliation(s)
- Ping Xu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jing-Shen Zhuang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Yu-Sheng Huang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jian-Ting Chen
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Zhao-Ming Zhong
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China,Correspondence to: Zhao-Ming Zhong, Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou510515, People’s Republic of China.
| |
Collapse
|
20
|
Park BJ, Seaman SC, Woodroffe RW, Noeller J, Hitchon PW. Surgical Options in Treating Ossification of the Posterior Longitudinal Ligament: Single-Center Experience. World Neurosurg 2021; 148:e617-e626. [PMID: 33482410 DOI: 10.1016/j.wneu.2021.01.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Ossified posterior longitudinal ligament (OPLL) of the cervical spine can lead to spinal stenosis and become clinically symptomatic. The optimal approach in addressing OPLL is a debated topic and dependent on factors such as preoperative lordosis and levels affected. METHODS In this study, we retrospectively identified patients undergoing operative management for OPLL. Demographics, operative details, radiographic parameters, outcome measurements, and complications were compared between the different approaches for OPLL treatment. RESULTS We identified a total of 44 patients with 16 undergoing laminoplasty (Plasty), 18 anterior corpectomy and diskectomy (Ant), and 10 laminectomy and instrumentation (Linst). Ant had least OPLL levels with median (range) 3 (2-5), compared with Plasty 4 (2-7) and Linst 4 (3-6). Plasty was associated with the shortest operative time and hospital stay. Ant showed significant correction in kyphosis from 0.5° (-13 to 16°) to 9.5° (-7 to 20°). There was loss in lordosis in Plasty and Linst. Sagittal balance significantly increased irrespective of surgical approach with the least increase in the Ant group. Complications were least in the Plasty group with similar overall improvement in outcome measurements. CONCLUSIONS All 3 approaches in the management of OPLL were associated with clinical improvement without 1 approach surpassing the others. Laminoplasty had the advantage of addressing more levels of stenosis than the anterior approach and was associated with a shorter operating time. Laminoplasty patients had a shorter hospital stay than those undergoing laminectomy and instrumentation and appeared to have fewer complications than the other approaches. Laminoplasty is the preferred approach in patients with preserved motion and lordosis, with the anterior approach effective in the correction of kyphosis.
Collapse
Affiliation(s)
- Brian J Park
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott C Seaman
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Royce W Woodroffe
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jennifer Noeller
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
| |
Collapse
|
21
|
Sun KQ, Sun JC, Shi JG, Guo YF. Novel Technique as a Revision Surgery for Failed Anterior Cervical Corpectomy and Fusion in the Treatment of Cervical Myelopathy Due to Ossification of the Posterior Longitudinal Ligament. World Neurosurg 2020; 141:37-43. [PMID: 32522645 DOI: 10.1016/j.wneu.2020.05.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This article aimed to introduce a novel technique, the "seesaw technique," for failed anterior cervical corpectomy and fusion (ACCF) in the treatment of cervical ossification of the posterior longitudinal ligament. METHODS A patient who underwent ACCF 12 years ago and suffered gradually deteriorating neurologic function was referred to our institution. Preoperative imaging showed residual ossified mass at C5/6 level, causing compression to his spinal cord. He patient was treated by the seesaw technique. The main surgical procedures include removal of the plate and screws, removal of the osteophytes and diskectomy of C4/5, resection of the anterior part of C5 vertebral body, establishment of a transverse hinge at C7 vertebral body, installation of cervical plate and hoisting tool, and antedisplacement of C5 vertebral body and titanium mesh. Images were investigated before and after the procedure. The Japanese Orthopaedic Association score was used to evaluate his neurologic function, and surgery-related complications were also analyzed. RESULTS The patient acquired significant improvement of his neurologic function 2 days after the surgery, and he could walk by himself without assistance. Postoperative images showed his spinal canal was enlarged sufficiently and the compression at C5/6 level was also released. At 13 months follow-up, his Japanese Orthopaedic Association score increased from 9 before surgery to 14, with an improvement rate of 62.5%. No surgery-related complications were observed during the whole follow-up. CONCLUSION The seesaw technique provides satisfactory outcomes with wide enough decompression window and serves as a safe, effective surgical alternative for patients with failed ACCF.
