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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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Sun X, Li F, Zhao B, Zhang B, Sun K, Sun J, Xu X, Wang Y, Shi J. A Clinical Classification of Cervical Ossification of the Posterior Longitudinal Ligament to Guide Surgical Strategy. Spine (Phila Pa 1976) 2024; 49:239-246. [PMID: 37982704 DOI: 10.1097/brs.0000000000004878] [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: 08/17/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
STUDY DESIGN A clinical classification of cervical ossification of the posterior longitudinal ligament (COPLL) was developed based on imaging findings. OBJECTIVE This study aimed to establish a clinical classification for COPLL and provide corresponding surgery strategies for each subtype. SUMMARY OF BACKGROUND DATA A practical and reliable classification is needed to guide the treatment of COPLL. MATERIALS AND METHODS This study retrospectively reviewed plain radiographs, computed tomography scans, and magnetic resonance images of patients diagnosed with COPLL between 2018 and 2022 at Shanghai Changzheng Hospital. The types of COPLL were classified according to the location, morphology, and canal-occupying ratio (OR) of the ossification mass. Interobserver and intraobserver reliability were evaluated using Cohen's kappa. RESULTS A total of 1000 cases were included, which were classified into five types: focal type (F type), short-sequential type (S type), long-sequential type (L type), high type (H type), and mixed type (M type). In addition, each type could be classified into subtype 1 or subtype 2 according to the canal-OR. Then each type could be further classified into other subtypes according to location and morphology. The interobserver reliabilities in the first and second rounds were 0.853 and 0.887, respectively. The intraobserver reliability was 0.888. CONCLUSION The authors classified COPLL into a system comprised of five types and several subtypes according to canal-OR, location, and morphology. Surgical strategies for each subtype are also suggested. This provides a theoretical guide for the description and surgical management of COPLL.
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Affiliation(s)
- Xiaofei Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Fudong Li
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Baolian Zhao
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Bin Zhang
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, Naval Medical Center, Navy Medical University, Shanghai, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Ximing Xu
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
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Onuma H, Sakai K, Arai Y, Torigoe I, Tomori M, Sakaki K, Hirai T, Egawa S, Kobayashi Y, Okawa A, Yoshii T. Augmented Reality Support for Anterior Decompression and Fusion Using Floating Method for Cervical Ossification of the Posterior Longitudinal Ligament. J Clin Med 2023; 12:jcm12082898. [PMID: 37109235 PMCID: PMC10143834 DOI: 10.3390/jcm12082898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Anterior decompression and fusion (ADF) using the floating method for cervical ossification of the posterior longitudinal ligament (OPLL) is an ideal surgical technique, but it has a specific risk of insufficient decompression caused by the impingement of residual ossification. Augmented reality (AR) support is a novel technology that enables the superimposition of images onto the view of a surgical field. AR technology was applied to ADF for cervical OPLL to facilitate intraoperative anatomical orientation and OPLL identification. In total, 14 patients with cervical OPLL underwent ADF with microscopic AR support. The outline of the OPLL and the bilateral vertebral arteries was marked after intraoperative CT, and the reconstructed 3D image data were transferred and linked to the microscope. The AR microscopic view enabled us to visualize the ossification outline, which could not be seen directly in the surgical field, and allowed sufficient decompression of the ossification. Neurological disturbances were improved in all patients. No cases of serious complications, such as major intraoperative bleeding or reoperation due to the postoperative impingement of the floating OPLL, were registered. To our knowledge, this is the first report of the introduction of microscopic AR into ADF using the floating method for cervical OPLL with favorable clinical results.
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Affiliation(s)
- Hiroaki Onuma
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Kyohei Sakaki
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Yutaka Kobayashi
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
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Sakaki K, Sakai K, Arai Y, Torigoe I, Tomori M, Hirai T, Onuma H, Kobayashi Y, Okawa A, Yoshii T. Prospective Comparative Study of Dysphagia after Subaxial Cervical Spine Surgery: Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament Ossification. J Clin Med 2023; 12:jcm12051774. [PMID: 36902561 PMCID: PMC10003155 DOI: 10.3390/jcm12051774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
We prospectively investigated the postoperative dysphagia in cervical posterior longitudinal ligament ossification (C-OPLL) and cervical spondylotic myelopathy (CSM) to identify the risk factors of each disease and the incidence. A series of 55 cases with C-OPLL: 13 anterior decompression with fusion (ADF), 16 posterior decompression with fusion (PDF), and 26 laminoplasty (LAMP), and a series of 123 cases with CSM: 61 ADF, 5 PDF, and 57 LAMP, were included. Vertebral level, number of segments, approach, and with or without fusion, and pre and postoperative values of Bazaz dysphagia score, C2-7 lordotic angle (∠C2-7), cervical range of motion, O-C2 lordotic angle, cervical Japanese Orthopedic Association score, and visual analog scale for neck pain were investigated. New dysphagia was defined as an increase in the Bazaz dysphagia score by one grade or more than one year after surgery. New dysphagia occurred in 12 cases with C-OPLL; 6 with ADF (46.2%), 4 with PDF (25%), 2 with LAMP (7.7%), and in 19 cases with CSM; 15 with ADF (24.6%), 1 with PDF (20%), and 3 with LAMP (1.8%). There was no significant difference in the incidence between the two diseases. Multivariate analysis demonstrated that increased ∠C2-7 was a risk factor for both diseases.
