1
|
Ni H, Mao W, Li H, Dong Y. Physiologic Osseous Remodeling of the Anterior Wall of the Spinal Canal after Anterior Cervical Corpectomy and Fusion: A Retrospective Observational Study. J Neurol Surg A Cent Eur Neurosurg 2024; 85:464-471. [PMID: 35354216 DOI: 10.1055/a-1812-9834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Anterior cervical corpectomy and fusion (ACCF) has been widely used in the treatment of cervical spondylotic myelopathy (CSM), ossification of posterior longitudinal ligament (OPLL), cervical trauma, and other cervical diseases, but few studies have reported the osseous and physiologic remodeling of the anterior wall of the spinal canal following ACCF. In this study, we analyze that remodeling process and its influence on titanium mesh cage (TMC) subsidence. METHODS We performed a clinical and radiologic analysis of consecutive patients treated with ACCF. Growth rates (GRs) reflecting the extent of remodeling of the remnants of the resected vertebral bodies were measured. We compared the computed tomography (CT) scans taken immediately and at least 1 year after surgery, and a literature review was conducted. RESULTS In all, 48 patients underwent ACCF at a mean age of 61.5 ± 12.0 years. The median follow-up was 36 months, and 159 CT images were analyzed. The GR values of the remnants of the vertebral bodies on CT images immediately and 1 year after surgery were 0.505 ± 0.077 and 0.650 ± 0.022 (p < 0.001), respectively, and the GR value at ≥4 years was 1. Axial CT scans showed that remodeling starts from the lateral remnants of the resected vertebral bodies, finally reaching the center. When fusion of the vertebral bodies and the titanium cage was complete during the first year after ACCF, osteogenesis and remodeling were initiated in the osseous anterior wall of the spinal canal. The remodeling of the osseous anterior wall of the spinal canal was completed at the fourth year after surgery, without recompressing the spinal cord, as seen on both axial and lateral CT scans. According to the literature review, there was no TMC subsidence at more than 4 years after surgery. CONCLUSION The anterior wall of the spinal canal undergoes osseous remodeling after ACCF. The process is complete in the fourth year after surgery and prevents TMC subsidence.
Collapse
Affiliation(s)
- Haofei Ni
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
- Department of Spinal Surgery, Tongji University School of Medicine, Tongji Hospital, Shanghai, China
| | - Wei Mao
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hailong Li
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Youhai Dong
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Lee DH, Lee HR, Riew KD. An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review. Asian Spine J 2024; 18:274-286. [PMID: 38146052 PMCID: PMC11065509 DOI: 10.31616/asj.2023.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.
Collapse
Affiliation(s)
- Dong-Ho Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hyung Rae Lee
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu,
Korea
| | - Kiehyun Daniel Riew
- Department of Orthopaedic Surgery, New York-Presbyterian Och Spine Hospital, Columbia University, New York, NY,
USA
| |
Collapse
|
3
|
Niu Y, Lv Q, Gong C, Duan D, Zhou Z, Wu J. Predictive Effect of Cervical Sagittal Parameters and Corresponding Segmental Paravertebral Muscle Degeneration on the Occurrence of Cervical Kyphosis Following Cervical Laminoplasty. World Neurosurg 2023; 175:e723-e729. [PMID: 37031734 DOI: 10.1016/j.wneu.2023.04.011] [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: 12/04/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Cervical sagittal parameters and paravertebral muscle degeneration are important factors for the occurrence of cervical spondylotic myelopathy. However, the relationship between the 2 risk factors and cervical kyphosis following cervical laminoplasty remains unknown. METHODS A total of 130 patients undergoing cervical laminoplasty were enrolled from July 2018 to July 2020 and were followed up for at least 24 months. Clinical recovery was recorded, including the Japanese Orthopedic Association, neck disability index and visual analog scale scores. Radiographic sagittal parameters were measured on cervical lateral radiographs: T1 slope (T1S), C2-C7 Cobb lordotic angle (CLA), C2-C7 sagittal vertical axis, O-C2 angle, and T1S-CLA. The magnetic resonance imaging (MRI) parameters of the paraspinal muscles were also measured, including cross-sectional area and fat infiltration (FI). The patients were divided into a kyphosis group and a lordosis group based on the last follow-up results of CLA. Multivariate logistic analysis was performed to analyze risk factors for kyphosis following laminoplasty. RESULTS Thirty-two patients were assigned to the kyphosis group and 98 were assigned to the lordosis group. Patient baseline and surgical information in the 2 groups showed no statistically significant difference. In the comparison of clinical recovery, patients with kyphosis showed a lower Japanese Orthopedic Association recovery rate than the lordosis group. For the radiographic parameters and muscle condition comparison, CLA, T1S-CLA, and FI were the most significant parameters. The logistic regression revealed that T1S-CLA and FI were the most important variables that predicted kyphosis. CONCLUSIONS We concluded that FI remarkably differed in the paraspinal muscles in the 2 groups. Multivariate logistic regression demonstrated that T1S-CLA and FI significantly influenced the process of kyphosis after cervical laminoplasty.
