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Iyer RD, Ramachandran K, Palaninathan P, Shetty T AP, K S SV, Kanna RM, Shanmuganathan R. Neuromonitoring Signal Changes in Degenerative Cervical Myelopathy: An Analysis of Risk Factors for Signal Drops During Posterior Cervical Decompression. World Neurosurg 2024:S1878-8750(24)01015-5. [PMID: 38906464 DOI: 10.1016/j.wneu.2024.06.057] [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: 05/03/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To analyze intraoperative neuromonitoring data of patients with degenerative cervical myelopathy undergoing cervical laminectomy and assess the incidence of signal drops and their risk factors. METHODS This retrospective observational study included patients with degenerative cervical myelopathy who underwent cervical laminectomy with intraoperative neuromonitoring between July 2018 and March 2023. We analyzed the signal changes for any correlation with the type of pathology (ossified posterior longitudinal ligament vs. cervical spondylotic myelopathy [CSM]) and clinical (severity of myelopathy, duration of symptoms) and radiological (length of cord signal changes and K-line) parameters. RESULTS Of 100 degenerative cervical myelopathy cases, 55 were diagnosed as OPLL and 45 as CSM. Signal drops were recorded in 26 patients-14 persistent drops and 12 transient drops. True positive drops were seen in 4 patients (2 OPLL and 2 CSM), 3 of whom had sustained bimodal drops (both somatosensory evoked potentials and motor evoked potentials). Signal drops were significantly more frequent with OPLL compared with CSM (P < 0.01). Ten of 14 persistent signal drops and 9 of 12 transient drops were seen in patients in OPLL. Continuous OPLL, negative K-line, hill type OPLL, severity of myelopathy, and longer duration of symptoms were risk factors for signal drops. CONCLUSIONS Patients with cervical OPLL have a higher incidence of false positive and transient signal drops after decompression compared with patients with CSM. Longer duration of symptoms, high-grade myelopathy, continuous OPLL, hill type OPLL, and negative K-line were risk factors for signal drops.
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Affiliation(s)
- R Dinesh Iyer
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Karthik Ramachandran
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Pranavakumar Palaninathan
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Ajoy Prasad Shetty T
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India.
| | - Sri Vijayanand K S
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Rajasekaran Shanmuganathan
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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Duan Q, Liang G, Chen C, Ye Y, Zheng X, Liang C, Chang Y. Accuracy of Realigned K-line for Predicting Surgical Outcomes After Laminoplasty in Patients With Degenerative Cervical Myelopathy. Global Spine J 2024; 14:1573-1582. [PMID: 36626180 DOI: 10.1177/21925682221150908] [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] [Indexed: 01/11/2023] Open
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVES To report a new index, the realigned K-line, for predicting surgical outcomes after laminoplasty in patients with degenerative cervical myelopathy (DCM). METHODS One hundred twenty-eight patients with DCM undergoing laminoplasty were enrolled from January 2018 to April 2021 in our department. A realigned K-line was defined as the line connecting the midpoints of the spinal cord between C2 and C7 on realigned T1-weighted magnetic resonance imaging. The minimum interval between the anterior compression factors of the spinal cord and the realigned K-line (INTrea), and the modified K-line (INTmod) were measured. A logistic regression analysis was performed to identify factors associated with unsatisfactory surgical outcomes. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was applied to evaluate the reliability of the multivariate logistic regression model. RESULTS Univariate analysis showed that the score for the bladder function section of the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire, numeric rating scale scores for arm pain, and INTrea might be related to the Japanese Orthopaedic Association (JOA) recovery rate (RR) not achieving the minimal clinically important difference (MCID) (P < .05). Only INTrea (odds ratio = .744, P < .05) was an independent preoperative factor related to the JOA RR not achieving the MCID (area under the curve, .743). A cutoff of 5.0 mm for INTrea had an accuracy of 71.9% and specificity of 80.3% for predicting the JOA RR not achieving the MCID. CONCLUSIONS INTrea is an independent preoperative risk factor related to the JOA RR not achieving the MCID in patients with DCM. A cutoff point of 5.0 mm is most appropriate for alerting spine surgeons to a high likelihood of the JOA RR not achieving the MCID.
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Affiliation(s)
- Qifei Duan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guoyan Liang
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chong Chen
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yongyu Ye
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiaoqing Zheng
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Changxiang Liang
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yunbing Chang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Wang S, Yang Y, Han D, Guo Y, Shi J, Wang Y, Sun J. Foramen Facet Spinal Classification for Ossification of the Posterior Longitudinal Ligament on Computed Tomography: Closely Related to Clinical Efficacy. Clin Spine Surg 2024; 37:E162-E169. [PMID: 38679813 DOI: 10.1097/bsd.0000000000001574] [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: 11/24/2022] [Accepted: 12/06/2023] [Indexed: 05/01/2024]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To develop and validate computed tomography (CT)-based classification schemes to eliminate ambiguity as much as possible and evaluate the adequacy and clinical value of its classification. BACKGROUND There is no objective criteria for laminoplasty of more than one million Chinese patients with ossification of the posterior longitudinal ligament (OPLL) every year. CT imaging can accurately show the location, size, and shape of ossification, it is very important to propose a recognized simple classification of ossifications. PATIENTS AND METHODS From 2016 to 2018, 100 patients with "moderate to severe" OPLL on CT were performed according to the following criteria. This study simply classifies the grade of the ossification as 1-2-3, the zone is A-B by the foramen facet spinal canal classification, and the interexaminer reliability is 96%. A prospective series of 60 patients for laminoplasty was performed between 2018 and 2019, and this classification scheme was verified according to the new standard. All patients with size 1 were selectively excluded from consideration for surgery. The Japanese Orthopedic Association scores from both series are superior to most published results for patients with OPLL. RESULTS The first and second series reported good to excellent results of 89% and 93.3%, respectively, and 80% and 85% for 24 months. The difference in the incidence of C5 paralysis and axial pain was statistically significant among the different zones, and most of them recovered within 6 months. The most common size and location types are 2-AB, 3-AB, and 2A. The most severe type is 3-AB. CONCLUSIONS The foramen facet spinal classification of OPLL is a simple and reliable method for objectively evaluating the ossification of patients with OPLL based on CT research. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
- 910 Hospital of China Joint Logistics Support Force, Quanzhou City, Fujian Province, People's Republic of China
| | - Yong Yang
- Department of Orthopedics, General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Dan Han
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yongfei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
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Jang HJ, Moon BJ, Kim KH, Park JY, Chin DK, Kim KS, Cho YE. Factors Associated With Repeat Surgery in Cervical Ossification of the Posterior Longitudinal Ligaments: Minimum 8-year Follow-up Study. Clin Spine Surg 2024; 37:131-137. [PMID: 38637933 DOI: 10.1097/bsd.0000000000001614] [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: 01/05/2024] [Accepted: 03/04/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Single-center retrospective study. OBJECTIVE The objective of this study is to identify the factors leading to repeat surgery in patients with cervical ossification of the longitudinal ligament (OPLL) during a minimal 8-year follow-up after the initial surgery. SUMMARY OF BACKGROUND DATA The long-term effects of cervical OPLL are well known, but it's not always clear how many patients need to have surgery again because their neurological symptoms get worse. METHODS This study is included 117 patients who underwent surgery for cervical OPLL and had a follow-up of at least 8 years. OPLL type, surgical extent, surgical method, and sagittal radiological parameters were measured, and OPLL characteristics were analyzed. RESULTS The average age of patients at the time of surgery was 53.2 years, with a male-to-female ratio of 78:39. The median follow-up duration was 122 months (96-170 mo). Out of the total, 20 cases (17.1%) necessitated repeat surgery, among which 8 cases required surgery at the same site as the initial operation. The highest rate of repeat surgery was observed in patients who underwent total laminectomy without fusion (TL), where 6 out of 21 patients (29%) needed a second surgery, and 5 of these (23%) involved the same surgical site. Patients who underwent repeat surgery at the same site exhibited a greater range of motion (ROM) one year postsurgery (16.4 ± 8.5° vs. 23.1 ± 12.7°, P =0.041). In addition, the ROM at 1 year was higher in patients who underwent TL compared with those who had laminoplasty. Furthermore, the recurrence rate for hill-shape OPLL was higher at 30.8% compared to 10% for plateau-shape OPLL ( P = 0.05). CONCLUSION Larger cervical ROM 1 year after surgery is related to repeat surgery at the same level as previous surgery, especially in laminectomy without fusion surgery.
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Affiliation(s)
- Hyun Jun Jang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Bong Ju Moon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Kyung Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Jeong Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Dong Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Keun Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Yong Eun Cho
- Department of Neurosurgery, Leon Wiltse Memorial Hospital, Suwon, Korea
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Hashimoto M, Hirai T, Sakai K, Yamada K, Sakaeda K, Hashimoto J, Egawa S, Morishita S, Matsukura Y, Inose H, Kobayashi Y, Onuma H, Sakaki K, Tomori M, Torigoe I, Ochi M, Ishiguro H, Tamura S, Ushio S, Yamada T, Miyake N, Kusano K, Otani K, Shindo S, Arai Y, Okawa A, Yoshii T. Comparison of Postoperative Complications and Outcomes in Anterior Cervical Spine Surgery: Ossification of the Posterior Longitudinal Ligament Versus Cervical Spondylotic Myelopathy. Clin Spine Surg 2024; 37:170-177. [PMID: 38637924 DOI: 10.1097/bsd.0000000000001612] [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: 01/12/2024] [Accepted: 03/04/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To compare the frequency of complications and outcomes between patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine and those with cervical spondylotic myelopathy (CSM) who underwent anterior surgery. SUMMARY OF BACKGROUND DATA Anterior cervical spine surgery for OPLL is an effective surgical procedure; however, it is complex and technically demanding compared with the procedure for CSM. Few reports have compared postoperative complications and clinical outcomes after anterior surgeries between the 2 pathologies. METHODS Among 1434 patients who underwent anterior cervical spine surgery at 3 spine centers within the same spine research group from January 2011 to March 2021, 333 patients with OPLL and 488 patients with CSM were retrospectively evaluated. Demographics, postoperative complications, and outcomes were reviewed by analyzing medical records. In-hospital and postdischarge postoperative complications were investigated. Postoperative outcomes were evaluated 1 year after the surgery using the Japanese Orthopaedic Association score. RESULTS Patients with OPLL had more comorbid diabetes mellitus preoperatively than patients with CSM ( P <0.001). Anterior cervical corpectomies were more often performed in patients with OPLL than in those with CSM (73.3% and 14.5%). In-hospital complications, such as reoperation, cerebrospinal fluid leak, C5 palsy, graft complications, hoarseness, and upper airway complications, occurred significantly more often in patients with OPLL. Complications after discharge, such as complications of the graft bone/cage and hoarseness, were significantly more common in patients with OPLL. The recovery rate of the Japanese Orthopaedic Association score 1 year postoperatively was similar between patients with OPLL and those with CSM. CONCLUSION The present study demonstrated that complications, both in-hospital and after discharge following anterior spine surgery, occurred more frequently in patients with OPLL than in those with CSM.