Collapse
Affiliation(s)
- Kai Qiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jing Chuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jian Gang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yong Fei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
| |
Collapse
|
22
|
Choice of the Open Side in Unilateral Open-Door Laminoplasty for Cervical Ossification of the Posterior Longitudinal Ligament. Spine (Phila Pa 1976) 2020; 45:741-746. [PMID: 31923132 DOI: 10.1097/brs.0000000000003378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine the optimal open side in unilateral open-door laminoplasty (UODL) for lateral cervical ossification of posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA No literature has reported which side of the vertebral arch should be chosen as the open side in UODL for lateral cervical OPLL. METHODS Patients with lateral cervical OPLL who were treated with UODL between 2013 and 2018 were retrospectively analyzed in two groups: Group A, where the open side was contralateral to the ectopic bone, and Group B, where the open side was ipsilateral to the ectopic bone. The Japanese Orthopaedic Association (JOA) Score, JOA recovery rate, spinal canal enlargement rate, cervical range of motion (ROM), and spinal cord area (SCA) were measured to evaluate and compare the clinical outcomes between the two groups. Statistical analysis was performed by t test and Hotelling T2 test. RESULTS There was no significant difference in patient demographics and major complications between the two groups. The postoperative JOA Score and JOA recovery rate in Group A were significantly higher than those in Group B. There was no significant difference in cervical ROM within or between the two groups during the 2-year follow-up period, nor was there significant difference in spinal canal enlargement between the two groups. However, both postoperative SCA and increased SCA in Group A were significantly higher than those in Group B. CONCLUSION The contralateral open side approach is preferable to the ipsilateral open side approach in UODL for lateral cervical OPLL. LEVEL OF EVIDENCE 3.
Collapse
|
23
|
Xu P, Zhuang JS, Huang YS, Tu C, Chen JT, Zhong ZM. Surgical outcomes of cervical myelopathy due to ossification of posterior longitudinal ligament: Anterior decompression and fusion versus posterior laminoplasty. J Orthop Surg (Hong Kong) 2020; 27:2309499019837907. [PMID: 30894095 DOI: 10.1177/2309499019837907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the surgical outcomes of anterior decompression and fusion (ADF) with that of posterior laminoplasty (LAMP) for cervical myelopathy caused by ossification of posterior longitudinal ligament (OPLL). METHODS We retrospectively assessed the medical records of patients who underwent surgery for cervical myelopathy owing to OPLL between 2007 and 2016 at our institution. Fifty patients were included in this study, including 17 patients in ADF group and 33 patients in LAMP group. Surgical outcomes were assessed under the Japanese Orthopaedic Association (JOA) score. The radiologic and clinical data were compared between two groups. RESULTS There was no significant difference in age, follow-up time, operation time, blood loss, length of stay, preoperative JOA score, occupying ratio of OPLL, diameter of spinal canal, preoperative and final follow-up C2-C7 Cobb angles, and the change of C2-C7 Cobb angle before and after operation between ADF and LAMP groups. The final follow-up JOA score and the neurological recovery rate were significantly higher in ADF group than in LAMP group, particularly in patients with segmental-type OPLL. Cerebrospinal fluid leakage is a major complication after ADF, C5 paralysis, and axial pain frequently results from LAMP. CONCLUSION Compared with LAMP, ADF shows better improvement of neurological function in patients with cervical myelopathy due to OPLL, especially in patients with segmental-type cervical OPLL.