Collapse
Affiliation(s)
- Yahui Niu
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Qingqing Lv
- Nursing School of Anhui Medical University, Anhui Province, China
| | - Chen Gong
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Duanqiang Duan
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Zhihua Zhou
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Jianming Wu
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China.
| |
Collapse
|
4
|
Katsumi K, Watanabe K, Yamazaki A, Hirano T, Ohashi M, Mizouchi T, Sato M, Sekimoto H, Izumi T, Shibuya Y, Kawashima H. Predictive biomarkers of ossification progression and bone metabolism dynamics in patients with cervical ossification of the posterior longitudinal ligament. 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 2023; 32:1282-1290. [PMID: 36757615 DOI: 10.1007/s00586-023-07565-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/12/2023] [Accepted: 01/25/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE This study aimed to establish biomarkers to predict the progression of ossification by examining ossification volume and bone metabolism dynamics in patients with ossification of the posterior longitudinal ligament (OPLL). METHODS We assessed OPLL progression using computed tomography-based three-dimensional (3D) image analysis and examined bone metabolism dynamics in 107 patients with OPLL (men, 72; women, 35; mean age, 63.6 years). The volume of OPLL was calculated twice during the follow-up period, and OPLL progression was evaluated by the annual rate of ossification increase. Bone metabolism dynamics were assessed by routine blood tests and analysis of various serum biomarkers (including 25-hydroxyvitamin D, intact parathyroid hormone, fibroblast growth factor 23, intact N-terminal propeptide of type 1, tartrate-resistant acid phosphatase isoform 5b, sclerostin, and Dickkopf-1) and bone mineral density (BMD). Patients were classified into the progression (P) or non-progression (NP) group according to the annual rate of increase in previous 3D image analyses, and associated factors between these groups were compared. RESULTS The P and NP groups consisted of 29 patients (23 men and 6 women) and 78 patients (49 men and 29 women), respectively. Univariate analysis revealed significant differences in terms of age, body mass index, serum phosphorus, serum sclerostin, and BMD. In multivariate analysis, age, serum phosphorus, and serum sclerostin were identified as independent factors associated with OPLL progression. CONCLUSION Younger age, hypophosphatemia, and high serum sclerostin are risk factors for OPLL progression. Serum phosphorus and sclerostin could serve as important biomarkers for predicting ossification progression.
Collapse
Affiliation(s)
- Keiichi Katsumi
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, 1-18 Shinkocho, Chuo-Ku, Niigata, 950-8556, Japan. .,Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-Ku, Niigata, 951-8510, Japan.