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Affiliation(s)
- Kyohei Sakaki
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan
| | - Hiroaki Onuma
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Yutaka Kobayashi
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan
- Correspondence: ; Tel.: +81-3-5803-5678
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Wada K, Imagama S, Matsuyama Y, Yoshida G, Ando K, Kobayashi K, Machino M, Kawabata S, Iwasaki H, Funaba M, Kanchiku T, Yamada K, Fujiwara Y, Shigematsu H, Taniguchi S, Ando M, Takahashi M, Ushirozako H, Tadokoro N, Morito S, Yamamoto N, Yasuda A, Hashimoto J, Takatani T, Tani T, Kumagai G, Asari T, Nitobe Y, Ishibashi Y. Comparison of intraoperative neuromonitoring accuracies and procedures associated with alarms in anterior versus posterior fusion for cervical spinal disorders: A prospective multi-institutional cohort study. Medicine (Baltimore) 2022; 101:e31846. [PMID: 36626536 PMCID: PMC9750642 DOI: 10.1097/md.0000000000031846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A prospective multicenter cohort study. To clarify the differences in the accuracy of transcranial motor-evoked potentials (TcE-MEPs) and procedures associated with the alarms between cervical anterior spinal fusion (ASF) and posterior spinal fusion (PSF). Neurological complications after TcE-MEP alarms have been prevented by appropriate interventions for cervical degenerative disorders. The differences in the accuracy of TcE-MEPs and the timing of alarms between cervical ASF and PSF noted in the existing literature remain unclear. Patients (n = 415) who underwent cervical ASF (n = 171) or PSF (n = 244) at multiple institutions for cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, spinal injury, and others were analyzed. Neurological complications, TcE-MEP alarms defined as a decreased amplitude of ≤70% compared to the control waveform, interventions after alarms, and TcE-MEP results were compared between the 2 surgeries. The incidence of neurological complications was 1.2% in the ASF group and 2.0% in the PSF group, with no significant intergroup differences (P-value was .493). Sensitivity, specificity, negative predictive value, and rate of rescue were 50.0%, 95.2%, 99.4%, and 1.8%, respectively, in the ASF group, and 80.0%, 90.9%, 99.5%, and 2.9%, respectively, in the PSF group. The accuracy of TcE-MEPs was not significantly different between the 2 groups (P-value was .427 in sensitivity, .109 in specificity, and .674 in negative predictive value). The procedures associated with the alarms were decompression in 3 cases and distraction in 1 patient in the ASF group. The PSF group showed Tc-MEPs decreased during decompression, mounting rods, turning positions, and others. Most alarms went off during decompression in ASF, whereas various stages of the surgical procedures were associated with the alarms in PSF. There were no significant differences in the accuracy of TcE-MEPs between the 2 surgeries.
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Affiliation(s)
- Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigenori Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University, Yamaguchi, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan
| | - Kei Yamada
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | | | - Muneharu Ando
- Department of Orthopedic Surgery, Kansai Medical University, Osaka, Japan
| | | | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Nobuaki Tadokoro
- Department of Orthopedic Surgery, Kochi University, Kochi, Japan
| | - Shinji Morito
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Naoya Yamamoto
- Department of Orthopedic Surgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
| | - Akimasa Yasuda
- Department of Orthopedic Surgery, National Defense Medical College Hospital, Saitama, Japan
| | - Jun Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tunenori Takatani
- Department of Central Operation, Nara Medical University, Nara, Japan
| | - Toshikazu Tani
- Department of Orthopedic Surgery, Kubokawa Hospital, Kochi, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshiro Nitobe
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Morishita S, Yoshii T, Inose H, Hirai T, Matsukura Y, Ogawa T, Fushimi K, Katayanagi J, Jinno T, Okawa A. Perioperative Complications of Anterior Decompression with Fusion in Degenerative Cervical Myelopathy-A Comparative Study between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database. J Clin Med 2022; 11:jcm11123398. [PMID: 35743467 PMCID: PMC9225569 DOI: 10.3390/jcm11123398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 02/06/2023] Open
Abstract
For ossification of the posterior longitudinal ligament (OPLL) and cervical spondylotic myelopathy (CSM), anterior decompression with fusion (ADF) can accurately achieve spinal decompression. However, the difference in perioperative complications in ADF between OPLL and CSM is poorly described. This study aimed to investigate the perioperative complication rates of patients with degenerative cervical myelopathy undergoing ADF, represented by OPLL and CSM, using a large national inpatient database. In the OPLL and CSM groups, postoperative complication (systemic and local) rates, reoperation rates, medical costs during hospitalization, and mortality after propensity score matching were compared. After matching, 1197 matched pairs were made. The incidence of total systemic complications was similar between both groups (OPLL, 12.4%; CSM, 12.2%). In the OPLL group, more perioperative local complications (cerebrospinal fluid leakage: CSFL, [OPLL, 2.7%; CSM, 0.3%] and surgical site infection: SSI [OPLL, 2.1%; CSM, 0.9%]) were detected, and the hospitalization cost was approximately $3200 higher than that in the CSM group. Moreover, medical costs were significantly higher in patients who experienced complications in both OPLL and CSM. The frequency of perioperative complications of OPLL and CSM in ADF was detailed using large real-world data. Compared to CSM, OPLL had more perioperative complications such as CSFL and SSI, and higher medical costs. Regardless of the disease, medical costs were significantly increased when perioperative complications occurred.
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Affiliation(s)
- Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
- Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi, Saitama 343-8555, Japan; (J.K.); (T.J.)
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
- Correspondence: ; Tel.: +81-3-5803-5272; Fax: +81-3-5803-0110
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan;
| | - Junya Katayanagi
- Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi, Saitama 343-8555, Japan; (J.K.); (T.J.)
| | - Tetsuya Jinno
- Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi, Saitama 343-8555, Japan; (J.K.); (T.J.)
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
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