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Zhang Y, Huang Z, Xu P, Xu Z, Xing X, Xin Y, Gao M, Li X, Xiao Y. Comparison of Anterior Controllable Antedisplacement and Fusion Versus Laminoplasty in the Treatment of Multisegment Ossification of Cervical Posterior Longitudinal Ligament: A Meta-Analysis of Clinical. World Neurosurg 2024; 185:193-206. [PMID: 38157983 DOI: 10.1016/j.wneu.2023.12.126] [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: 08/06/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study aims to provide a comprehensive summary of the existing literature and conduct a systematic evaluation of the clinical outcomes associated with anterior controllable antedisplacement and fusion (ACAF) and posterior laminoplasty (LP) for the treatment of multisegment ossification of the cervical posterior longitudinal ligament (OPLL). METHODS We conducted an electronic search of databases, including PubMed, Embase, Cochrane Library, and CNKI, from the inception of the initial database to March 2023. We analyzed various parameters, including demographic data, operation time, intraoperative blood loss, cervical curvature, Japanese Orthopaedic Association (JOA) scores, Visual Analog Scale (VAS) scores, and postoperative complications. Two independent reviewers screened the literature, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using RevMan 5.4 software. RESULTS Our evaluation encompassed 7 studies involving a total of 467 patients. The patient cohort was divided into 2 groups: Group A (ACAF) comprised 226 patients, while Group B (LP) comprised 241 patients. Overall, our statistical analysis revealed significant differences between the 2 groups (P < 0.05) in terms of intraoperative blood loss, operative time, JOA score, JOA score improvement rate, postoperative VAS score, postoperative cervical curvature, and the incidence of certain postoperative complications (C5 nerve root paralysis, dysphagia, and axial symptoms). However, there was no statistically significant difference in the incidence of postoperative cerebrospinal fluid leakage and postoperative total complications between the 2 groups (P > 0.05). CONCLUSIONS The findings of this study suggest that, in the treatment of multilevel cervical OPLL, ACAF yields superior outcomes compared to LP. Specifically, ACAF improves postoperative neurologic function, reduces postoperative pain, lowers intraoperative blood loss, improves postoperative cervical curvature, and decreases the incidence of C5 nerve root paralysis and postoperative axial symptoms. Nonetheless, ACAF is associated with longer operative times and a higher incidence of postoperative dysphagia, though the overall incidence of postoperative complications is similar. It is important to note that these conclusions should be interpreted cautiously due to the limited sample size and the variable quality of the included studies. Further research involving larger, high-quality studies is warranted to validate these findings.
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Affiliation(s)
- Yiming Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Zhen Huang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Peng Xu
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Zhentao Xu
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Xiaohui Xing
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Yexin Xin
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China; School of Clinical Medicine, Weifang Medical University, Weifang, Shangdong, China
| | - Mingxu Gao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Xueyuan Li
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Yilei Xiao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China.
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Zheng R, Chen Y, Yao G, Zeng J, Ma X, Yuan G, Hu X. Computed Tomography-Based Morphometric Analysis of Lower Cervical Anterior Transpedicular Screw Fixation and Related Factors in the Chinese Population. World Neurosurg 2024; 182:e721-e733. [PMID: 38092354 DOI: 10.1016/j.wneu.2023.12.026] [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: 10/26/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Anterior transpedicular screw (ATPS) internal fixation of the lower cervical spine is an alternative for patients who cannot tolerate combined anterior and posterior surgery. The cervical vertebral anatomy varies with many factors, including age, gender, height, weight, and race. METHODS Three-dimensional (3D) CT reconstructions were performed on 122 patients. We selected the best level and measured the relevant parameters on both sides of the cervical vertebrae. RESULTS We identified the entry point and orientation parameters of ATPS fixation for the C3-C7 vertebrae, and analyzed cervical pedicle parameters. Outer pedicle width (OPW), outer pedicle height (OPH), and pedicle axis length (PAL) were not correlated with body weight and age, but were positively correlated with body height (P < 0.05). After multiple linear regression analysis to exclude the effects of body height, no significant differences in OPW, OPH, and PAL were found between male and female subjects at most cervical levels. Pedicle cortical thickness was negatively correlated with age (P < 0.05). The percentage of pedicles with OPW <4.5 mm was: C3, 38.10%; C4, 34.92%; C5, 12.70%; C6, 9.52%; and C7, 0%. The percentage of pedicles with OPWs ≤4.5 mm, ≤4.0 mm, and ≤3.5 mm was higher among subjects with body height <160 cm. CONCLUSIONS This study presents the internal anatomy of the cervical spine and provides accurate preoperative evaluation data for ATPS fixation. OPW, OPH, and PAL are positively correlated with body height, while pedicle cortical thickness is negatively correlated with age.
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Affiliation(s)
- Ruiwu Zheng
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Yuchun Chen
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Guanfeng Yao
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Jicang Zeng
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Xueming Ma
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Guixin Yuan
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Xianghua Hu
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China.
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Yang H, Gao C, Lu X, Shi J, Wang L, Sun Y, Sun J. Exclusion of Ossified Ligaments Behind C2 Vertebra Combined with Anterior Controllable Antedisplacement and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament Extending to C2 Segment. World Neurosurg 2020; 146:e1351-e1359. [PMID: 33307264 DOI: 10.1016/j.wneu.2020.12.015] [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: 09/12/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We sought to introduce an anterior surgical technique for cervical ossification of posterior longitudinal ligament (OPLL) extending to C2. METHODS A total of 29 patients with multilevel OPLL extending to C2 underwent surgery from January 2016 to January 2019. The rationale of our surgical technique is to transect the ossified ligament at the level of C2/3, dividing OPLL into 2 parts. OPLL behind the C2 vertebra is reserved as "focus exclusion," and OPLL below C2 is performed anterior controllable antedisplacement and fusion. Neurologic condition was evaluated using the Japanese Orthopaedic Association scoring system and its improvement ratio. Radiologic assessment included type and extent of OPLL, occupying rate, thickness and length of ossified mass, and curvature of spinal cord. Surgery- and implant-related complications were recorded. RESULTS The mean Japanese Orthopaedic Association score increased from 9.4 to 15.8 points at last follow-up, with a significant improvement (P < 0.01). The mean preoperative length of the ossified mass behind C2 was 15.4 mm, and its thickness was 2.2 mm, with no significant progression at last follow-up (15.3 mm and 2.2 mm, P > 0.05). There was also no statistical difference in OPLL thickness at the largest occupying rate level between preoperation and last follow-up (7.4 mm vs. 7.3 mm, P > 0.05). Four patients presented with cerebrospinal fluid leakage, 1 with screw displacement, and 1 with dysphagia. CONCLUSIONS For patients with cervical OPLL extending to C2, exclusion of ossified ligaments behind C2 combined with anterior controllable antedisplacement and fusion below C2 is an effective and alternative technique.
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Affiliation(s)
- Haisong Yang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Chunyan Gao
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xuhua Lu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiangang Shi
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liang Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yuling Sun
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jingchuan Sun
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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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.
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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
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