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Akiyoshi Yamazaki
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, 1-18 Shinkocho, Chuo-Ku, Niigata, 950-8556, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-Uonuma City, Niigata, 949-7302, Japan
| | - Masayuki Ohashi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Tatsuki Mizouchi
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, 1-18 Shinkocho, Chuo-Ku, Niigata, 950-8556, Japan
| | - Masayuki Sato
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, 1-18 Shinkocho, Chuo-Ku, Niigata, 950-8556, Japan
| | - Hiroyuki Sekimoto
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, 1-18 Shinkocho, Chuo-Ku, Niigata, 950-8556, Japan
| | - Tomohiro Izumi
- Department of Orthopedic Surgery, Niigata Minami Hospital, 2007-6, Toyano, Chuo-Ku, Niigata, 950-8601, Japan
| | - Yohei Shibuya
- Department of Orthopedic Surgery, Niigata Prefectural Shibata Hospital, 1-2-8, Honcho, Shibata, Niigata, 957-8588, Japan
| | - Hiroyuki Kawashima
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-Ku, Niigata, 951-8510, Japan
| |
Collapse
|
5
|
Lee DH, Park S, Hong CG, Kim S, Cho JH, Hwang CJ, Yang JJ, Lee CS. Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament. Global Spine J 2022; 12:1074-1083. [PMID: 33222538 PMCID: PMC9210231 DOI: 10.1177/2192568220975387] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Vertebral body sliding osteotomy (VBSO) has previously been reported as a technique to decompress ossification of the posterior longitudinal ligament (OPLL) by translating the vertebral body anteriorly. This study aimed to evaluate the radiological and clinical efficacies of VBSO and clarify the surgical indications of VBSO for treating myelopathy caused by OPLL. METHODS Ninety-seven patients with symptomatic OPLL-induced cervical myelopathy treated with VBSO or laminoplasty who were followed up for more than 2 years were retrospectively reviewed. Cervical alignment, range of motion, fusion, modified K-line (mK-line) status, and minimum interval between ossified mass and mK-line (INT(min)), and the Japanese Orthopaedic Association (JOA) score were assessed. Patients in the VBSO group were compared with those who underwent laminoplasty. RESULTS Cervical lordosis and INT(min) significantly increased in the VBSO group. All patients in the VBSO group assessed as mK-line (-) preoperatively were assessed as mK-line (+) postoperatively. However, in the LMP group, the mK-line status changed from (+) preoperatively to (-) postoperatively in 3 patients. Final JOA score (p = 0.02) and JOA score improvement (p = 0.01) were significantly higher in the VBSO group. JOA recovery ratio (p = 0.03) and proportion of patients with a recovery rate ≥50% were significantly higher in the VBSO group (p < 0.01). CONCLUSIONS VBSO is an effective surgical option for OPLL-induced myelopathy, demonstrating favorable neurological recovery and lordosis restoration with low complication rates. It is best indicated for kyphotic alignment, OPLL with a high space-occupying ratio, and OPLL involving ≤3 segments.
Collapse
Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea,Sehan Park, MD, Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 14 Siksadong, Ilsandonggu, Goyangsi, Gyeonggido 411-773, Korea.
| | - Chul Gie Hong
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Korea
| | - Shinseok Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
6
|
Shi H, Chen L, Zhu L, Jiang ZL, Wu XT. Instrumented fusion versus instrumented non-fusion following expansive open-door laminoplasty for multilevel cervical ossification of the posterior longitudinal ligament. Arch Orthop Trauma Surg 2022; 143:2919-2927. [PMID: 35678891 DOI: 10.1007/s00402-022-04498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the outcomes of expansive open-door laminoplasty with instrumented fusion (ELIF) and expansive open-door laminoplasty with instrumented non-fusion (ELINF) for multilevel cervical ossification of the posterior longitudinal ligament (OPLL). METHODS Patients who underwent ELIF or ELINF due to multilevel cervical OPLL from June 2013 to June 2019 were identified. Clinical and radiological outcomes were compared between the two groups. RESULTS A total of 78 patients were enrolled in this study with a minimum follow-up of 24 months, including 42 patients in the ELIF group and 36 patients in the ELINF group. At the final follow-up, sagittal vertical axis (SVA) and C2-C7 Cobb angle in the ELIF group were significantly better than those in the ELINF group, and cervical range of movement (ROM) in the ELIF group decreased significantly than that in the ELINF group. The incidence of OPLL progression at the final follow-up was 4.76% (2/42) in the ELIF group and 27.78% (10/36) in the ELINF group. Postoperative Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) score improved significantly in each group, but JOA score and recovery rate (RR) in the ELIF group were significantly better than those in the ELINF group at the final follow-up. When K-line was positive, the difference in the final JOA score between the two groups was not significant, but the RR in the ELIF group was significantly better than that in the ELINF group. When K-line was negative, the final JOA score and RR in the ELIF group were significant higher than those in the ELINF group. CONCLUSIONS ELIF and ELINF were two effective surgical procedures for treating multilevel cervical OPLL. However, ELIF was superior to ELINF due to better postoperative JOA score and RR, significant improvement of C2-C7 Cobb angle and maintenance of SVA, and suppressant effect on OPLL progression, especially for patients with K-line ( - ) OPLL.