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Affiliation(s)
- Motonori Hashimoto
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Kenichiro Sakai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Saitama
| | - Kentaro Yamada
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Kentaro Sakaeda
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Jun Hashimoto
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Satoru Egawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Shingo Morishita
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Yu Matsukura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Hiroyuki Inose
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Yutaka Kobayashi
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Saitama
| | - Hiroaki Onuma
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Saitama
| | - Kyohei Sakaki
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Saitama
| | - Masaki Tomori
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Saitama
| | - Ichiro Torigoe
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Saitama
| | - Miharu Ochi
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Hiroki Ishiguro
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Satoshi Tamura
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Shuta Ushio
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Tsuyoshi Yamada
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Norihiko Miyake
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Kazuo Kusano
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Kazuyuki Otani
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Shigeo Shindo
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Saitama
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo
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Ito S, Nakashima H, Yoshii T, Egawa S, Sakai K, Kusano K, Tsutui S, Hirai T, Matsukura Y, Wada K, Katsumi K, Koda M, Kimura A, Furuya T, Maki S, Nagoshi N, Nishida N, Nagamoto Y, Oshima Y, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Miyagi M, Kaito T, Yamada K, Banno T, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Oda M, Mori K, Taneichi H, Kawaguchi Y, Takeshita K, Matsumoto M, Yamazaki M, Okawa A, Imagama S. Deep learning-based prediction model for postoperative complications of cervical posterior longitudinal ligament ossification. 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; 32:3797-3806. [PMID: 36740608 DOI: 10.1007/s00586-023-07562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Postoperative complication prediction helps surgeons to inform and manage patient expectations. Deep learning, a model that finds patterns in large samples of data, outperform traditional statistical methods in making predictions. This study aimed to create a deep learning-based model (DLM) to predict postoperative complications in patients with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS This prospective multicenter study was conducted by the 28 institutions, and 478 patients were included in the analysis. Deep learning was used to create two predictive models of the overall postoperative complications and neurological complications, one of the major complications. These models were constructed by learning the patient's preoperative background, clinical symptoms, surgical procedures, and imaging findings. These logistic regression models were also created, and these accuracies were compared with those of the DLM. RESULTS Overall complications were observed in 127 cases (26.6%). The accuracy of the DLM was 74.6 ± 3.7% for predicting the overall occurrence of complications, which was comparable to that of the logistic regression (74.1%). Neurological complications were observed in 48 cases (10.0%), and the accuracy of the DLM was 91.7 ± 3.5%, which was higher than that of the logistic regression (90.1%). CONCLUSION A new algorithm using deep learning was able to predict complications after cervical OPLL surgery. This model was well calibrated, with prediction accuracy comparable to that of regression models. The accuracy remained high even for predicting only neurological complications, for which the case number is limited compared to conventional statistical methods.
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Affiliation(s)
- Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan.
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan.
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kenichiro Sakai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi, Saitama, 332-8558, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kazuo Kusano
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudanminami, Chiyodaku, 102-0074, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Shinji Tsutui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 KImiidera, Wakayama-city, Wakayama, 641-8510, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Yu Matsukura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Keiichi Katsumi
- Department of Orthopaedic Surgery, Niigata University Medicine and Dental General Hospital, 1-754 Asahimachidori, Chuo Ward, Niigata, Niigata, 951-8520, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Atsushi Kimura
- Department of Orthopaedic, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-8670, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-8670, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Norihiro Nishida
- Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, 111 Minami Kogushi, Ube, Yamaguchi, 755-8505, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Sakaishi, Osaka, 591-8025, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Myokencho 2-9, Showa Ward, Nagoya, Aichi, 466-8650, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Sapporo, 060-8638, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masayuki Miyagi
- Department of Orthopedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitazato, Minami-ku, Sagamiharashi, Kanagawa, 252-0375, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kei Yamada
- Department of Orthopaedic Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3125, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo Ward, Yamanashi, 409-3898, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Haruo Kanno
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aoba Ward, Sendai, Miyagi, 980-8574, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masahiro Oda
- Information Strategy Office, Information and Communications, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, Aichi, 464-8601, Japan
| | - Kensaku Mori
- Information Strategy Office, Information and Communications, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, Aichi, 464-8601, Japan
- Department of Intelligent Systems, Nagoya University Graduate School of Informatics, Furo-cho, Chikusa-ku, Nagoya, Aichi, 464-8601, Japan
- Research Center for Medical Bigdata, National Institute of Informatics, 2-1-2 Hitotsubashi, Chiyoda-ku, Tokyo, 101-8430, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
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Liu J, Wang J, Ding Z, Hai Y, Zhang Y, Kang N, Wang Q. Effect of K‑line on posterior cervical surgery versus anterior cervical surgery in patients with multi-level ossification of 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; 32:2396-2401. [PMID: 37150768 DOI: 10.1007/s00586-023-07736-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/03/2022] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To evaluate the influence of K-line on the outcome of open-door laminoplasty versus anterior cervical corpectomy decompression and fusion (ACCF) for patients with more than two levels of ossification of the posterior longitudinal ligament (OPLL). METHODS 60 patients undergoing open-door laminoplasty and 62 patients undergoing ACCF from January 2013 to January 2020 with more than 2 years of follow-up were included. Eighty-four cases with the ossification mass not beyond the K-line were grouped as K-line (+), while thirty-eight cases were grouped as K-line (-). The operation time, intraoperative blood loss, hospital stay, preoperative, postoperative, and last follow-up JOA scores, and postoperative complications were investigated. RESULTS The improvement rate of JOA scores after posterior approaches in cases of group K-line (+) and K-line (-) was 72.4% and 53.1%, respectively, which showed a significant difference (P < 0.01). In group K-line (+), the improvement of JOA scores for open-door laminoplasty was 73.4% and 71.8% for ACCF, which showed no significant difference (P > 0.05). In group K-line (-), the improvement of JOA scores for ACCF was 52.1% and 42.9% for open-door laminoplasty, which showed a significant difference (P < 0.05). The incidence of C5 palsy was significantly lower in cases with ACCF than in cases with open-door laminoplasty (P < 0.05). CONCLUSION For patients with more than two levels of OPLL, preoperative K-line (+) predicates a better outcome than K-line (-). For cases with K-line (-), ACCF provides better neurologic function recovery. For patients with K-line (+), open-door laminoplasty provides the same neurologic function recovery of ACCF.
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Affiliation(s)
- Jingwei Liu
- Department of Orthopedic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Dongdan DaHuaLu 1#, Dong-Cheng District, Beijing, 100730, China
| | - Jianqiang Wang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Zihao Ding
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Yiqi Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Nan Kang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Qiang Wang
- Department of Orthopedic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Dongdan DaHuaLu 1#, Dong-Cheng District, Beijing, 100730, China.
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Usefulness of K-line in predicting prognosis of laminoplasty for cervical spondylotic myelopathy. BMC Musculoskelet Disord 2023; 24:118. [PMID: 36774455 PMCID: PMC9921366 DOI: 10.1186/s12891-023-06214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/31/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND K-line is widely recognized as a useful index for evaluating cervical alignment and the size of the cervical ossification at the posterior longitudinal ligament (OPLL). The purpose of this study was to investigate whether the K-line could be a useful clinical tool for predicting the prognosis of laminoplasty (LP) for cervical spondylotic myelopathy (CSM). METHODS Adult CSM patients scheduled for cervical LP were recruited for this study. C2-7 angle, local kyphosis angle, and K-line was evaluated by T2-weighted sagittal magnetic resonance imaging (MRI). Clinical findings were evaluated by the JOA score and the recovery rate. Clinical and radiological findings were evaluated preoperation and final follow-up. Patients were grouped into K-line ( +) and K-line (-). Patients with Kline (-) were further divided into two sub-groups: disc type (anterior cord compression due to disc protrusion with kyphosis) and osseous type (due to osseous structure such as osteophyte). RESULTS Sixty-eight patients were included in the analysis. The recovery rate of K-line (-) group (n = 11,19.4%) was significantly worse than that of K-line ( +) group (n = 57, 50.6%, p<0.05). Among 11 K-line (-) patients, 7 were disc type and 4 were osseous type. Over the period of follow-up, the disc type K-line (-) patients changed to K-line ( +) and showed significantly better recovery rate (27.6%) compared to the osseous type K-line (-) group (5.0%, p < 0.05). CONCLUSION The present of this study indicate that K-line may have a predictive value for clinical outcome in patients undergoing LP for CSM. K-line (-) of osseous type was worse than k-line (-) of disc type.
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Lee DH, Lee SK, Cho JH, Hwang CJ, Lee CS, Yang JJ, Kim KJ, Park JH, Park S. Efficacy and safety of oblique posterior endplate resection for wider decompression (trumpet-shaped decompression) during anterior cervical discectomy and fusion. J Neurosurg Spine 2023; 38:157-164. [PMID: 36152331 DOI: 10.3171/2022.7.spine22614] [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: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) provides a limited workspace, and surgeons often need to access the posterior aspect of the vertebral body to achieve sufficient decompression. Oblique resection of the posterior endplate (trumpet-shaped decompression [TSD]) widens the workspace, enabling removal of lesions behind the vertebral body. This study was conducted to evaluate the efficacy and safety of oblique posterior endplate resection for wider decompression. METHODS In this retrospective study, 227 patients who underwent ACDF for the treatment of cervical myelopathy or radiculopathy caused by spondylosis or ossification of the posterior longitudinal ligament and were followed up for ≥ 1 year were included. Patient characteristics, fusion rates, subsidence, and patient-reported outcome measures, including the neck pain visual analog scale (VAS) score, arm pain VAS score, and Neck Disability Index (NDI), were assessed. Patients who underwent TSD during ACDF (TSD group) and those who underwent surgery without TSD (non-TSD group) were compared. RESULTS Fifty-seven patients (25.1%) were included in the TSD group and 170 patients (74.9%) in the non-TSD group. In the TSD group, 28.2% ± 5.5% of the endplate was resected, and 26.0% ± 6.1% of the region behind the vertebral body could be visualized via the TSD technique. The resection angle was 26.9° ± 5.9°. The fusion rate assessed on the basis of interspinous motion, intragraft bone bridging, and extragraft bone bridging did not significantly differ between the two groups. Furthermore, there were no significant intergroup differences in subsidence. The patient-reported outcome measures at the 1-year follow-up were also not significantly different between the groups. CONCLUSIONS TSD widened the workspace during ACDF, and 26% of the region posterior to the vertebral body could be accessed using this technique. The construct stability was not adversely affected by TSD as demonstrated by the similar fusion and subsidence rates among patients who underwent TSD and those who did not. Therefore, TSD can be safely applied during ACDF when compressive lesions extend behind the vertebral body and are not limited to the disc space, enabling adequate decompression without disrupting the construct stability.
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Affiliation(s)
- Dong-Ho Lee
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk-Kyu Lee
- 2Department of Orthopedic Surgery, Asan Bone Hospital, Jeju-si, Republic of Korea
| | - Jae Hwan Cho
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Choon Sung Lee
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- 3Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Kook Jong Kim
- 4Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungcheongbuk-do, Cheongju-si, Republic of Korea; and
| | - Jae Hong Park
- 5Department of Orthopedic Surgery, Asan Bone Hospital, Seoul, Republic of Korea
| | - Sehan Park
- 3Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
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Yu Z, Xie H, Ouyang Z, Zhang H. Cervical single open-door laminoplasty with or without local lateral mass screw fixation and fusion to treat cervical spinal cord injuries accompanied by segmental spinal canal stenosis. Front Surg 2023; 9:1050308. [PMID: 36684349 PMCID: PMC9845616 DOI: 10.3389/fsurg.2022.1050308] [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: 09/21/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023] Open
Abstract
Study Design Retrospective. Objectives To investigate the efficacy of cervical single open-door laminoplasty with and without local lateral mass screw fixation and fusion as treatments for cervical spinal cord injuries accompanied by multisegmental spinal canal stenosis. Setting The Second Affiliated Hospital, School of Medicine, Zhejiang University. Methods Of all enrolled patients, 42 formed a stable group who underwent cervical single open-door laminoplasty alone and 14 formed an unstable group who underwent the procedure combined with lateral mass screw fixation and fusion. Neurological function was evaluated before surgery, at discharge, and at final follow-up using the American Spinal Cord Injury Association (ASIA) impairment scale and the Japanese Orthopedic Association (JOA) score. Results ASIA scores reflected improved neurological function in 52.5% of the stable group (15 with grade-D and 4 with grade-A injuries did not improve) and 45.5% of the unstable group (3 with grade-D and 3 with grade-A injuries did not improve). Postoperative JOA scores reflected 19.1% ± 21.6% improvement in the stable group and 18.6% ± 18.4% improvement in the unstable group (P > 0.05). Final follow-up JOA scores reflected 49.2% ± 31.7% improvement in the stable group and 47.1% ± 39.2% improvement in the unstable group (P > 0.05). Conclusions Laminoplasty combined with local fusion aided the treatment of unstable cervical spinal cord injuries and spinal stenosis. Such stenosis is the main pathological factor causing multiple spinal cord compressions in patients with cervical spinal cord injuries.