Collapse
Affiliation(s)
- Ping Xu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing-Shen Zhuang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu-Sheng Huang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chen Tu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian-Ting Chen
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhao-Ming Zhong
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
24
|
Yee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of the literature. JOURNAL OF SPINE SURGERY 2020; 6:302-322. [PMID: 32309668 DOI: 10.21037/jss.2020.01.14] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential complications overlap with those of the posterior approach, the distinct anatomy of the anterior neck also presents a unique set of hazards. We performed a systematic review of the literature to assess the etiology, presentation, natural history, and management of these complications. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a PubMed search was conducted to evaluate clinical studies and case reports of patients who suffered a complication of anterior cervical spine surgery. The search specifically included articles concerning adult human subjects, written in the English language, and published from 1989 to 2019. The PubMed search yielded 240 articles meeting our criteria. The overall rates of complications were as follows: dysphagia 5.3%, esophageal perforation 0.2%, recurrent laryngeal nerve palsy 1.3%, infection 1.2%, adjacent segment disease 8.1%, pseudarthrosis 2.0%, graft or hardware failure 2.1%, cerebrospinal fluid leak 0.5%, hematoma 1.0%, Horner syndrome 0.4%, C5 palsy 3.0%, vertebral artery injury 0.4%, and new or worsening neurological deficit 0.5%. Morbidity rates in anterior cervical spine surgery are low. Nevertheless, the unique anatomy of the anterior neck presents a wide variety of potential complications involving vascular, aerodigestive, neural, and osseous structures.
Collapse
Affiliation(s)
- Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Swong
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
25
|
Yoshii T, Egawa S, Hirai T, Kaito T, Mori K, Koda M, Chikuda H, Hasegawa T, Imagama S, Yoshida M, Iwasaki M, Okawa A, Kawaguchi Y. A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical ossification of the posterior longitudinal ligament. J Orthop Sci 2020; 25:58-65. [PMID: 30905611 DOI: 10.1016/j.jos.2019.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/24/2019] [Accepted: 03/01/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The optimal surgical procedure for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial because there are few comprehensive studies investigating the surgical methods. Therefore, we conducted a systematic review and meta-analysis to evaluate evidence in the literature and compare the surgical outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP), which are representative procedures for cervical OPLL. METHODS An extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and LAMP for cervical OPLL. The language was restricted to English, and the year of publication was from January 1980 to December 2018. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) score, cervical alignment, surgical complications and reoperation rate. Then, meta-analysis was performed for these surgical outcomes. RESULTS Twelve studies were obtained, including 1 prospective cohort study and 11 retrospective cohort studies. In the meta-analysis, neurological recovery rate in JOA score was greater in ADF than in LAMP, especially in patients with a large canal occupying ratio (≥60%) and preoperative kyphotic alignment. ADF also exhibited more favorable results in postoperative cervical alignment. In contrast, operating time and intraoperative blood loss were greater in ADF. Surgical complications were more frequently seen in ADF, leading to higher rates of reoperation. CONCLUSIONS This systematic review and meta-analysis showed both the merits and shortcomings of ADF and LAMP. ADF resulted in more favorable neurological recovery compared to LAMP, especially for patients with massive OPLL and kyphotic alignment. Postoperative cervical lordosis was also better preserved in ADF. However, ADF was associated with greater surgical invasion and higher incidences of surgical complications.
Collapse
Affiliation(s)
- Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo 113-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan.
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo 113-8511, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo 113-8511, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Kanji Mori
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2112, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Hirotaka Chikuda
- Department of Orthopedic Surgery, Gunma University School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8513, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3125, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi 466-8550, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masahiro Yoshida
- Department of Surgery, International University of Health and Welfare Ichikawa Hospital, Konodai 6-1-14, Ichikawashi, Chiba 272-0827, Japan
| | - Motoki Iwasaki
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Nagasonecho 1179-3, Sakaishi, Kitaku, Osaka 591-8025, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo 113-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0114, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| |
Collapse
|
26
|
Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:1001-1012. [DOI: 10.1007/s00586-019-06216-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/02/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
|
27
|
Head J, Rymarczuk G, Stricsek G, Velagapudi L, Maulucci C, Hoelscher C, Harrop J. Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications. Neurospine 2019; 16:517-529. [PMID: 31607083 PMCID: PMC6790740 DOI: 10.14245/ns.1938222.111] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/05/2019] [Indexed: 01/30/2023] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.