Collapse
Affiliation(s)
- Hang Shi
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Lu Chen
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Lei Zhu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Zan-Li Jiang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Xiao-Tao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.
| |
Collapse
|
7
|
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
|
8
|
A deep learning algorithm to identify cervical ossification of posterior longitudinal ligaments on radiography. Sci Rep 2022; 12:2113. [PMID: 35136170 PMCID: PMC8826389 DOI: 10.1038/s41598-022-06140-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/25/2022] [Indexed: 12/16/2022] Open
Abstract
The cervical ossification of the posterior longitudinal ligament (cOPLL) is sometimes misdiagnosed or overlooked on radiography. Thus, this study aimed to validate the diagnostic yield of our deep learning algorithm which diagnose the presence/absence of cOPLL on cervical radiography and highlighted areas of ossification in positive cases and compare its diagnostic accuracy with that of experienced spine physicians. Firstly, the radiographic data of 486 patients (243 patients with cOPLL and 243 age and sex matched controls) who received cervical radiography and a computer tomography were used to create the deep learning algorithm. The diagnostic accuracy of our algorithm was 0.88 (area under curve, 0.94). Secondly, the numbers of correct diagnoses were compared between the algorithm and consensus of four spine physicians using 50 independent samples. The algorithm had significantly more correct diagnoses than spine physicians (47/50 versus 39/50, respectively; p = 0.041). In conclusion, the accuracy of our deep learning algorithm for cOPLL diagnosis was significantly higher than that of experienced spine physicians. We believe our algorithm, which uses different diagnostic criteria than humans, can significantly improve the diagnostic accuracy of cOPLL when radiography is used.
Collapse
|
9
|
Lee DH, Nam WD, Kim NY, Park JW, Hong CG. Fate of Ossification of Posterior Longitudinal Ligament Following Anterior Cervical Fusion: Progression of Cervical Ossification of Posterior Longitudinal Ligament After Vertebral Body Sliding Osteotomy or Laminoplasty. World Neurosurg 2020; 146:e1270-e1277. [PMID: 33276178 DOI: 10.1016/j.wneu.2020.11.142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In the treatment of ossification of posterior longitudinal ligament (OPLL)-induced cervical myelopathy, laminoplasty (LMP) is the most widely used surgical procedure. However, the progression of ossification masses is a well-known complication of LMP. This study aimed to investigate whether the novel anterior cervical decompression technique (vertebral body sliding osteotomy; VBSO) based on anterior column fusion suppresses the progression of OPLL compared with motion-preserving posterior decompression surgery (LMP). METHODS All 77 consecutive patients (VBSO group, n = 33; LMP group, n = 44) who underwent VBSO or LMP for cervical OPLL at our institute between January 2012 and November 2017 were included. A total of 62 and 86 cervical motion segments in the VBSO and LMP groups were investigated, respectively. The OPLL thickness was measured twice (immediate postoperative and final follow-up), and the change of OPLL thickness was compared between the 2 groups. RESULTS The increase in OPLL thickness in the VBSO group (-0.18 ± 0.24 mm) was significantly smaller than that in the LMP group (1.0 ± 0.9 mm, P < 0.001). Interestingly, in some patients, suppressed OPLL progression and decreased OPLL thickness were observed. CONCLUSIONS The solid fusion of the anterior column by VBSO is associated with the lower incidence of OPLL growth and potential for growth arrest.