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Affiliation(s)
- Zihao Yu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Orthopedics Research Institute, Zhejiang University, Hangzhou, China,Key Laboratoryof Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Hongwei Xie
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Orthopedics Research Institute, Zhejiang University, Hangzhou, China,Key Laboratoryof Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Ziyu Ouyang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Orthopedics Research Institute, Zhejiang University, Hangzhou, China,Key Laboratoryof Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Hua Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Orthopedics Research Institute, Zhejiang University, Hangzhou, China,Key Laboratoryof Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China,Correspondence: Hua Zhang
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Tung NTC, He Z, Makino H, Yasuda T, Seki S, Suzuki K, Watanabe K, Futakawa H, Kamei K, Kawaguchi Y. Association of Inflammation, Ectopic Bone Formation, and Sacroiliac Joint Variation in Ossification of the Posterior Longitudinal Ligament. J Clin Med 2023; 12:jcm12010349. [PMID: 36615149 PMCID: PMC9821616 DOI: 10.3390/jcm12010349] [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: 11/02/2022] [Revised: 11/22/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is considered a multifactorial condition characterized by ectopic new bone formation in the spinal ligament. Recently, its connections with inflammation as well as sacroiliac (SI) joint ankylosis have been discussed. Nevertheless, whether inflammation, spinal ligament ossification, and SI joint changes are linked in OPLL has never been investigated. In this study, whole-spinal computed tomography and serum high-sensitive C-reactive protein (hs-CRP) levels were obtained in 162 patients with cervical OPLL. Ossification lesions were categorized as plateau and hill shapes. Accordingly, patients were divided into plateau-shaped (51 males and 33 females; mean age: 67.7 years) and hill-shaped (50 males and 28 females; mean age: 67.2 years) groups. SI joint changes were classified into four types and three subtypes, as previously described. Interactions among ossification shapes, hs-CRP levels, and morphological changes in the SI joint were investigated. The plateau shape was more common in the vertebral segments (59.5%), compared to the hill shape, which was predominant in the intervertebral regions (65.4%). Serum hs-CRP levels in the plateau-shaped group (0.11 ± 0.10 mg/dL) were significantly higher than those in the hill-shaped group (0.07 ± 0.08 mg/dL). SI joint intra-articular fusion was the main finding in the plateau-shaped group and showed significantly higher hs-CRP levels compared to the anterior para-articular bridging, which more frequently occurred in the hill-shaped group. Our findings suggested a possible inflammation mechanism that might contribute to the new bone formation in OPLL, particularly the plateau shape.
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Affiliation(s)
- Nguyen Tran Canh Tung
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
- Department of Trauma and Orthopaedic Surgery, Vietnam Military Medical University, Hanoi 100000, Vietnam
| | - Zhongyuan He
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Taketoshi Yasuda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Kenta Watanabe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hayato Futakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
- Correspondence: ; Tel.: +81-76-434-7353; Fax: +81-76-434-5035
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12
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Tang Z, Chen T, Tan J, Zhang H. Impact of the K-line in patients with ossification of the posterior longitudinal ligament: Analysis of sagittal cervical curvature changes and surgical outcomes. Front Surg 2023; 10:1095391. [PMID: 36874452 PMCID: PMC9975339 DOI: 10.3389/fsurg.2023.1095391] [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: 11/11/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
Objective This study aimed to investigate the relationship of the K-line with sagittal cervical curvature changes and surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods We retrospectively reviewed 84 patients with OPLL who underwent posterior cervical single-door laminoplasty. The patients were divided into a K-line-positive (+) group and a K-line-negative (-) group. Perioperative data, radiographic parameters, and clinical outcomes were compared between the two groups. Results Of 84 total patients, 50 patients were in the K (+) group and 29 patients were in the K (-) group. Neurological function improved in both groups after laminoplasty. The C2-7 Cobb angle, T1 slope, and C2-7 sagittal vertical axis were significantly changed in the K(-) group compared with those in the K (+) group before the operation and at the 3-month and final follow-ups. Conclusion Neurological function was recovered in both groups, and the clinical effect on the K (+) group was better than that on the K (-) group. The cervical curvature in patients with OPLL tends to be anteverted and kyphotic after laminoplasty and is an important factor in reducing the clinical effect.
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Affiliation(s)
- Zhongxin Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tailong Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Tan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huafeng Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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13
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Li YC, Liu ZH, Li YS, Yeap MC, Liu YT, Huang YC, Chen CC, Tu PH. The surgical strategy for multilevel massive ossification of the posterior longitudinal ligaments. Front Surg 2022; 9:1066120. [PMID: 36684268 PMCID: PMC9850370 DOI: 10.3389/fsurg.2022.1066120] [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: 10/10/2022] [Accepted: 11/25/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose Creating enough decompression, favorable outcome, less complication, and maintain adequate lordosis and stability in the patients with cervical myelopathy due to multilevel massive ossification of the posterior longitudinal ligament (OPLL) still poses a challenge for surgeons. The aim of our study is to retrospectively evaluate our patients and try to seek a better surgical strategy. Methods Between 2015 and 2019, 55 consecutive patients with multilevel massive OPLL underwent surgical treatment. Among these, 40 patients were treated with cervical laminectomy and then anterior decompression, fusion, and fixation (ADF), which was defined as group 1, and 15 patients were treated with cervical laminectomy and fixation simultaneously, which was defined as group 2. The patient's radiographic characteristics and postoperative outcomes were evaluated. Results Better postoperative cervical sagittal lordosis and less long-term axial pain was achieved in group 1 (p < 0.001), though the functional outcome had no significant difference. In the multivariable analysis, anterior fixation accounts for independent factors for better cervical sagittal alignment (p < 0.001). No complications directly associated with cervical laminectomy were observed. Conclusion In patients with cervical multilevel massive OPLL, laminectomy at compression level and then ADF depended on the severity and range of compression, but corpectomy of not more than two vertebral bodies is suggested, except K-line (+) and long-segment massive OPLL majorly involving the C2 and posterior laminectomy above and below the OPLL-affected levels with posterior fixation simultaneously.
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Affiliation(s)
- Ying-Ching Li
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan,School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Ying-Sheng Li
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Yu-Tse Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan,School of Medicine, National Tsing Hua University, Hsinchu, Taiwan,Correspondence: Po-Hsun Tu
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14
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Prospective Investigation of Surgical Outcomes after Anterior Decompression with Fusion and Laminoplasty for the Cervical Ossification of the Posterior Longitudinal Ligament: A Propensity Score Matching Analysis. J Clin Med 2022; 11:jcm11237012. [PMID: 36498586 PMCID: PMC9736093 DOI: 10.3390/jcm11237012] [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: 10/18/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
The ideal surgical strategy for cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial due to the lack of high-quality evidence. Herein, we prospectively investigated the surgical outcomes of anterior cervical decompression with fusion (ADF) and laminoplasty (LAMP) with cervical OPLL. Three hundred patients were included in this study (ADF: n = 89; LAMP: n = 211 patients), and propensity score matching yielded 67 pairs of patients with ADF and LAMP, in which clinical outcomes were compared. Crude analysis revealed that the ADF group showed greater neurological recovery in cervical Japanese Orthopedic Association scores at two years, compared with that in the LAMP group (53.1% vs. 44.3%, p = 0.037). The ratio of minimum clinically important difference (MCID) success was significantly greater in the ADF group (59.6% vs. 43.6%, p = 0.016). Multivariate analysis showed that the factors affecting MCID success were age, body mass index, duration of symptoms, and choice of ADF. In the 1:1 matched analysis, neurological improvement was more favorable in the ADF group (57.2%) compared to the LAMP group (46.8%) at two years (p = 0.049). However, perioperative complications, such as dysphagia and graft-related complications, were more common in the ADF group.
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15
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Wei B, Liu W, Wu H. Analysis between preoperative cervical radiographic parameters represented by the K-line tilt and the short-term prognosis of laminoplasty for posterior longitudinal ligament ossification: A retrospective study. Front Surg 2022; 9:950707. [PMID: 36211268 PMCID: PMC9535077 DOI: 10.3389/fsurg.2022.950707] [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: 05/23/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo investigate the relationship between preoperative radiographic parameters and the short-term prognosis of patients with cervical ossification of the posterior longitudinal ligament (OPLL) who underwent laminoplasty (LAMP).MethodsA retrospective analysis of Cervical OPLL 50 patients with K-line (+) OPLL with no cervical kyphosis who received LAMP was performed. Based on preoperative neutral position x-ray, the K-line tilt, C2–C7 SVA (sagittal vertical axis), CL (cervical lordosis), T1 slope, and T1 slope-CL were recorded. The JOA (Japanese orthopaedic association scores) score and the cervical kyphosis change were recorded 1 year after surgery. Patients were divided into good and poor prognosis groups according to the median (12.5) of the postoperative JOA score.ResultsThere were differences between the two groups in K-line tilt, C2–C7 SVA, and T1 slope (all ps < 0.05). There was a strong linear correlation between the three, K-Line tilt, JOA score, and C2–C7 SVA. The degree of influence of K-line tilt, C2–C7 SVA, T1 slope on postoperative JOA score was analyzed using multiple linear regression, and the absolute value of the standardized coefficient Beta were 0.550, 0.319, 0.185, respectively. There was no cervical kyphosis change 1 year after surgery.ConclusionAs preoperative cervical parameters, the influence of K-line tilt, C2–C7 SVA, and T1 slope on postoperative JOA score decreases in order. There was a linear relationship between preoperative K-line tilt and postoperative JOA score, implying that patients with cervical OPLL with high K-line tilt were not eligible for LAMP. K-line tilt was not predictive of cervical kyphosis change after LAMP in patients with OPLL at short-term follow-up.
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Affiliation(s)
- Baixing Wei
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wanting Liu
- Department of Clinical Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- Correspondence: Han Wu
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Xue R, Liu D, Li Y, Zhang D. Different standing postures are the influencing factors for the efficacy of laminoplasty in the treatment of K-Line (-) patients with 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 2022; 31:2377-2382. [PMID: 35854158 DOI: 10.1007/s00586-022-07300-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the relationship between different standing postures and surgical outcomes of K-Line (-) ossification of the posterior longitudinal ligament (OPLL) patients after laminoplasty with a titanium basket. There is a lack of data evaluating the relationship between the postoperative satisfaction of K-Line (-) patients and their standing postures. METHODS OPLL patients enrolled in the study were divided into a K-Line (+) group (Group A) and a K-Line (- group (Group B) in natural and relaxed standing positions. We compared the postoperative outcomes after cervical laminoplasty with titanium basket surgery using the Japanese Orthopaedic Association score (JOA), recovery rate and the degree of improvement in the six JOA score items. The degree of satisfaction with the outcome was assessed at the 1-year follow-up using a 7-point numerical rating scale. RESULTS A total of 34 K-Line (+) patients with OPLL (age 61.9 ± 2.9 years) in Group A and 40 K-Line (-)patients with OPLL (age 60.4 ± 3.5 years) in Group B in natural and relaxed standing positions were recruited. In Group A, the mean preoperative and postoperative JOA scores were 10.1 ± 1.4 and 13.1 ± 0.8 points, respectively, and in Group B, the mean preoperative and postoperative JOA scores were 9.7 ± 1.3 and 11.1 ± 0.9 points, respectively. A significant improvement in the JOA score was seen in both groups postoperatively, but the recovery rate of the patients' JOA scores was significantly lower in Group B. In Group A, significant improvements were seen in all JOA score items, but in Group B, improvements were seen only in upper- and lower-extremity sensory functions. CONCLUSION Different standing postures are risk factors in the treatment of K-Line (-) patients, and therefore, natural and relaxed standing positions should be given more attention before devising the surgical plan.
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Affiliation(s)
- Rui Xue
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, 139 Ziqiang Road, Shi Jiazhuang, 050051, China
| | - Dai Liu
- Rehabilitation Teaching Office, The Third Hospital of HeBei Medical University, 139 Ziqiang Road, Shi Jiazhuang, 050051, China
| | - Yao Li
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, 139 Ziqiang Road, Shi Jiazhuang, 050051, China
| | - Di Zhang
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, 139 Ziqiang Road, Shi Jiazhuang, 050051, China.