Collapse
Affiliation(s)
- Jeffery Head
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - George Rymarczuk
- Division of Neurosurgery, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Geoffrey Stricsek
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lohit Velagapudi
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Christian Hoelscher
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
28
|
Vaziri S, Lockney DT, Dru AB, Polifka AJ, Fox WC, Hoh DJ. Does Ossification of the Posterior Longitudinal Ligament Progress After Fusion? Neurospine 2019; 16:483-491. [PMID: 31607080 PMCID: PMC6790726 DOI: 10.14245/ns.1938286.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/19/2019] [Indexed: 12/02/2022] Open
Abstract
Starting in the 1960s, ossification of the posterior longitudinal ligament (OPLL) became more commonly diagnosed in Japan. The disease is characterized by a gradual increase in calcification of the posterior longitudinal ligament with the eventual sequelae of cervical canal stenosis and myelopathy. Surgical interventions to relieve stenosis and neurologic symptoms are performed to decompress the cervical canal. Studies demonstrate continued ossification of the OPLL in both nonsurgical and surgically treated patients. In this review, the authors evaluate the epidemiology, pathophysiology, and literature regarding disease progression in OPLL after cervical fusion.
Collapse
Affiliation(s)
- Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Dennis Timothy Lockney
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Alexander B Dru
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Adam J Polifka
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - W Christopher Fox
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Daniel J Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| |
Collapse
|
29
|
Kim DH, Lee CH, Ko YS, Yang SH, Kim CH, Park SB, Chung CK. The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An Updated Systematic Review and Meta-Analysis. Neurospine 2019; 16:530-541. [PMID: 31607084 PMCID: PMC6790730 DOI: 10.14245/ns.1938326.163] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/28/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Theoretically, the optimal approach is determined by the status of ossification of the posterior longitudinal ligament (OPLL) and sagittal alignment. However, there have long been disputes about the optimum surgical approach of OPLL. This study is to compare risk-effectiveness between anterior decompression and fusion (ADF) and laminoplasty and laminectomy with fusion (LP/LF) for the patient with cervical myelopathy due to multilevel cervical OPLL. METHODS We searched core databases, and compared complication and outcomes between ADF and LP/LF for patients with multiple OPLL for the cervical spine. The incidence of complications such as neurologic deterioration, C5 palsy, and dura tear was assessed. Changes in JOA score between baseline and final evaluations were assessed for 2 groups. The minimal clinically important difference (MCID) was utilized for evaluating clinical significance. We calculated Peto odds ratio (POR) and mean difference for the incidence and continuous variables, respectively. RESULTS We included data from 21 articles involving 3,872 patients with cervical myelopathy with OPLL. Major neurologic deficits such as paraplegia, quadriplegia developed 2.17% in the ADF group and 1.11% in the LP/LF group, and POR was 2.16. Mean difference of JOA score improvement of 2 groups was 1.30, and the mean difference showed a statistical significance. However, 1.3 points of JOA improvement cannot reach 2.5 points of the MCID. CONCLUSION Anterior surgery often led to rare but critical complications, and the difference of neurological improvement between 2 groups was below a clinically meaningful level. Posterior surgeries may be appropriate in the treatment of multilevel cervical myelopathy with OPLL.
Collapse
Affiliation(s)
- Dong Hwan Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Young San Ko
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| |
Collapse
|
30
|
Li Q, Han X, Wang R, Zhang Y, Liu P, Dong Q. Clinical recovery after 5 level of posterior decompression spine surgeries in patients with cervical spondylotic myelopathy: A retrospective cohort study. Asian J Surg 2019; 43:613-624. [PMID: 31481282 DOI: 10.1016/j.asjsur.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/14/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/OBJECTIVE The selection of surgical technique in patients with cervical spondylotic myelopathy relies on the surgeon(s) and patients' conditions. The objectives of the study were to test the hypotheses that French-door laminoplasty recovers faster than laminectomy and has good outcome measures. METHODS Data regarding surgical, radiological, and clinical outcome measures of 330 patients with cervical spondylotic myelopathy operated under French-door laminoplasty (fdLP group, n = 110), open-door laminoplasty (odLP group, n = 110), or laminectomy (LC group, n = 110) were collected from the records of institute and analyzed. RESULTS Patients of fdLP group (p < 0.0001, q = 11.65) and odLP group (p < 0.0001, q = 11.27) both had significantly improved modified Rankin scale score than those of LC group. In addition, patients of fdLP group had minimum blood loss during operations and that was maximum for patients of the LC group. Unlike patients of fdLP group (p < 0.0001, q = 80) and LC group (p < 0.0001, q =122), those of odLP group had lost more amount of cervical lordotic after surgery. Open-door laminoplasty had significantly reduced cervical range of motion than laminectomy (p < 0.0001, q = 15.45) and French-door laminoplasty (p < 0.0001, q = 13.45). After 12-months, fdLP group had higher bone union rate than odLP group (p = 0.007, q = 3.395) and LC group (p = 0.007, q = 4.243). French door laminoplasty had a better postoperative quality of life. CONCLUSIONS Among the posterior decompression spine surgeries, French-door laminoplasty is superior surgical procedure than laminectomy and could be superior surgical technique than open-door laminoplasty.