Collapse
Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Woo Dong Nam
- Kangwon National University Hospital, Gangwon-do
| | - Nam Yeop Kim
- Kangwon National University Hospital, Gangwon-do
| | - Jin Woo Park
- Kangwon National University Hospital, Gangwon-do
| | | |
Collapse
|
10
|
Doi T, Sakamoto R, Horii C, Okamoto N, Nakajima K, Hirai S, Oguchi F, Kato S, Taniguchi Y, Matsubayashi Y, Hayashi N, Tanaka S, Oshima Y. Risk factors for progression of ossification of the posterior longitudinal ligament in asymptomatic subjects. J Neurosurg Spine 2020; 33:316-322. [PMID: 32384273 DOI: 10.3171/2020.3.spine2082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The incidence and risk factors for the progression of ossification of the posterior longitudinal ligament (OPLL) have been previously reported in surgically and nonsurgically treated symptomatic patients. However, the correlates of OPLL progression in asymptomatic subjects with OPLL are not well characterized. This study aimed to clarify the incidence and risk factors for OPLL progression in asymptomatic subjects based on whole-body CT. METHODS The authors retrospectively reviewed 2585 healthy subjects who underwent whole-body CT at a single health center from September 2007 to December 2011. This study included asymptomatic subjects with OPLL who underwent CT scans twice with an interval of at least 5 years. Progression of OPLL was assessed based on initial and final CT scan. Subjects were divided into two groups: nonprogression (OPLL-NP) and progression (OPLL-P) groups. Clinical characteristics, bone mineral density status, OPLL types, and OPLL involvement of multiple vertebral levels between the two groups were compared. Risk factors for progression of OPLL were identified by logistic regression analysis after propensity score adjustment. RESULTS Of the 109 subjects with OPLL (91 men and 18 women), 20 (18.3%) exhibited OPLL progression (OPLL-P group). Subjects in the OPLL-P group were significantly younger (p = 0.031), had higher prevalence of multilevel OPLL involvement (p = 0.041) and continuous type of OPLL (p = 0.015), and had higher uric acid (UA) levels (p = 0.004) at the time of initial CT examination compared to the OPLL-NP group. Younger age (adjusted odds ratio [aOR] 0.95, 95% CI 0.90-0.99), OPLL involvement of multiple vertebral levels (aOR 2.88, 95% CI 1.06-7.83), continuous type of OPLL (aOR 4.21, 95% CI 1.35-13.10), and higher UA levels (aOR 2.09, 95% CI 1.24-3.53) were significant risk factors for OPLL progression. CONCLUSIONS Younger age, OPLL involvement of multiple vertebral levels, continuous type of OPLL, and higher UA levels are significant risk factors for OPLL progression in asymptomatic subjects.
Collapse
Affiliation(s)
- Toru Doi
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Ryuji Sakamoto
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Chiaki Horii
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Naoki Okamoto
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Koji Nakajima
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Shima Hirai
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Fumihiko Oguchi
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - So Kato
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Yuki Taniguchi
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | | | - Naoto Hayashi
- 2Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Sakae Tanaka
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| | - Yasushi Oshima
- 1Department of Orthopaedic Surgery, University of Tokyo; and
| |
Collapse
|
11
|
Lee DH, Park S, Hong CG. A novel anterior decompression technique for kyphosis line (K-line) ossification of posterior longitudinal ligament (OPLL): vertebral body sliding osteotomy. JOURNAL OF SPINE SURGERY 2020; 6:196-204. [PMID: 32309657 DOI: 10.21037/jss.2019.12.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Conventional anterior cervical corpectomy and fusion (ACCF) for cervical ossification of the posterior longitudinal ligament (OPLL) is associated with a high incidence of surgery-related complications. A novel anterior decompression technique [vertebral body sliding osteotomy (VBSO)] has been developed to prevent such complications and achieve effective anterior decompression for severe OPLL patients. The purpose of this study was to describe the procedure of novel surgical technique and to evaluate the long-term surgical outcomes. Methods Between 2012 and 2014, 24 patients underwent VBSO for treatment of cervical myelopathy caused by severe OPLL. Operation time, estimated blood loss (EBL), neurologic outcomes and perioperative complications were investigated. Various radiographic parameters such as the preoperative canal occupying ratio, postoperative canal widening, and preoperative and postoperative cervical sagittal alignment were also measured. Minimum follow-up was 24 months. Results The mean Japanese Orthopaedic Association score for cervical myelopathy (C-JOA score) improved from 12.4±2.9 preoperatively to 16.0±1.4 at the final follow-up (P<0.05). The mean recovery rate of the C-JOA score at the final follow-up was 68.65%±17.80%. The mean operating time was 130.7±21.0 minutes and the EBL was 176.3±38.0 mL. There were no perioperative complications. Pseudarthrosis was detected in two cases at 12 months postoperatively. The average spinal canal compromised ratio by OPLL decreased from 64.0%±15.0% preoperatively to 15.5%±12.2% postoperatively (P<0.05), with an average postoperative canal widening of 5.15±1.39 mm. Conclusions Novel anterior decompression technique termed VBSO may be an effective and safe surgical option for anterior decompression surgery in patients with severe cervical OPLL. Since, VBSO does not involve a direct manipulation of the OPLL mass or dissection of the interspace between the OPLL and dura mater, this may significantly decrease the incidence of surgery-related complications, operation time, and intraoperative blood loss.