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17
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Nagoshi N, Yoshii T, Egawa S, Sakai K, Kusano K, Tsutsui S, Hirai T, Matsukura Y, Wada K, Katsumi K, Koda M, Kimura A, Furuya T, Maki S, Nishida N, Nagamoto Y, Oshima Y, Ando K, Nakashima H, Takahata M, Mori K, Nakajima H, Murata K, Miyagi M, Kaito T, Yamada K, Banno T, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Watanabe K, Taneichi H, Imagama S, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Yamazaki M, Okawa A. Clinical Indicators of Surgical Outcomes After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study. Spine (Phila Pa 1976) 2022; 47:1077-1083. [PMID: 35867608 DOI: 10.1097/brs.0000000000004359] [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: 12/16/2021] [Accepted: 03/13/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective multicenter study. OBJECTIVE This study aims to evaluate patient-reported outcomes using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and clarify clinical factors that affect the therapeutic effects for patients with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Although previous studies identified factors that affected the surgical outcomes, their assessment was mainly based on the Japanese Orthopedic Association score, which only includes neurological function. Investigating this pathology through multiple functions and quality of life (QOL) is pivotal to understanding the comprehensive clinical pictures of the cervical OPLL and its therapeutic outcomes. MATERIALS AND METHODS This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of the patients, 168 received laminoplasties and fully completed questionnaires. Demographic information, imaging findings, and clinical outcomes were collected. Patients were grouped according to effective or ineffective surgical outcomes as defined by the JOACMEQ using logistic regression analyses. RESULTS Laminoplasty resulted in functional improvement in the cervical spine and upper extremity around 40% of the patients, while QOL showed only 21.4% ( P <0.01). Multivariable analyses revealed that younger age and a postoperative decrease in arm or hand pain were correlated with significantly improved function of the upper extremities. A reduction in lower limb pain favorably affected the postoperative lower extremity function. A postoperative reduction in upper extremity pain enhanced the QOL recovery. CONCLUSIONS Surgeons should recognize the diversity of surgical outcomes after laminoplasty and understand the necessity of pain management even after the surgery to enhance bodily functions and QOL in patients with cervical OPLL.
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Affiliation(s)
- Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
| | - Toshitaka Yoshii
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoru Egawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyadaku, Japan
| | - Shunji Tsutsui
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takashi Hirai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yu Matsukura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Japan
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedics, Jichi Medical University, Tochigi, Japan
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoshi Maki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Norihiro Nishida
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroaki Nakashima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiko Takahata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Shiga, Japan
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Fukui, Japan
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masayuki Miyagi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Kitasato Universiy Hospital, Kanagawa, Japan
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka UniversityOsaka, Japan
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Tomohiro Banno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Satoshi Inami
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
| | - Hiroshi Taneichi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Shiro Imagama
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedics, Jichi Medical University, Tochigi, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
| | - Masashi Yamazaki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Atsushi Okawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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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.
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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
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Namgoong J, Lee YH, Ju AR, Chai J, Choi D, Choi HJ, Seo JY, Park KS, Lee YJ, Lee J, Ha IH. Long-Term Follow-Up of Patients with Neck Pain Associated with Ossification of the Posterior Longitudinal Ligament Treated with Integrative Complementary and Alternative Medicine: A Retrospective Analysis and Questionnaire Survey. J Pain Res 2022; 15:1527-1541. [PMID: 35637765 PMCID: PMC9148200 DOI: 10.2147/jpr.s356280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Integrative Korean medicine treatment (KMT) is a conservative treatment approach for the ossification of the posterior longitudinal ligament (OPLL) in Korea; nonetheless, relevant studies focusing on KMT for OPLL are lacking. A multicenter retrospective analysis of patient medical records and a questionnaire survey were conducted to investigate the effectiveness of integrative KMT in patients with OPLL treated for neck pain. Patients and Methods A total of 78 inpatients radiologically diagnosed with OPLL and treated for neck pain at four Korean medicine hospitals from April 1, 2016, to December 31, 2019, were enrolled. The primary index was an improvement in the numeric rating scale (NRS) score for neck pain, whereas the secondary outcome indices were improvements in the NRS score for arm pain, neck disability index (NDI) score, and EuroQol 5-dimension 5-level (EQ-5D-5L) score. Results At discharge, the NRS score for neck pain, NRS score for arm pain, and NDI score decreased by 2.47 (95% confidence interval [CI], −2.81 to −2.14), 1.32 (95% CI, −1.73 to −0.91), and 16.02 (95% CI, −18.89 to −13.15), respectively, as compared with the scores at admission (p < 0.001). The EQ-5D-5L score increased by 0.12 (95% CI, 0.09 to 0.16) as compared with the score at admission (p < 0.001). This trend was also evident during follow-up. With respect to Patient Global Impression of Change evaluation, 33 (61.1%) patients claimed to have very much improved, whereas 17 (31.5%) patients reported to have much improved. Conclusion Inpatients with OPLL who received integrative KMT showed improvements in neck pain, arm pain, the NDI, and quality of life, which were retained throughout the follow-up period.
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Affiliation(s)
- Jin Namgoong
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Yun-Ha Lee
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Ah Ra Ju
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Jiwon Chai
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - DongJoo Choi
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Hyo Jung Choi
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Ji-Yeon Seo
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Kyoung Sun Park
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea.,Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jinho Lee
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea.,Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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20
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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.
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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
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Hua Z, Li J, Li W, Zhang Y, Wang F, Wang L, Shen Y. Risk factors for poor neurological outcomes after unilateral open-door laminoplasty: an analysis of the characteristics of ectopic bone. J Orthop Surg Res 2022; 17:181. [PMID: 35331279 PMCID: PMC8944033 DOI: 10.1186/s13018-022-03074-9] [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: 12/09/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background The factors affecting neurological outcomes with unilateral open-door laminoplasty have been controversial. The purpose of this study was to evaluate the impact of the characteristics of ectopic bone on poor neurological outcomes after unilateral open-door laminoplasty. Methods We retrospectively analyzed the clinical data of 112 patients who underwent unilateral open-door laminoplasty from September 2017 to September 2020. According to the Japanese Orthopedic Association score recovery rate after surgery (Japanese Orthopedic Association recovery rate ≥ 50% and < 50%, respectively), all patients were divided into “poor” and “good” groups. The characteristics of ectopic bone and the position relationship between the open side and ectopic bone (for lateral ossification) in the two groups were compared and analyzed. Univariate and multivariate analyses were used to determine the risk factors for poor neurological outcome. Results We identified patients with a mean age of 58.39 years and a mean follow-up of 25.43 months. Sixty (53.6%) patients experienced recovery of poor neurological function. On univariable analysis, significant predictors of poor neurological recovery were occupation rate of spinal canal > 60% (p = 0.000), ossification extending to C2 (p = 0.006), lateral ossification (p = 0.032) and opening side on the ipsilateral side of the ectopic bone (p = 0.011). Multivariate logistic regression analysis revealed that the occupation rate of spinal canal > 60% (P = 0.003), ossification extending to C2 (P = 0.041) and opening the door on the ipsilateral side for lateral ossification (P = 0.013) were independent risk factors for poor prognosis of neurological function. Conclusions An occupation ratio > 60% is the most important risk factor. Another one is ossification of the posterior longitudinal ligament extending to C2. Meanwhile, opening the door on the ipsilateral side is indeed a risk factor for lateral ossification. Better neurological function may be obtained by choosing the opposite side of the heterotopic bone as the open side. Therefore, the design of the surgical plan should comprehensively consider these factors.
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Affiliation(s)
- Zijian Hua
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Jia Li
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Wenshuai Li
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Yu Zhang
- Department of Orthopedic Surgery, Heze Municipal Hospital, Heze, 274000, People's Republic of China
| | - Feng Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Yong Shen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China. .,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
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22
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Hirai T, Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Wada K, Katsumi K, Fujii K, Kimura A, Furuya T, Nagoshi N, Kanchiku T, Nagamoto Y, Oshima Y, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Imagama S, Koda M, Kawaguchi Y, Takeshita K, Matsumoto M, Yamazaki M, Okawa A. Severity of Myelopathy is Closely Associated With Advanced Age and Signal Intensity Change in Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Nationwide Investigation. Clin Spine Surg 2022; 35:E155-E161. [PMID: 33769979 DOI: 10.1097/bsd.0000000000001164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective, nationwide case series. OBJECTIVE To identify preoperative factors associated with myelopathy and neurological impairment in patients with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Various studies have reported clinical outcomes following the surgical treatment of OPLL. However, there has been no large-scale study of preoperative clinical features in patients with cervical OPLL. MATERIALS AND METHODS Data were prospectively collected from 28 institutions nationwide in Japan. In total, 512 patients with neurological impairment caused by cervical OPLL requiring surgery were enrolled. Basic demographic and clinical data, including age, sex, diabetes status, body mass index, smoking history, and disease duration were collected. C2-7 lordotic angle, canal narrowing ratio, range of motion in flexion-extension at C2-7, and type of OPLL were evaluated on lateral radiographs to identify factors influencing the clinical features of patients with OPLL in whom surgery was planned. RESULTS Complete documentation was available for 490 patients (362 male, 128 female). In total, 34 patients had the localized type, 181 had the segmental type, 64 had the continuous type, and 211 had the mixed type. Although there were no significant differences in age, body mass index, disease duration, Japanese Orthopedic Association (JOA) score, and lordotic angle at C2-7 according to the type of OPLL, significant differences were observed in a range of motion at C2-7 and the canal narrowing ratio among the 4 types. Multiple regression analysis revealed that the JOA score was significantly associated with age and signal intensity change on magnetic resonance imaging. CONCLUSIONS This is the first large-scale, prospective, multicenter case series study to investigate factors influencing preoperative neurological status in patients with OPLL. Age and signal intensity change on magnetic resonance images were significantly associated with JOA score in patients requiring surgery. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyadaku
| | - Yukihiro Nakagawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, Wakayama
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Aomori
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Niigata University Medicine and Dental General Hospital, Niigata
| | - Kengo Fujii
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedics, Jichi Medical University, Tochigi
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba
| | - Narihito Nagoshi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo
| | - Tsukasa Kanchiku
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Osaka
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi
| | - Masahiko Takahata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Shiga
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Fukui
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo
| | - Shunji Matsunaga
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshimashi
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Fukuoka
| | - Sho Kobayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi
| | - Satoshi Inami
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Tochigi
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Miyagi
| | - Shiro Imagama
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedics, Jichi Medical University, Tochigi
| | - Morio Matsumoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo
| | - Masashi Yamazaki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
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23
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Nakashima H, Imagama S, Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Fujii K, Kimura A, Furuya T, Kanchiku T, Nagamoto Y, Oshima Y, Nagoshi N, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Li Y, Yatsuya H, Koda M, Kawaguchi Y, Takeshita K, Matsumoto M, Yamazaki M, Okawa A. Comparison of laminoplasty and posterior fusion surgery for cervical ossification of posterior longitudinal ligament. Sci Rep 2022; 12:748. [PMID: 35031694 PMCID: PMC8760337 DOI: 10.1038/s41598-021-04727-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022] Open
Abstract
This prospective multicenter study, established by the Japanese Ministry of Health, Labour and Welfare and involving 27 institutions, aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL), in order to address the controversy surrounding the role of instrumented fusion in cases of posterior surgical decompression for OPLL. 478 patients were considered for participation in the study; from among them, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, there were no significant differences among the participants in terms of patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments. The overall risk of perioperative complications was found to be lower with LM (odds ratio [OR] 0.40, p = 0.006), and the rate of C5 palsy occurrence was significantly lower with LM (OR 0.11, p = 0.0002) than with PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients who had PF was significantly smaller than in those who had LM. However, multivariable logistic regression analysis showed no significant difference among the participants in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in the LM group than in the PF group (OR 2.73, p = 0.0002). Both LM and PF for cervical myelopathy due to OPLL had resulted in comparable postoperative outcomes at 2 years after surgery.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan.