Collapse
Affiliation(s)
- Qiaomei Li
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Xiaoqiang Han
- Department of Orthopedic, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Renqiang Wang
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Yuanyuan Zhang
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Puke Liu
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Qingqing Dong
- Department of Outpatient, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| |
Collapse
|
31
|
Moghaddamjou A, Fehlings MG. An Age-old Debate: Anterior Versus Posterior Surgery for Ossification of the Posterior Longitudinal Ligament. Neurospine 2019; 16:544-547. [PMID: 31607086 PMCID: PMC6790737 DOI: 10.14245/ns.19edi.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Ali Moghaddamjou
- Division of Neurosurgery and Spine Program, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
32
|
Xu Y, Chen F, Wang Y, Zhang J, Hu J. Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis. J Orthop Surg Res 2019; 14:224. [PMID: 31319870 PMCID: PMC6639962 DOI: 10.1186/s13018-019-1265-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/08/2019] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) often indicates severe compression in patients with cervical myelopathy (CM). The optimal surgical approach for CM patients with ISI on T2-weighted MRI remains unclear. This meta-analysis aims to compare the clinical outcomes between anterior and posterior approaches for the treatment of these patients. METHODS MEDLINE, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) were searched for relevant studies through January 2019. Statistical comparisons were made when appropriate. RESULTS A total of 9 studies (748 participants) out of 1066 citations were included in this study. All of the selected studies were high quality, as indicated by the Newcastle-Ottawa scale and the Cochrane Collaboration tool for assessing the risk of bias. Clinical outcomes were compared between anterior and posterior approaches in 4 studies (237 participants). The preoperative Japanese Orthopedic Association (JOA) score was similar between the two groups [P = 0.98, weighted mean difference (WMD) = 0.01 (- 0.58, 0.59)]. The postoperative JOA score [P < 0.05, WMD = 0.68 (0.06, 1.30)] and recovery rates [P < 0.01, WMD = 0.12 (0.06, 0.17)] were significantly higher in the anterior group than in the posterior group. CONCLUSION The anterior approach was associated with better postoperative neural function than the posterior approach in CM patients with ISI on T2-weighted MRI.
Collapse
Affiliation(s)
- Yuan Xu
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Feng Chen
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yipeng Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jianhua Hu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
| |
Collapse
|
33
|
Yang H, Xu X, Shi J, Guo Y, Sun J, Shi G, Wang Y. Anterior Controllable Antedisplacement Fusion as a Choice for Ossification of Posterior Longitudinal Ligament and Degenerative Kyphosis and Stenosis: Postoperative Morphology of Dura Mater and Probability Analysis of Epidural Hematoma Based on 63 Patients. World Neurosurg 2019; 121:e954-e961. [DOI: 10.1016/j.wneu.2018.10.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 01/30/2023]
|
34
|
Chen TP, Qian LG, Jiao JB, Li QG, Sun B, Chen K, Wang YF, Liang ZX, Chen YM, Meng J. Anterior decompression and fusion versus laminoplasty for cervical myelopathy due to ossification of posterior longitudinal ligament: A meta-analysis. Medicine (Baltimore) 2019; 98:e13382. [PMID: 30608381 PMCID: PMC6344170 DOI: 10.1097/md.0000000000013382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/31/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Both anterior decompression and fusion (ADF) and laminoplasty (LAMP) are frequently used for the treatment of cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). However, some controversies still remained in surgical options. We investigated whether ADF had better neurological outcome than LAMP in the treatment of cervical myelopathy due to OPLL. Secondary outcomes included operation time, blood loss, rate of complication and reoperation. METHODS PubMed, EMBASE and the Cochrane Register of Controlled Trials database were searched to identify potential clinical studies compared ADF with LAMP for treatment of cervical myelopathy owing to OPLL. We also manually