Collapse
Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chul Gie Hong
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do, South Korea
| |
Collapse
|
12
|
How Does Ossification of Posterior Longitudinal Ligament Progress in Conservatively Managed Patients? Spine (Phila Pa 1976) 2020; 45:234-243. [PMID: 31513119 DOI: 10.1097/brs.0000000000003240] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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. OBJECTIVE The aim of this study was to elucidate the progression of ossification of the posterior longitudinal ligament (OPLL) in conservatively managed patients and determine its risk factors SUMMARY OF BACKGROUND DATA.: Although several studies have demonstrated how OPLL progresses after laminoplasty or fusion, its progression in conservatively managed patients remains unclear. METHODS The vertical length of the ossified mass and its thickness at each segment were evaluated on sagittal computed tomography images. Patients with vertical growth >2 mm were included in the vertical progression group. Segments with a thickness progression >1 mm were classified as thickness progressed segments, and patients who had at least one progressed segment were included in the thickness progression group. Based on the characteristics at each disc level, the ossified mass at each segment was classified into four types: type 1, no disc space involvement; type 2, involving the disc space, but not crossing; type 3, crossing the disc space, but not fused; and type 4, completely fused. RESULTS The progression of ossified mass was observed in younger patients (P < 0.01) and in C2-C3 involvement (P < 0.01) cases. Moreover, progression in both directions was observed more frequently in the mixed-type OPLL (P < 0.01). Progression occurred most often in type 3 segments (72.0%, P < 0.01). In type 3 segments, thickness progression was found more frequently in segments with segmental range of motion (ROM) ≥5° (55.6% vs. 27.8%, P = 0.04). The proportion of segments whose initial thickness was >5 mm was significantly higher among progressed segments (60.0% vs. 35.2%, P = 0.03). CONCLUSION Young age, C2-C3 involvement, and mixed-type OPLL are risk factors for OPLL progression. Segments with morphology of crossing the segment, but without fusion (type 3), segmental ROM ≥5°, and initial thickness >5 mm need special attention. LEVEL OF EVIDENCE 3.
Collapse
|
13
|
Yang X, Liu X, Liang C, Yu M, Liu X, Liu Z. Three-Dimensional Analysis of the Radiological Risk Factors for Progression of the Thoracic Ossification of the Posterior Longitudinal Ligament After Posterior Decompression and Stabilization. World Neurosurg 2019; 134:e739-e746. [PMID: 31706973 DOI: 10.1016/j.wneu.2019.10.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although research shows that the ossified masses of ossification of the posterior longitudinal ligament (OPLL) continue to grow postoperatively, information regarding thoracic OPLL (T-OPLL) is lacking. To date, no study has investigated the progression of T-OPLL within each motion segment. The purpose of this study was to analyze the progression of T-OPLL in each motion segment using a 3-dimensional measurement and evaluate whether the type of T-OPLL and surgical methods affect its progression postoperatively. METHODS Clinical data from 20 patients (101 segments) with thoracic myelopathy secondary to OPLL were evaluated retrospectively. All patients underwent posterior decompression (laminectomy and stabilization or circumferential decompression [CD] and stabilization) at a single center. The 3-dimensional measurement of OPLL volume was performed using computed tomography scans. The ossified masses were classified into 2 types based on the fusion of each segment at the intervertebral space: type 1 = complete bridging (fused); type 2 = not fused. Statistical analyses were performed to determine the degree of T-OPLL progression according to the types and surgical methods. RESULTS Mean OPLL progression was significantly higher in type 2. The mean annual growth rates of OPLL (AGRO) for groups 1 and 2 were 6.21% ± 6.11% per year and 23.50% ± 11.34% per year, respectively (P < 0.01). Further, no statistically significant differences were seen between the fixed and non-fixed groups (P = 0.23), and CD and non-CD segments (P = 0.56). CONCLUSIONS The mean AGRO does not decrease even after stabilization and CD. Type 2 intervertebral space was a risk factor for T-OPLL progression. Cases of type 2 without CD need close follow-up.