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Satoru Egawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Kenichiro Sakai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi, Saitama, 332-8558, Japan
| | - Kazuo Kusano
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudanminami, Chiyodaku, 102-0074, Japan
| | - Yukihiro Nakagawa
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Itogun, Wakayama, 649-7113, Japan
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan
| | - Keiichi Katsumi
- Department of Orthopaedic Surgery, Niigata University Medicine and Dental General Hospital, 1-754 Asahimachidori, Chuo Ward, Niigata, Niigata, 951-8520, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Atsushi Kimura
- Department of Orthoaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-8670, Japan
| | - Tsukasa Kanchiku
- Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, 111 Minami Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Sakaishi, Osaka, 591-8025, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Sapporo, 060-8638, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kazuma Murata
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Shunji Matsunaga
- Department of Orthopaedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuocho, Kagoshimashi, 892-8502, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Kei Yamada
- Department of Orthopaedic Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Sho Kobayashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3125, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo Ward, Yamanashi, 409-3898, Japan
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Haruo Kanno
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aoba Ward, Sendai, Miyagi, 980-8574, Japan
| | - Yuanying Li
- Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan.,Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Katsushi Takeshita
- Department of Orthoaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
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24
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Machine Learning Approach in Predicting Clinically Significant Improvements After Surgery in Patients with Cervical Ossification of the Posterior Longitudinal Ligament. Spine (Phila Pa 1976) 2021; 46:1683-1689. [PMID: 34027925 DOI: 10.1097/brs.0000000000004125] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of prospectively collected data. OBJECTIVE This study aimed to create a prognostic model for surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using machine learning (ML). SUMMARY OF BACKGROUND DATA Determining surgical outcomes helps surgeons provide prognostic information to patients and manage their expectations. ML is a mathematical model that finds patterns from a large sample of data and makes predictions outperforming traditional statistical methods. METHODS Of 478 patients, 397 and 370 patients had complete follow-up information at 1 and 2 years, respectively, and were included in the analysis. A minimal clinically important difference (MCID) was defined as an acquired Japanese Orthopedic Association (JOA) score of ≥2.5 points, after which a ML model that predicts whether MCID can be achieved 1 and 2 years after surgery was created. Patient background, clinical symptoms, and imaging findings were used as variables for analysis. The ML model was created using LightGBM, XGBoost, random forest, and logistic regression, after which the accuracy and area under the receiver-operating characteristic curve (AUC) were calculated. RESULTS The mean JOA score was 10.3 preoperatively, 13.4 at 1 year after surgery, and 13.5 at 2 years after surgery. XGBoost showed the highest AUC (0.72) and high accuracy (67.8) for predicting MCID at 1 year, whereas random forest had the highest AUC (0.75) and accuracy (69.6) for predicting MCID at 2 years. Among the included features, total preoperative JOA score, duration of symptoms, body weight, sensory function of the lower extremity sub-score of the JOA, and age were identified as having the most significance in most of ML models. CONCLUSION Constructing a prognostic ML model for surgical outcomes in patients with OPLL is feasible, suggesting the potential application of ML for predictive models of spinal surgery.Level of Evidence: 4.
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Abstract
STUDY DESIGN A bibliometric review of the literature. OBJECTIVES The aim of this study was to identify the most highly cited articles relating to cervical myelopathy and to analyze the most influential articles. SUMMARY OF BACKGROUND DATA Over the past several decades, a lot of research has been conducted regarding the subject of cervical myelopathy. Although there are a large number of articles on this topic, to our knowledge, this is the first bibliometric analysis. METHODS A selection of search terms and keywords were inputted into the "Dimensions" database and the most highly cited articles in cervical myelopathy were selected from high impact factor journals. The top 100 articles were analyzed for year of publication, authorship, publishing journals, institution and country of origin, subject matter, article type, and level of evidence. RESULTS The 100 most cited articles in the topic of cervical myelopathy were published from 1956 to 2015. These articles, their corresponding authors, and number of citations are shown in Table 1. The number of citations ranged from 121 times for the 100th article to 541 times for the top article in a total of 20 journals. The most common topic was operative technique, whereas the journals which contributed the most articles were the Spine journal and the Journal of Neurosurgery. CONCLUSION Our study provided an extensive list of the most historically significant articles regarding cervical myelopathy, acknowledging the key contributions made to the advancement of this field.Level of Evidence: 5.
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Pérez-Bovet J, Buxó M, Rimbau Muñoz J. Clinical Practice in Spine Surgery: An International Survey. J Neurol Surg A Cent Eur Neurosurg 2021; 83:451-460. [PMID: 34897620 DOI: 10.1055/s-0041-1739223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The availability of diverse and sophisticated surgical options to treat spine conditions is compounded by the scarcity of high-level evidence to guide decision-making. Although studies on discrete treatments are frequently published, little information is available regarding real-world surgical practice. We intended to survey spine surgeons to assess clinical management of common spine diagnosis in day-to-day settings. METHODS An online survey was distributed among neurosurgeons and orthopaedic surgeons worldwide. The obtained assessment of common surgical practice is contextualized in a review of the best available evidence. RESULTS The survey was answered by more than 310 members of several European, Australasian, and South African professional societies. The submitted responses translate a surgical practice generally grounded on evidence, favoring well-tried techniques, providing comprehensive treatment for the most severe diagnoses. Such practice comes mostly from neurosurgeons focused on spine surgery, practicing in teaching hospitals. CONCLUSION We believe that the pragmatic, day-to-day approach to spine conditions captured in the present survey offers an informative insight to involved surgeons.
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Affiliation(s)
- Jordi Pérez-Bovet
- Department of Neurosurgery, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Maria Buxó
- Department of Statistics, Girona Biomedical Research Institute, Salt, Girona, Spain
| | - Jordi Rimbau Muñoz
- Department of Neurosurgery, University Hospital Dr. Josep Trueta, Girona, Spain.,Department of Neurosurgery, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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27
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Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Fujii K, Kimura A, Furuya T, Nagoshi N, Kanchiku T, Nagamoto Y, Oshima Y, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Imagama S, Koda M, Kawaguchi Y, Takeshita K, Matsumoto M, Yamazaki M, Okawa A. Perioperative Complications in Posterior Surgeries for Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Nationwide Investigation. Clin Spine Surg 2021; 34:E594-E600. [PMID: 34347632 DOI: 10.1097/bsd.0000000000001243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a prospective multicenter study. OBJECTIVE The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures. MATERIALS AND METHODS We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications. RESULTS Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2-C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery. CONCLUSIONS In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2-C7 angle were the independent risk factors for motor palsy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchishi
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyadaku
| | - Yukihiro Nakagawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, Wakayama
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Niigata University Medicine and Dental General Hospital, Niigata
| | - Kengo Fujii
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedics, Jichi Medical University, Shimotsuke
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba
| | - Narihito Nagoshi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo
| | - Tsukasa Kanchiku
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Osaka
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Fukui
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo
| | - Shunji Matsunaga
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshimashi
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Fukuoka
| | - Sho Kobayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi
| | - Satoshi Inami
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Tochigi
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Miyagi
| | - Shiro Imagama
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedics, Jichi Medical University, Shimotsuke
| | - Morio Matsumoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo
| | - Masashi Yamazaki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
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Fujimori T, Nakajima N, Sugiura T, Ikegami D, Sakaura H, Kaito T, Iwasaki M. Epidemiology of symptomatic ossification of the posterior longitudinal ligament: a nationwide registry survey. JOURNAL OF SPINE SURGERY (HONG KONG) 2021; 7:485-494. [PMID: 35128122 DOI: 10.21037/jss-21-78] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ossification of the posterior longitudinal ligament (OPLL) is radiographically detectable in 3-6% of Asian individuals, although not all detectable OPLL cases lead to myelopathy. To date, it is unknown how many patients suffer from neurological symptoms due to OPLL. The purpose of this study was to investigate the epidemiology of symptomatic OPLL using Japan's national registry database. METHODS We examined the registry data of patients with OPLL who held a certificate of medical subsidy from the Japanese Ministry of Health, Labor and Welfare. The study period was from January 1, 2011 to December 31, 2012. RESULTS Registry data revealed that the incidence and the period prevalence of symptomatic OPLL were 0.005% (5 per 100,000 population) and 0.027% (27 per 100,000 population), respectively. OPLL occurred twice as often in men as in women. The peak age for onset of symptoms was 60-69 years. The mean Japanese Orthopedic Association (JOA) score was 9 points. Ninety percent of OPLL patients underwent surgery, and 90% of these surgeries were performed with a posterior approach. The most common indication for surgery was a JOA score of 11 points. CONCLUSIONS According to registry data, the prevalence of symptomatic OPLL was less than one-hundredth of that of radiographically detected OPLL. This indicates that most cases of radiographically detectable OPLL may be asymptomatic.
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Affiliation(s)
- Takahito Fujimori
- Department of Orthopedic Surgery, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Japan.,Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Nozomu Nakajima
- Department of Orthopedic Surgery, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Japan
| | - Tsuyoshi Sugiura
- Department of Orthopedic Surgery, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Japan
| | - Daisuke Ikegami
- Department of Orthopedic Surgery, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Japan
| | - Hironobu Sakaura
- Department of Orthopedic Surgery, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motoki Iwasaki
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan
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Prospective Investigation of Postoperative Complications in Anterior Decompression with Fusion for Severe Cervical Ossification of the Posterior Longitudinal Ligament: A Multi-institutional Study. Spine (Phila Pa 1976) 2021; 46:1621-1629. [PMID: 34747909 DOI: 10.1097/brs.0000000000004088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective multicenter study. OBJECTIVE This study aims to investigate the postoperative complications of anterior decompression with fusion (ADF) for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Surgical treatment for cervical OPLL has a high risk of various complications. ADF is reported to be effective for cervical OPLL, especially for massive OPLL. However, few studies have focused on the surgical complications of ADF. METHODS We prospectively included 102 patients undergoing ADF for severe cervical OPLL with average canal occupying ratio of 49.8%. We evaluated systemic and local complications, neurological complications, and risk factors related to the postoperative complications. RESULTS Frequently observed complications included graft/ implant complications (18.6%), neurological complications (11.8%), and cerebrospinal fluid leak (11.8%). Motor palsy involving only the upper extremity was found in nine patients (8.8%), and other motor palsies involving the lower extremities were found in three patients (2.9%). None of the preoperative factors were significantly associated with the occurrence of neurological palsies, whereas the number of operated levels was a significant factor related to the postoperative graft/implant complications (P = 0.003; odds ratio, 2.112). The incidence of graft/implant complications and related reoperation increased as the number of operated levels increased (especially four levels or more). Most motor palsies were observed immediately after surgery. Of the motor palsies in the bilateral upper extremities and palsies involving the lower extremities, 85.7% showed good recovery, whereas only 40% of unilateral upper extremity motor palsies showed good recovery during the follow-up period. CONCLUSION In ADF for cervical OPLL, the number of operated levels was a significant factor related to the postoperative complication. Specifically, the incidence of graft/implant complications and reoperation rate increased in ADF with four or more levels.Level of Evidence: 3.
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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.
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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.)
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Current Advances in Spinal Diseases of the Elderly: Introduction to the Special Issue. J Clin Med 2021; 10:jcm10153298. [PMID: 34362083 PMCID: PMC8347409 DOI: 10.3390/jcm10153298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022] Open
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Katsumi K, Hirai T, Yoshii T, Maki S, Mori K, Nagoshi N, Nishimura S, Takeuchi K, Ushio S, Furuya T, Watanabe K, Nishida N, Watanabe K, Kaito T, Kato S, Nagashima K, Koda M, Ito K, Imagama S, Matsuoka Y, Wada K, Kimura A, Ohba T, Katoh H, Matsuyama Y, Ozawa H, Haro H, Takeshita K, Watanabe M, Matsumoto M, Nakamura M, Yamazaki M, Okawa A, Kawaguchi Y. The impact of ossification spread on cervical spine function in patients with ossification of the posterior longitudinal ligament. Sci Rep 2021; 11:14337. [PMID: 34253758 PMCID: PMC8275804 DOI: 10.1038/s41598-021-93602-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. The bridging of ossified lesions to the vertebral body gradually increases, thereby decreasing the mobility of the cervical spine; thus, cervical spine function may decrease over time. However, cervical spine function in patients with cervical OPLL has not been evaluated in large prospective studies. Therefore, we conducted a prospective multicenter study to clarify whether ossification spread can influence cervical spine function and quality of life (QOL) in patients with cervical OPLL. In total, 238 patients (162 men, 76 women; mean age, 63.9 years) were enrolled from 16 institutions. Each patient underwent whole spine computed tomography and was evaluated for cervical spine function and QOL using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). In the multivariate regression analysis, a higher neck VAS score and a larger number of bridge formations of OPLL in the whole spine were significant predictors of adverse outcomes related to cervical spine function. This is the first prospective multicenter study to reveal the impact of ossification spread on cervical spine function. These findings are important to understand the natural course of OPLL and can serve as controls when evaluating postoperative cervical spine function.