searched the reference lists of articles and reviews for possible relevant studies. Quality assessment was performed according to Cochrane Handbook and meta-analysis was conducted using Stata 12.0 software. RESULTS Nine studies involving 712 patients were finally included in this analysis. Compared with LAMP, ADF was associated with an increase of the Japanese Orthopaedic Association (JOA) score (WMD = 1.86, 95% CI 0.43 to 3.29, P = .011) and recovery JOA score at final follow-up (WMD = 30.94, 95% CI 20.56 to 41.33, P = .000). And, ADF was associated with a decrease of the late neurologic deterioration than LAMP group (RR = 0.34, 95% CI 0.12 to 0.92, P = .003). However, ADF was associated with an increase of the postoperative cervical lordosis (WMD = 4.47, 95% CI 1.58 to 7.36, P = .002) than LAMP. There was no significant difference between the complication, reoperation rate (P > .05). What's more, ADF was associated with an increase of the operation time than LAMP (P < .05). CONCLUSIONS ADF yields better neurological improvement, but higher cervical lordosis and longer operation time compared with LAMP for cervical myelopathy caused by OPLL. No significant difference was found in the complication and re-operation rate.
Collapse
Affiliation(s)
- Tao-ping Chen
- Department of Orthopaedic, Affiliated Hospital of Hebei University
| | - Li-gang Qian
- Department of Orthopaedic, Affiliated Hospital of Hebei University
| | - Jian-bao Jiao
- Department of Orthopaedic, Affiliated Hospital of Hebei University
| | - Qing-gui Li
- Department of Orthopaedic, Affiliated Hospital of Hebei University
| | - Bo Sun
- Department of Orthopaedic, Affiliated Hospital of Hebei University
| | - Kang Chen
- Department of Orthopaedic, Affiliated Hospital of Hebei University
| | - Yun-fei Wang
- Department of Orthopaedic, Affiliated Hospital of Hebei University
| | - Zhi-xing Liang
- Department of Orthopaedic, Affiliated Hospital of Hebei University
| | - Yu-min Chen
- Hebei University, No. 405, Wusidong Road, Baoding, Hebei Province, China
| | - Jie Meng
- Department of Orthopaedic, Affiliated Hospital of Hebei University
| |
Collapse
|
35
|
Sun J, Sun K, Wang Y, Shi J, Yang H, Guo Y, Xu X, Kong Q, Chen K, Zheng B, Shi G, Wang Y. Quantitative Anterior Enlargement of the Spinal Canal by Anterior Controllable Antedisplacement and Fusion for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament with Myelopathy. World Neurosurg 2018; 120:e1098-e1106. [DOI: 10.1016/j.wneu.2018.08.233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022]
|
36
|
Anterior controllable antedisplacement fusion as a choice for 28 patients of cervical ossification of the posterior longitudinal ligament with dura ossification: the risk of cerebrospinal fluid leakage compared with anterior cervical corpectomy and fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:370-379. [DOI: 10.1007/s00586-018-5813-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 09/30/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
|
37
|
Hou Y, Shi G, Shi J, Sun J, Guo Y, Xu G, Yuan W, Jia L. WITHDRAWN: A Comparative Study Between Anterior Controllable Antedisplacement and Fusion Versus Laminoplasty in the Surgical Management of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament. World Neurosurg 2018:S1878-8750(18)32147-8. [PMID: 30261377 DOI: 10.1016/j.wneu.2018.09.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 11/22/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
Collapse
Affiliation(s)
- Yang Hou
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Guodong Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiangang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jingchuan Sun
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yongfei Guo
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Guohua Xu
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen Yuan
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lianshun Jia
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
38
|