Collapse
Affiliation(s)
- Xiaosong Yang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Xiao Liu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Chen Liang
- The Center for Pain Medicine, Peking University Third Hospital, Beijing, China
| | - Miao Yu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China.
| | - Zhongjun Liu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| |
Collapse
|
14
|
Wang L, Jiang Y, Li M, Qi L. Postoperative Progression of Cervical Ossification of Posterior Longitudinal Ligament: A Systematic Review. World Neurosurg 2019; 126:593-600. [PMID: 30930321 DOI: 10.1016/j.wneu.2019.03.229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to provide a systematic and comprehensive review of the existing literature regrading postoperative ossification of posterior longitudinal ligament (OPLL) progression. METHODS Using the PRISMA guidelines, we conducted an exhaustive review of electronic databases. Potential articles were screened and related information was extracted and analyzed. Twenty-four articles with low-quality evidence were included in the review. The findings of the literature review were divided into several groups: the relationship of surgery to OPLL progression; incidence and risk factors; timing and process of OPLL progression; the effect of additional instrumentation on progression; and neurologic deterioration related with progression. RESULTS There was no definitive conclusion for whether surgery could accelerate OPLL progression compared with the natural course. The incidence of postoperative OPLL progression was reported from 3.3% to 74.5%. Younger age, involvement of multiple levels and mixed or continuous types are recognized as risk factors. OPLL could progress transversely and longitudinally and progression in length appeared more significant than progression in thickness. Although radiologic OPLL progression was observed significantly more frequently after laminoplasty than after fusion surgery, whether additional instrumented fusion could suppress progression needs further research. Radiographic progression of OPLL did not positively correspond with neurologic deterioration. CONCLUSIONS The lack of high-level evidence makes it difficult to draw definite conclusions and further research and long-term follow-up clinical studies are needed to better understand postoperative OPLL progression.
Collapse
Affiliation(s)
- Liang Wang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yunpeng Jiang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Mu Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Lei Qi
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| |
Collapse
|
15
|
Choo YH, Kim SW, Jeon I. Investigation of Symptomatic Unstable Changes of Non-Fused Component in the Mixed-Type Cervical Ossification of Posterior Longitudinal Ligament Using Dynamic Magnetic Resonance Imaging: A Case Report. Korean J Neurotrauma 2018; 14:164-168. [PMID: 30402439 PMCID: PMC6218338 DOI: 10.13004/kjnt.2018.14.2.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 12/03/2022] Open
Abstract
A 43-year-old man was transferred to our hospital with recurring myelopathic symptoms after previous anterior and posterior surgical decompressions for mixed-type cervical ossification of the posterior longitudinal ligament (OPLL). Conventional magnetic resonance imaging (MRI) showed a preserved cervical curve and the achievement of successful decompression after the previous surgeries. The patient's symptoms were aggravated when he was in the extended neck posture. Dynamic MRI performed with the patient in an extended neck position revealed cord compression by OPLL from C3 to C4 with newly developed retrolisthesis of the C4–5 segment. We recommend the use of dynamic MRI to investigate motion-dependent cord compression caused by instability of the non-fused OPLL component.
Collapse
Affiliation(s)
- Yoon Hee Choo
- Department of Neurosurgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Woo Kim
- Department of Neurosurgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|