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Affiliation(s)
- Keiichi Katsumi
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, 1-18 Shinkocho, Chuo-ku, Niigata, Niigata, 950-8556, Japan. .,Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata, Niigata, 951-8510, Japan. .,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan.
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-0856, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo , Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Soraya Nishimura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo , Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Kazuhiro Takeuchi
- Department of Orthopedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Okayama, Okayama, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Shuta Ushio
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-0856, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata, Niigata, 951-8510, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Norihiro Nishida
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo , Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Satoshi Kato
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Katsuya Nagashima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-0065, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-0065, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 53 Honcho, Hirosaki, Aomori, 036-8203, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Tetsuro Ohba
- Department of Orthopedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-ku, Yamanashi, 409-3898, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3125, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Hirotaka Haro
- Department of Orthopedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-ku, Yamanashi, 409-3898, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo , Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo , Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.,Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan
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Risk factors for surgical complications in the management of ossification of the posterior longitudinal ligament. Spine J 2021; 21:1176-1184. [PMID: 33775844 DOI: 10.1016/j.spinee.2021.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 03/13/2021] [Accepted: 03/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ossification of the posterior longitudinal ligament (OPLL) is a progressive, debilitating disease most commonly affecting the cervical spine. When compared to other degenerative pathologies, OPLL procedures carry a significantly higher risk of complications owing to increased case complexity and technical difficulties. Most previous studies have focused on functional outcomes and few have reported on risk factors for postoperative complications in OPLL patients. PURPOSE To identify clinical and radiological risk factors of surgical complications following treatment for cervical OPLL STUDY DESIGN: Retrospective review PATIENT SAMPLE: One hundred thirty-one patients with cervical myelopathy secondary to OPLL who underwent surgical decompression with complete 2-year follow-up. OUTCOME MEASURES Surgical and medical postoperative complications were analyzed. Revision surgery rates and mortality rates were recorded. METHODS Clinical, surgical, and radiological characteristics were collected for each patient. Complications within 30 days were identified. Univariate and multivariate analysis were performed to identify risk factors for surgical complications. RESULTS There were 39 (29.8%) surgical complications in the cohort, which included C5 palsy (7.6%), dural tear (3.1%), surgical site infection (3.1%), and epidural hematoma (1.5%). 2-year revision and mortality rates were 4.6% and 2.3%, respectively. Univariate analysis revealed that blood loss ≥750mL (OR 3.42, p=0.028), operative duration ≥5.5 hours (OR 3.16, p=0.008), hill-type OPLL (OR 3.08, p=0.011), K-line (-) OPLL (OR 5.39, p<0.001), and presence of a double-layer sign (OR 3.79, p=0.002) were significant risk factors. In multivariate analysis, only hill-type OPLL (OR 2.61, p=0.048) and K-line (-) OPLL (OR 2.98, p=0.031) were found to be significant. Patients with both hill-type and K-line (-) OPLL had a 3.5 times risk of developing surgical complications (p=0.009). CONCLUSIONS Patients with OPLL have a higher risk of perioperative surgical complications if they had a hill-shaped OPLL and K-line (-) OPLL on preoperative imaging studies. To the best of the authors' knowledge, this study is the first to link hill-type and K-line (-) OPLL morphology as risk factors for perioperative surgical complications.
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Liu X, Tan B, Xiao B, Zou X, Liu S. Modified K-line for Making Decisions Regarding the Surgical Approach in Patients with K-line (-) OPLL. Orthop Surg 2021; 13:1351-1358. [PMID: 33998781 PMCID: PMC8274184 DOI: 10.1111/os.12931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 10/28/2020] [Accepted: 12/20/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate whether the modified K‐line can be used to predict the clinical outcome and to determine the surgical approach for K‐line (−) patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods A new modified K‐line was defined as the line connecting the midpoints of the spinal cord at C4 and C6 on the lateral cervical radiographs. A total of four consecutive patients (three men and one woman) with cervical myelopathy due to OPLL were included in this research. The patients were diagnosed with OPLL with K‐line (−) while they were also classified as modified K‐line (+). Preoperative modified K‐line was used to predict the surgical outcome in K‐line (−) patients with OPLL according to the original K‐line. And a modified laminoplasty with C3 laminectomy and C4‐6 bilateral open‐door laminoplasty was adopted to perform on all the patients. The Japanese Orthopaedic Association scores before surgery and at 1‐year follow‐up after surgery were evaluated and the recovery rate was calculated. The visual analogue scale (VAS) scores were also evaluated before surgery and after surgery. Furthermore, cervical plain radiographs in neutral position before surgery and after surgery were obtained to measure C2–C7 angles for assessing the cervical sagittal alignment. Results The results showed that good neurological improvement could be achieved in all K‐line (−) patients who underwent C3 laminectomy with C4–C6 bilateral open‐door laminoplasty. The Postoperative JOA scores improved from 13.5 to 16.5, from 11 to 16.5, from 13 to 16, and from 12.5 to 13, respectively. The mean recovery rate was 65.4% in the K‐line (−) patients. And the VAS scores dropped from 3 to 1, 5 to 2, 5 to 3, and 4 to 2, respectively. The JOA and VAS scores showed satisfaction in all patients at the 1‐year follow‐up. Relatively satisfactory and stable cervical sagittal alignment was observed on postoperative lateral radiography in all patients at the 3‐month follow‐up period. There were no postoperative complications associated with this technique found in all the patients. Conclusions Modified K‐line may predict the clinical outcome of this modified laminoplasty and offer guidance regarding the choice of surgical method for K‐line (−) patients with OPLL. Additionally, C3 laminectomy with C4–C6 bilateral open‐door laminoplasty should be recommended for the use in patients with K‐line (−) OPLL, who were also classified as modified K‐line (+). However, further studies with more cases will be required to reveal its generalizability and availability.
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Affiliation(s)
- Xizhe Liu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Bizhi Tan
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Bin Xiao
- Department of Spine Surgery, Beijing Jishuitan Hospital, The 4th Clinical College of Peking University, Beijing, China
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Shaoyu Liu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Orthopaedics, The Seventh Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, China
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35
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Sakai K, Yoshii T, Arai Y, Hirai T, Torigoe I, Inose H, Tomori M, Sakaki K, Yuasa M, Yamada T, Matsukura Y, Oyaizu T, Morishita S, Okawa A. K-Line Tilt is a Predictor of Postoperative Kyphotic Deformity After Laminoplasty for Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament. Global Spine J 2021; 13:1005-1010. [PMID: 33949218 DOI: 10.1177/21925682211012687] [Citation(s) in RCA: 3] [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 single-center study. OBJECTIVES K-line is a decision-making tool to determine the appropriate surgical procedures for patients with cervical ossification of the posterior longitudinal ligament (C-OPLL). Laminoplasty (LAMP) is one of the standard surgical procedures indicated on the basis of K-line measurements (+: OPLL does not cross the K-line). We investigated the impact of K-line tilt, a radiographic parameter of cervical sagittal balance measured using the K-line, on surgical outcomes after LAMP. METHODS The study included 62 consecutive patients with K-line (+) C-OPLL who underwent LAMP. The following preoperative and postoperative radiographic measurements were evaluated: (1) the K-line, (2) K-line tilt (an angle between the K-line and vertical line), (3) center of gravity of the head -C7 sagittal vertical axis, (4) C2-C7 lordotic angle, (5) C7 slope, and (6) C2-C7 range of motion. Clinical results were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score). RESULTS All the patients had non-kyphotic cervical alignment (CL ≥ 0°) preoperatively; however, kyphotic deformity (CL < 0°) was observed in 6 patients (9.7%) postoperatively. The recovery rate of the C-JOA scores was poor in the kyphotic deformity (+) group (7.8%) than in the kyphotic deformity (-) group (47.5%). The K-line tilt was identified to be a preoperative risk factor in the multivariate analysis, and the cutoff K-line tilt for predicting the postoperative kyphotic deformity was 20°. CONCLUSIONS LAMP is not suitable for K-line (+) C-OPLL patients with K-line tilts >20°.
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Affiliation(s)
- Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Kyohei Sakaki
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuyoshi Yamada
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuya Oyaizu
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Shao T, Gu J, Zhu Y, Tang W, Li Q, Lu J, Hu Y, Yu Z, Shen H. Modified axial computed tomography classification of cervical ossification of the posterior longitudinal ligament: selecting the optimal operating procedure and enhancing the accuracy of prognosis. Quant Imaging Med Surg 2021; 11:1888-1898. [PMID: 33936972 DOI: 10.21037/qims-20-862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cervical ossification of the posterior longitudinal ligament (OPLL) causes spinal cord compression, which can lead to myelopathy or radiculopathy. Non-surgical treatments have little effect on this condition. Current OPLL classification systems offer little guidance on the selection of an appropriate operating procedure. In this study, we developed a modified axial computed tomography classification (MACTC) scheme. We then examined the usefulness of the MACTC scheme and two other existing classification schemes in guiding OPLL operation choice. Methods Following screening in which a defined exclusion criteria was used, a total of 91 patients with OPLL participated in the study. Patients' follow-up data for at least 2 years were obtained. The recovery rate of the Japanese Orthopaedic Association (JOA) scores was compared to two other classification schemes. Results According to the MACTC, central-sharp-type OPLL had a lower recovery rate of the JOA score than that of central-gentle-type OPLL (36.05±32.38 vs. 83.90±23.52, P≤0.05). The recovery rate of the JOA scores in the ipsilateral open-door OPLL group was significantly lower than that in the contralateral group of the lateral-steep type (36.67±41.5 vs. 88.89±17.21, P=0.04), but not of that in the lateral-gentle type. There was no significant difference in the recovery rates of the JOA scores between groups when using either existing classification scheme (P>0.05). Conclusions The MACTC scheme can assist surgeons to choose the most appropriate operating procedure, and provide an accurate prognosis. If operations on central-sharp-type OPLL are not performed using both the posterior and anterior approaches, prognosis will be poor. The contralateral side should be the first choice for door opening in laminoplasty, especially for patients with lateral-steep-type OPLL. Severe OPLL may not be an absolute contraindication for the posterior approach.
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Affiliation(s)
- Tuo Shao
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiao Gu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yigeng Zhu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weilong Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qingsong Li
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Juncheng Lu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuhang Hu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhange Yu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongtao Shen
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Li S, Peng J, Xu R, Zheng R, Huang M, Xu Y, He Y, Chai Y, Song H, Asakawa T. Comparison of the surgeries for the ossification of the posterior longitudinal ligament-related cervical spondylosis: A PRISMA-compliant network meta-analysis and literature review. Medicine (Baltimore) 2021; 100:e24900. [PMID: 33655951 PMCID: PMC7939206 DOI: 10.1097/md.0000000000024900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/29/2020] [Accepted: 02/01/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE We designed and performed a network meta-analysis to compare the clinical outcomes among the 5 surgeries-anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement fusion (ACAF), laminoplasty (LP), laminectomy (LC), and posterior decompression with instrumented fusion (PDF)-for patients with cervical spondylosis related to the ossification of the posterior longitudinal ligament (OPLL). METHODS Databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019) were selected for literature search. We performed a network meta-analysis with the included studies. A Newcastle-Ottawa scale was employed to assess the study quality of the included studies. RESULTS Total 23 studies with 1516 patients were included in our analysis. We found that ACCF achieved the most improvement in the Japanese Orthopaedic Association Scores and excellent and good recovery rate, ACAF achieved the best improvement of the improvement rate and lordosis. LP got the best operative time and blood loss. CONCLUSIONS Our results suggested that both anterior (ACCF and ACAF) and posterior (LP, LC, and PDF) procedures have their strengths and weaknesses. Clinicians need to select the most appropriate surgery with a comprehensive consideration of the clinical condition of each patient with OPLL-related cervical spondylosis.