Wang W, Ding T, Harrop JS, Yang H, Gu X, Feng D, Zhang Y, Liu H, Tang F, Xue Y, Lu M, Wu C. Cervical posterior longitudinal ligament ossification : Microscopy-assisted anterior corpectomy and fusion. DER ORTHOPADE 2018; 48:426-432. [PMID: 30238145 DOI: 10.1007/s00132-018-3640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the clinical efficacy and safety of microscopy-assisted anterior corpectomy and fusion for cervical ossification of the posterior longitudinal ligament (OPLL). METHODS A retrospective review of 32 cervical OPLL patients who underwent microscopy-assisted anterior corpectomy and fusion from June 2012 to March 2017 was carried out. Patients were evaluated with outcome metrics: Japanese Orthopaedic Association (JOA) scores (17 points method), visual analog scale (VAS), and radiographic parameters of the lordotic angle. The complications during treatment and follow-up were recorded. RESULTS This study included 32 patients (15 males and 17 females) with a mean age of 58.3 ± 2.9 years (range 42-68 years). The average duration of follow-up was 19.0 ± 3.5 months (range 11-46 months). The scores of postoperative VAS significantly decreased (P < 0.05). The average JOA score at 12 months postoperation significantly improved (p < 0.05). The lordotic angle increased after surgery (P < 0.05). There was no titanium mesh subsidence, no pseudarthrosis or hardware failure at 1‑year follow-up. COMPLICATIONS One cerebrospinal fluid leakage in the surgery was managed using a gelatine sponge and the patient recovered after 1 week: One patient developed laryngeal nerve injury symptom of hoarseness and recovered spontaneously in 2 weeks without intervention and 1 patient suffered slight postoperative infection. There was no worsening of neurological function. CONCLUSION Microscopy-assisted anterior cervical anterior surgery appears to be a safe and effective treatment option for selected cases of cervical posterior longitudinal ligament ossification.
Collapse
Affiliation(s)
- Wanyi Wang
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Tao Ding
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China.
| | - James S Harrop
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 19107, Philadelphia, PA, USA
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaofeng Gu
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Dehong Feng
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Yafeng Zhang
- Department of Orthopaedics, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, Jiangsu, China
| | - Hao Liu
- Department of Orthopaedics, Wuxi 9th People Hospital, Wuxi, Jiangsu, China
| | - Fenglin Tang
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Yuntao Xue
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Miao Lu
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Chao Wu
- Wuxi 3th People Hospital, Wuxi, Jiangsu, China
| |
Collapse
|
39
|
Han S, Kwon YC, Kim SM, Hyun SJ, Jahng TA, Kim KJ, Kim HJ, Choi HY, Park YS, Seok Park K. Risk Factor Analysis of Change in Intraoperative Neurophysiologic Monitoring During Cervical Open Door Laminoplasty. World Neurosurg 2018; 119:e235-e243. [PMID: 30048788 DOI: 10.1016/j.wneu.2018.07.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study is to determine the risk factors affecting intraoperative neurophysiologic monitoring (IONM) changes, when such changes take place, and clinical outcomes associated with IONM change during cervical open door laminoplasty (COL) for cervical compressive myelopathy. METHODS Between 2010 and 2015, 79 patients who underwent COL with IONM recording were studied. Changes in motor evoked potentials or somatosensory evoked potentials over an alarm criterion were defined as IONM change. Patients with IONM change were assigned to the alarm group, and the others were classified as the control group. Baseline data and radiographic measurements were compared between the 2 groups. Radiologic parameters including maximal compression level (MCL), area and diameter of the spinal canal and ventral compressive lesion, stenosis grade, and occupying ratio of area (ORA) and length at the MCL were measured with magnetic resonance imaging. RESULTS Thirteen patients were assigned to the alarm group and 66 patients were assigned to the control group. Multivariate analysis identified ORA at the MCL (odds ratio, 1.520; 95% confidence interval, 1.192-1.37; P = 0.001) as an independent risk factor for IONM change. Immediately after decompression, the IONM change occurred. One of 4 patients who did not fully recover from the IONM change had postoperative motor deficits. CONCLUSIONS IONM change during COL occurred immediately after decompression, and a risk factor of IONM change was ORA at the MCL. If the IONM change was not fully recovered, a new motor deficit occurred after COL.
Collapse
Affiliation(s)
- Sanghyun Han
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, DaeJeon, Korea
| | - Yong Chul Kwon
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Hyun-Jib Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ho Yong Choi
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Young-Seop Park
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Graduate School of Medicine, Jinju, Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
40
|
Surgical Approaches for the Treatment of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: Results of a Decision Analysis. World Neurosurg 2018; 112:e375-e384. [DOI: 10.1016/j.wneu.2018.01.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 01/24/2023]
|
41
|
Lee SH, Son DW, Lee JS, Kim DH, Sung SK, Lee SW, Song GS. Differences in Cervical Sagittal Alignment Changes in Patients Undergoing Laminoplasty and Anterior Cervical Discectomy and Fusion. Neurospine 2018; 15:91-100. [PMID: 29656629 PMCID: PMC5944642 DOI: 10.14245/ns.1834864.432] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) and laminoplasty (LP) are the most commonly performed procedures for degenerative cervical spondylosis. Cervical sagittal alignment (CSA) has recently been studied as an important predictor of clinical and radiological outcomes. The data from previous studies are insufficient for analysis using the recently designed CSA parameters, T1 slope (T1s), and T1s minus cervical angle (T1sCA). METHODS We retrospectively collected data from patients who underwent ACDF and LP from January 2013 to May 2016. The CSA parameters included CA, sagittal vertical axis, T1s, and T1sCA. T1sCA values were used to evaluate the preoperative cervical balance (T1sCA>20°: imbalance). Clinical results were evaluated using the neck disability index (NDI) and recovery rate (RR) according to the Japanese Orthopedic Association scoring system. RESULTS We analyzed the data of 72 patients (ACDF, n=39; LP, n=33). Imbalance on ACDF was associated with an increase in CA (balance: preoperative [PRE], 15.64° → follow-up [F/U], 15.74°, p=0.953; imbalance: PRE, -1.14° → F/U, 8.045°, p=0.008), whereas balance on LP was associated with a significant decrease in CA (balance: PRE, 16.26°→ F/U, 11.59°, p=0.009; imbalance: PRE, 5.36°→ F/U, 2.38°, p=0.249). No significant difference was found in the RR and NDI changes in the ACDF group based on balance, but a significant difference was found in RR in the LP group (balance: 61.65%±19.88%, imbalance: 46.90%±15.71%, p=0.046). CONCLUSION We found a significant difference in postoperative alignment in cases of ACDF and LP according to preoperative cervical sagittal balance. The postoperative clinical results of the LP group were more affected by F/U alignment than by the degree of alignment change.
Collapse
Affiliation(s)
- Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
42
|
Rustagi T, Alonso F, Schmidt C, Oskouian RJ, Chapman JR, Tubbs RS, Fisahn C. Rapid Progression of Ossification of the Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion. World Neurosurg 2017; 110:11-16. [PMID: 29107718 DOI: 10.1016/j.wneu.2017.10.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ossification of the posterior longitudinal ligament (OPLL) has a reported incidence of 1.9%-4.3%. Disease progression is associated with surgery, with most studies focusing on OPLL progression after laminoplasty. The continued range of motion following surgery is believed to place strain on adjacent levels, driving calcification of the ligament. We present a case of marked progression of OPLL at levels adjacent to a previous anterior cervical discectomy and fusion. CASE REPORT A 59-year-old man initially presented for progressive loss of balance and dexterity and underwent a C4-6 anterior cervical discectomy and fusion procedure. Computed tomography performed 1 year postoperatively showed fusion across C4-6 with no evidence of OPLL at any level. Two years following index surgery, the patient reported right-side arm pain. Computed tomography revealed new minimal OPLL opposite the C3-4 level that was not causing cord compression. A sparing midline bilateral C3-7 laminotomy was performed to correct stenosis seen on magnetic resonance imaging. At 7 years after the index procedure, the patient presented with myelopathic symptoms exceeding symptoms at his index presentation. Computed tomography revealed marked progression of OPLL. The patient underwent C2-T2 posterior fusion with laminectomy from C2-C7 and responded well with gradual improvements in balance and arm pain after surgery. CONCLUSIONS Our report demonstrates that OPLL progression, which is largely reported following laminoplasty, may similarly occur following anterior cervical discectomy and fusion and supports the concept of motion-related OPLL progression.
Collapse
Affiliation(s)
- Tarush Rustagi
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Department of Spine Surgery, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
| | - Fernando Alonso
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Cameron Schmidt
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA.
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Christian Fisahn
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|