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Affiliation(s)
- Sihan Li
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou
- The second people's Hospital affiliated to Fujian University of traditional Chinese Medicine, Fuzhou
| | - Jiajie Peng
- Department of Orthopedics, Zhongshan Jishuitan orthopedic hospital, Zhongshan, Guangdong
| | - Ruoying Xu
- The second people's Hospital affiliated to Fujian University of traditional Chinese Medicine, Fuzhou
| | - Rong Zheng
- The second people's Hospital affiliated to Fujian University of traditional Chinese Medicine, Fuzhou
| | - Minghan Huang
- The second people's Hospital affiliated to Fujian University of traditional Chinese Medicine, Fuzhou
| | - Yongzhen Xu
- Xiamen Hospital of Beijing University of Chinese Medicine, Xiamen
| | - Youcheng He
- The second people's Hospital affiliated to Fujian University of traditional Chinese Medicine, Fuzhou
| | - Yujuan Chai
- School of Medical Engineering, Health Science Center, Shenzhen University, Shenzhen
| | - Hongmei Song
- The second people's Hospital affiliated to Fujian University of traditional Chinese Medicine, Fuzhou
| | - Tetsuya Asakawa
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
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38
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Yu H, Li X, Chen S, Zhang L, Yang G, Welle K, Gathen M, Kabir K. Comparative Effectiveness and Safety of Anterior Cervical Corpectomy with Fusion, Laminoplasty, and Laminectomy and Instrumented Fusion for Ossification of the Posterior Longitudinal Ligament: A Systematic Review and Network Meta-Analysis. J INVEST SURG 2021; 35:667-676. [PMID: 33472478 DOI: 10.1080/08941939.2020.1871535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND To evaluate the comparative effectiveness and safety of anterior cervical corpectomy with fusion (ACCF), laminoplasty (LP), and laminectomy and instrumented fusion (LF) in the treatment of ossification of the posterior longitudinal ligament (OPLL). METHODS Embase, Pubmed, and Cochrane library were searched from their date of inception to June 13, 2020. Relevant randomized controlled trials (RCTs) and cohort studies comparing different procedures among ACCF, LP, and LF were identified, data were extracted to perform a network meta-analysis (NMA). The outcomes were the Japanese Orthopedic Association (JOA) score and complications. RESULTS We deemed 14 trials eligible, including 877 patients. In NMA, ACCF showed a significant improvement of JOA score compared with LP [MD= -0.89, 95% CI (-1.73, -0.18)], but no significant difference was found when compared LF with ACCF or LP. No significant differences in complications were found when compared LF with LP or ACCF, while ACCF showed significantly higher in complications than LP [OR = 1.99, 95% CI (1.10, 3.35)]. The surface under the cumulative ranking curves (SUCRA) showed that the rank of JOA score improvement is as follows: ACCF (82.5%), LF (79.5%), and LP (2.3%). And the rank of complication rate is as follows: LF (65.8%), ACCF (68.4%), and LP (2.1%). LIMITATION The biggest limitation was that none of the included studies were RCTs. CONCLUSIONS Despite the higher probability of complications than LP, ACCF was the more recommended procedure for its highest ranking spectrums of JOA score improvement to treat the OPLL.
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Affiliation(s)
- Hui Yu
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Xian Li
- Department of Orthopedic and Trauma Surgery, Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Shu Chen
- School of Business and Management, Shanghai International Studies University, Shanghai, China
| | - Li Zhang
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Ge Yang
- Department of Orthopedic Surgery, Hunan Children's Hospital, Hunan, People's Republic of China
| | - Kristian Welle
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin Gathen
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Koroush Kabir
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
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39
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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.
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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.
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Sasada S, Hiramatsu M, Kusumegi A, Fujimura H, Oshikata S, Takahashi Y, Nishida K, Yasuhara T, Date I. Arteriovenous Fistula at the Craniocervical Junction Found After Cervical Laminoplasty for Ossification of the Posterior Longitudinal Ligament. Neurospine 2020; 17:947-953. [PMID: 33401875 PMCID: PMC7788406 DOI: 10.14245/ns.2040200.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 09/30/2018] [Indexed: 11/19/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is common in East Asia. Arteriovenous fistula at the craniocervical junction (CCJ-AVF), in contrast, is rare. As OPLL occurs most often in the cervical region, these 2 conditions can coexist in the cervical spinal canal of a single patient. We report a case of CCJ-AVF found after cervical laminoplasty (CLP) for OPLL. A 68-year-old man experienced progressive myelopathy due to cervical OPLL. Magnetic resonance imaging (MRI) revealed a high-intensity area inside the spinal cord. CLP was performed and his symptoms immediately improved. Three months after CLP, however, myelopathy recurred. MRI revealed an exacerbated and enlarged high-intensity area inside the cord from the medulla oblongata to the C4/5 level with a flow void around the cord. Left vertebral artery angiography revealed CCJ-AVF with ascending and descending draining veins. Direct surgery was performed to interrupt shunt flow into the draining veins. The patient’s symptoms improved to a limited degree. In this case, increased pressure inside the spinal canal due to OPLL might have decreased the shunt flow of the CCJ-AVF. Thus, the venous congestion induced by CCJ-AVF might have been exacerbated after the pressure was removed by CLP. Magnetic resonance angiography screening could help detect concurrent CCJ-AVF and OPLL.
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Affiliation(s)
- Susumu Sasada
- Department of Spinal Surgery, Shinkomonji Hospital, Kitakyushu, Japan.,Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akira Kusumegi
- Department of Spinal Surgery, Shinkomonji Hospital, Kitakyushu, Japan
| | - Haruto Fujimura
- Department of Neurosurgery, Shinkomonji Hospital, Kitakyushu, Japan
| | - Shogo Oshikata
- Department of Neurosurgery, Shinkomonji Hospital, Kitakyushu, Japan
| | - Yuichi Takahashi
- Department of Spinal Surgery, Shinkomonji Hospital, Kitakyushu, Japan
| | - Kenki Nishida
- Department of Spinal Surgery, Shintakeo Hospital, Takeo, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Kwok SSS, Cheung JPY. Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches. BMC Musculoskelet Disord 2020; 21:823. [PMID: 33292175 PMCID: PMC7724709 DOI: 10.1186/s12891-020-03830-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. Main body of the abstract A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives. Conclusion From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.
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Affiliation(s)
- Suzanna Sum Sum Kwok
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
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Lee DH, Park S, Lee WS, Byun CW, Seok SY, Cho JH, Hwang CJ, Lee CS, Lee HR. Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis. Neurospine 2020; 17:640-647. [PMID: 33022167 PMCID: PMC7538360 DOI: 10.14245/ns.2040482.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/06/2020] [Indexed: 11/23/2022] Open
Abstract
Cervical spondylotic myelopathy is surgically demanding when associated with rigid kyphosis. Posterior surgery cannot restore cervical lordosis, and adequate decompression is not possible with rigid kyphosis. Vertebral body sliding osteotomy (VBSO) is a safe and novel technique for anterior decompression in patients with multilevel cervical spondylotic myelopathy. It is safe in terms of dural tear, pseudarthrosis, and graft dislodgement, which are demonstrated at high rates in anterior cervical corpectomy and fusion. In addition, VBSO is a powerful method for restoring cervical lordosis through multilevel anterior cervical discectomy and fusion above and below the osteotomy level. It may be a feasible treatment option for patients with cervical spondylotic myelopathy and kyphotic deformity. This is a technical note and literature review that describes the procedures involved in VBSO.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Woon Sang Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Woong Byun
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yun Seok
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Rae Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Liu X, Wen BT, Chen ZQ, Tan L, Zhong J. Ultrasonic osteotome versus high-speed burr in cervical anterior vertebral subtotal resection: A retrospective study of 81 cases. Neurochirurgie 2020; 66:369-372. [PMID: 32861685 DOI: 10.1016/j.neuchi.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/09/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022]
Abstract
AIM This study aimed to investigate the safety and effectiveness of ultrasonic osteotome in cervical anterior vertebral subtotal resection. METHODS Retrospective clinical data were collated for 81 patients with cervical spondylotic myelopathy who required cervical anterior vertebral subtotal resection. RESULTS Group A (n=40) was treated with an ultrasonic osteotome and group B (n=41) with a high-speed burr. Vertebrectomy time, intraoperative blood loss, surgical complications, Japanese Orthopedic Association (JOA) scores and JOA score improvement were compared. Group A showed significantly shorter vertebrectomy time and significantly less intraoperative blood loss (P<0.05). In group A, dysphagia occurred in one patient, and superior laryngeal nerve injury in one. Urinary tract infection occurred in one patient in group B. JOA score in both groups significantly increased 3 days after surgery (P<0.05), and at last follow-up compared with 3 days after surgery (P<0.05). CONCLUSION Ultrasonic osteotome was a safe and effective tool for subtotal anterior cervical vertebral resection.
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Affiliation(s)
- X Liu
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China
| | - B-T Wen
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China.
| | - Z-Q Chen
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China
| | - L Tan
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China
| | - J Zhong
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China
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Comparison of Anterior Controllable Antedisplacement and Fusion With Posterior Laminoplasty in the Treatment of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective, Randomized, and Control Study With at Least 1-Year Follow Up. Spine (Phila Pa 1976) 2020; 45:1091-1101. [PMID: 32097261 DOI: 10.1097/brs.0000000000003462] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, randomized, controlled study. OBJECTIVE To compare anterior controllable antidisplacement and fusion (ACAF) with laminoplasty in the treatment of multilevel ossification of the posterior longitudinal ligament (OPLL), and evaluate the efficacy and safety of this procedure. SUMMARY OF BACKGROUND DATA The optimal approach for the treatment of OPLL still remains controversial. Both anterior and posterior approaches have their advantages and disadvantages. METHODS Between September 2016 and April 2018, a total of 80 patients with multilevel OPLL were randomized in a 1:1 ratio to ACAF group and laminoplasty group. All patients were followed up at least 1 year. Clinical and radiological results were compared between ACAF group and laminoplasty group. RESULTS ACAF took a longer operation time. C5 palsy and axial pain occurred more commonly in laminoplasty group, whereas dysphagia and hoarseness appeared easily in ACAF group. At 1-year follow-up, the final Japanese Orthopedic Association (JOA) score and recovery rate were significant higher in ACAF group than those in laminoplasty group, when occupying rate (OR) was not less than 60%, or K-line was negative. ACAF was also good at preservation of cervical lordosis and sagittal balance, but range of movement of cervical spine in both groups decreased significantly. CONCLUSION Generally speaking, ACAF is a safe and effective alternative for multilevel OPLL. Compared with laminoplasty, ACAF is more effective in the cases when OR is not less than 60%, or K-line is negative. LEVEL OF EVIDENCE 2.
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Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Propensity Score Matching Analysis Using a Nation-Wide Inpatient Database. Spine (Phila Pa 1976) 2020; 45:E1006-E1012. [PMID: 32150133 DOI: 10.1097/brs.0000000000003469] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective comparative study. OBJECTIVE To compare the perioperative complications and costs of anterior decompression with fusion (ADF) and posterior decompression with fusion (PDF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Surgical treatment of cervical OPLL has a high risk of various complications. ADF and PDF are effective for the treatment of cervical OPLL; however, few studies have compared the two procedures in terms of the perioperative surgical complications. METHODS Patients undergoing ADF and PDF for cervical OPLL from 2010 to 2016 were identified in a nation-wide inpatient database. We investigated systemic and local complications, length of hospital stay, costs for hospitalization, reoperation, and mortality. Propensity score was calculated from patients' characteristics and preoperative comorbidities, and one to one matching was performed. RESULTS Propensity score-matching produced 854 pairs of patients who underwent ADF and PDF. The rate of at least one systemic complication was significantly higher in the ADF group (P = 0.004). The incidence rates of postoperative respiratory failure (P = 0.034) and dysphagia (P = 0.008) were significantly higher in the ADF group. The rates of pneumonia (P = 0.06) and hoarseness (P = 0.08) also tended to be higher in the ADF group. However, no difference was found in the mortality rate (P = 0.22). In the local complications, spinal fluid leakage was significantly higher in the ADF group (P < 0.001). However, blood transfusion rate was significantly higher in the PDF group (P = 0.001). Hospital stay was significantly longer in the PDF group (P < 0.001) and the cost for hospitalization was greater in the PDF group (P < 0.001). CONCLUSION The present study demonstrated that perioperative complications, such as respiratory failure, dysphagia, and spinal fluid leakage, were more common in the ADF group. However, hospital stay was longer in the PDF group, and the cost for hospitalization was greater in the PDF group. LEVEL OF EVIDENCE 3.
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Noh SH, Kim KH, Park JY, Kuh SU, Chin DK, Kim KS, Cho YE. Anterior cervical discectomy and fusion vs posterior laminoplasty for the treatment of myelopathy due to two-level localized ossification of the posterior longitudinal ligament. Medicine (Baltimore) 2020; 99:e20955. [PMID: 32871974 PMCID: PMC7437741 DOI: 10.1097/md.0000000000020955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 11/26/2022] Open
Abstract
We conducted a retrospective study to compare the clinical and radiological results of anterior cervical discectomy and fusion (ACDF) and posterior laminoplasty for two-level localized ossification of the posterior longitudinal ligament (OPLL).ACDF and posterior laminoplasty are performed for localized OPLL at the disc and vertebral body levels, respectively.Eighty six patients with two-level localized OPLL who underwent surgery from January 2011 to December 2016 were retrospectively investigated (41, ACDF group; 45, laminoplasty group). Clinical outcomes were reviewed, and radiologic results such as occupying ratio (OR), space available in the spinal cord, cranial and caudal OPLL-to-disc distance (ODD)/posterior body height (PBH) ratios, segmental angle, C2-C7 Cobb angle, T1 slope, C2-C7 sagittal vertical axis (SVA), and range of motion were investigated.Patients were followed-up for an average of 42.7 ± 10.5 months. Clinical outcomes, postoperative OR, and space available in the spinal cord were significantly improved at the final follow-up in both groups. Preoperatively, the OR and cranial and caudal ODD/PBH ratios were not significantly different between the groups. Compared to pre-operative values, differences in the segmental and C2-C7 Cobb angles at the final follow-up were statistically significant for the ACDF group (P < .05). The mean operative time, bleeding volume, and the duration of hospitalization were significantly lower in the ACDF group than in the laminoplasty group (P < .05). Complications occurred in 1 ACDF case and in 5 laminoplasty cases.Both ACDF and laminoplasty provided satisfactory clinical and radiologic outcomes for two-level localized OPLL. However, ACDF was associated with a lower operation time, bleeding loss, duration of hospitalization, and complications.
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Affiliation(s)
- Sung Hyun Noh
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang
- Department of Neurosurgery
| | - Kyung Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Nakashima H, Kanemura T, Satake K, Ito K, Ouchida J, Morita D, Ando K, Kobayashi K, Ishiguro N, Imagama S. Reoperation for Late Neurological Deterioration After Laminoplasty in Individuals With Degenerative Cervical Myelopathy: Comparison of Cases of Cervical Spondylosis and Ossification of the Posterior Longitudinal Ligament. Spine (Phila Pa 1976) 2020; 45:E909-E916. [PMID: 32675602 DOI: 10.1097/brs.0000000000003408] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The objective of this study was to elucidate the rate and causes of reoperation for late neurological deterioration after cervical laminoplasty by comparing cases of cervical spondylotic myelopathy (CSM) with those of ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Although the long-term surgical outcomes of cervical laminoplasty in patients with CSM or OPLL are satisfactory, reoperation is sometimes required for late neurological deterioration after laminoplasty. However, limited information is available about long-term follow-up in such cases. METHODS This retrospective cohort study included 623 patients who underwent cervical laminoplasty for cervical myelopathy (average follow-up duration, 6.1 [range, 2-15] years). The rate of reoperations for late neurological deterioration (>6 mo after the initial surgery) was investigated. RESULTS Primary diagnoses were CSM and OPLL in 522 (83.8%) and 101 (16.2%) patients, respectively. During the follow-up period, 10 (1.6%) patients required reoperation: 7 (1.3%) in the CSM group and 3 (3.0%) in the OPLL group. No significant difference was found between the CSM and OPLL groups regarding patients requiring reoperation (P = 0.26). The mean elapsed time between primary surgery and reoperation was 4.7 ± 3.2 and 10.0 ± 5.7 years in the CSM and OPLL groups, respectively. The predicted risk percentages of reoperation at 10 years after primary surgery were 2.9% and 1.0% in the CSM and OPLL group, respectively. The causes of reoperation for CSM were C5 palsy in five, severe radiculopathy in one, and restenosis due to instability after laminoplasty in one case; the cause of reoperation for OPLL was enlargement of ossification in all three cases. CONCLUSION Although the clinical outcomes of laminoplasty were favorable in most patients, reoperation for late neurological deterioration was required in approximately 1.0% to 3.0% of CSM and OPLL cases within 10 years after laminoplasty. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Orthopedic Surgery, Konankosei Hospital, Konan, Aichi, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konankosei Hospital, Konan, Aichi, Japan
| | - Kotaro Satake
- Department of Orthopedic Surgery, Konankosei Hospital, Konan, Aichi, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Konankosei Hospital, Konan, Aichi, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Konankosei Hospital, Konan, Aichi, Japan
| | - Daigo Morita
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Nagamoto Y, Iwasaki M, Okuda S, Matsumoto T, Sugiura T, Takahashi Y, Furuya M. Anterior selective stabilization combined with laminoplasty for cervical myelopathy due to massive ossification of the posterior longitudinal ligament: report of early outcomes in 14 patients. J Neurosurg Spine 2020; 33:58-64. [PMID: 32168487 DOI: 10.3171/2020.1.spine191068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical management of massive ossification of the posterior longitudinal ligament (OPLL) is challenging. To reduce surgical complications, the authors have performed anterior selective stabilization combined with laminoplasty (antSS+LP) for massive OPLL since 2012. This study aimed to elucidate the short-term outcome of the antSS+LP procedure. METHODS The authors' analysis was based on data from 14 patients who underwent antSS+LP for cervical myelopathy caused by massive OPLL and were followed up for at least 2 years after surgery (mean follow-up duration 3.3 years). Clinical outcome was evaluated preoperatively, at 6 months and 1 year postoperatively, and at the final follow-up using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy and the recovery rate of the JOA score. The following radiographic parameters were measured preoperatively, immediately after surgery, at 1 year after surgery, and at the final follow-up: the C2-7 angle, measured on lateral plain radiographs, and the segmental lordosis angle (SLA), measured on sagittal CT scans. The correlation between radiographic parameters and clinical outcomes was evaluated. RESULTS The mean JOA score increased from 10.4 before surgery to 13.6 and 13.8 at 6 months and 1 year after surgery, respectively; at the final follow-up the mean score was 13.4. This postoperative recovery was significant (p = 0.004) and was maintained until the final follow-up. No patient required revision surgery due to postoperative neurological deterioration. However, the C2-7 angle gradually deteriorated postoperatively. Similarly, the SLA was significantly increased immediately after surgery, but the improvement was not maintained. The recovery rate at the final follow-up correlated positively with the change in C2-7 angle (r = 0.60, p = 0.03) and the change in SLA (r = 0.72, p < 0.01). CONCLUSIONS AntSS+LP is safe and effective and may be an alternative to anterior decompression and fusion for the treatment of patients with massive OPLL. No postoperative neurological complications or significant postoperative exacerbation of neck pain were observed in our case series. Not only reducing intervertebral motion and decompressing the canal at the maximal compression level but also acquiring segmental lordosis at the maximal compression level are crucial factors for achieving successful outcomes of antSS+LP.
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Xu P, Sun GD, Xun L, Huang SS, Li ZZ. Posterior decompression and fusion versus laminoplasty for cervical ossification of posterior longitudinal ligament: a systematic review and meta-analysis. Neurosurg Rev 2020; 44:1457-1469. [PMID: 32535873 DOI: 10.1007/s10143-020-01317-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/25/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
Both posterior decompression and fusion (PDF) and laminoplasty (LAMP) have been used to treat cervical myelopathy due to multilevel ossification of posterior longitudinal ligament (OPLL). However, considerable controversy exists over the choice of the two surgical strategies. Thus, the aim of this study is to compare clinical outcomes of PDF and LAMP for treatment of cervical myelopathy due to multilevel OPLL. We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials database to identify relevant clinical studies compared with clinical outcomes of PDF and LAMP for cervical OPLL. The primary outcomes including Japanese Orthopaedic Association (JOA) score and recovery rate of JOA were evaluated, and the secondary outcomes involving visual analogue scale (VAS), cervical curvature, OPLL progression rate, complication rate, reoperation rate and surgical trauma were also evaluated using Stata software. A total of nine studies were included in the current study, involving 324 patients. The current study suggests that compared with LAMP, PDF achieves a lower OPLL progression rate, better postoperative cervical curvature and similar neurological improvement in the treatment of multilevel cervical OPLL. However, PDF has a higher complication rate, more surgical trauma and higher postoperative VAS than LAMP.
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Affiliation(s)
- Ping Xu
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, 601 West Whampoa Avenue, Guangzhou, 510000, China
| | - Guo-Dong Sun
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, 601 West Whampoa Avenue, Guangzhou, 510000, China
| | - Lu Xun
- International School of Jinan University, 601 West Whampoa Avenue, Guangzhou, 510000, China
| | - Shi-Shu Huang
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, 601 West Whampoa Avenue, Guangzhou, 510000, China.
| | - Zhi-Zhong Li
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, 601 West Whampoa Avenue, Guangzhou, 510000, China. .,Heyuan Affiliated Hospital of Jinan University, 733 Wenxiang Road City, Heyuan, 517000, China.
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Yan C, Jia HC, Sun JC, Shi JG. Anterior controllable antidisplacement and fusion surgery for the treatment of extensive cervico-thoracic ossification of posterior longitudinal ligament with severe myelopathy: case report and literature review. Br J Neurosurg 2020:1-6. [PMID: 32401059 DOI: 10.1080/02688697.2020.1765975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OPLL generally occurs in the cervical spine and involves no more than three vertebral segments, while extensive OPLL that involves the cervico-thoracic spine and spans over multiple segments is rare. Surgically it is difficult to achieve a satisfactory clinical outcome without surgical complications via the traditional anterior or posterior approaches. We report the first application of Anterior controllable antidisplacement and fusion (ACAF) in treating extensive cervico-thoracic OPLL. A 45-year old patient experienced severe walking disturbance, bladder and bowel dysfunction for 5 months after a fall. His preoperative Japanese Orthopedic Association (JOA) score was 8 of 17. Preoperative CT and MRI demonstrated a K-line (-) and mixed-type extensive OPLL from C2 to T2, causing significant cord compression. After ACAF surgery, neurological symptoms improved immediately without postoperative complications. Postoperative CT and MRI scanning showed restoration of spinal canal cross section and cord decompression. At 6 months he was able to stand and walk again without assistance and urinary bladder and bowel function returned to normal completely. At 15 months his JOA score was 14 of 17. ACAF surgery provides a promising alternative for the treatment of extensive cervico-thoracic OPLL.
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Affiliation(s)
- Chen Yan
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Undergraduate Incubation Center, Second Military Medical University, Shanghai, China
| | - Huai-Cheng Jia
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Undergraduate Incubation Center, Second Military Medical University, Shanghai, China
| | - Jing-Chuan Sun
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian-Gang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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