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Cao B, Zhou S, Liao X, Jia L, Chen X. Diagnostic accuracy of cervical spine imaging to predict thoracic ossification of the posterior longitudinal ligament: Retrospective chart review. Clin Neurol Neurosurg 2022; 222:107416. [DOI: 10.1016/j.clineuro.2022.107416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/05/2022] [Accepted: 08/14/2022] [Indexed: 11/16/2022]
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Prabhu RM, Rathod TN, Mohanty SS, Hadole BS, Marathe NA, Rai AK. A case of cervical OPLL and DISH mimicking stroke. Surg Neurol Int 2022; 13:158. [PMID: 35509544 PMCID: PMC9062959 DOI: 10.25259/sni_247_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/02/2022] [Indexed: 12/18/2022] Open
Abstract
Background:
Ossification of the posterior longitudinal ligament (OPLL) is a progressive disorder that mostly involves the cervical spine. It is more prevalent in East Asian countries. Patients typically present with the gradual onset of myelopathy, while about 5% show rapid progression.
Case Description:
A 51-year-old diabetic and hypertensive male presented with a left-sided hemiparesis following trivial trauma. The first diagnosis was a stroke, but the subsequent workup proved negative. Subsequently, the MRI and CT studies demonstrated significant cord compression due to OPLL extending from C2 to C7. There was also a heterogeneous hyperintense intramedullary cord signal indicative of edema/myelomalacia in the retro- odontoid region. The CT also diagnosed C2–C7 diffuse idiopathic skeletal hyperostosis.
Conclusion:
Patients with cervical myelopathy due to OPLL rarely present about 5% of the time with the acute onset of neurological deficit following minor trauma. Certainly, one must consider high cervical OPLL as responsible for hemiparesis in a patient whose brain MR has ruled out a stroke.
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Affiliation(s)
- Rudra Mangesh Prabhu
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Tushar N. Rathod
- Department of Orthopaedics, Seth G.S Medical College and K.E.M Hospital, Mumbai, India
| | | | - Bhushan S. Hadole
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Nandan A. Marathe
- Department of Orthopaedics, Chaitanya Spine Clinic, Vasai, Maharashtra, India
| | - Abhishek K. Rai
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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Zhao H, Ren R, Ma W, Xu S, Peng L, Zhong Z, Zheng Y. Comparison of Laminoplasty vs. Laminectomy for Cervical Spondylotic Myelopathy: A Systematic Review and Meta-Analysis. Front Surg 2022; 8:790593. [PMID: 35111804 PMCID: PMC8801503 DOI: 10.3389/fsurg.2021.790593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Laminoplasty (LP) and laminectomy (LC) with or without fusion are recommended as treatment procedures for cervical spondylotic myelopathy (CSM). The purpose of this study is to conduct a meta-analysis to analyze the results of CSM patients undergoing LP or LC surgery. METHODS We systematically and comprehensively searched Web of Science, Cochrane Library, PubMed, EMBASE, OVID, VIP database, Google Scholar, Chinese Bio-medicine Literature database, and China Scientific Journal Full-text database to July 2021 for randomized controlled trials (RCTs) and observational case series that compared LP and LC in patients with CSM. The main endpoints were the surgical process, radiographic outcomes, clinical outcomes, and surgical complications. RESULTS A total of 19 were included the inclusion criteria in this meta-analysis (n = 4,348 patients). There was no significant difference in range of motion (ROM), sagittal vertical axis (SVA), Japanese Orthopedic Association (JOA), Cobb angle, visual analog scale (VAS), cervical curvature index (CCI), Nurick score, Neck Dysfunction Index (NDI), and complications. LP was found to be superior than LC in terms of complications of C5 radiculopathy and surperficial infection. CONCLUSION Our results indicate that LP can achieve better results in C5 radiculopathy and superficial infection in surgical treatment of CSM compared with LC. Further high-quality research is warranted to further verify our findings. SYSTEMATIC REVIEW REGISTRATION PRISMA: CRD42018107070.
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Affiliation(s)
- Huaguo Zhao
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Rong Ren
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Weihu Ma
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Song Xu
- Department of Hepatobiliary Surgery, Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Linrui Peng
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Zhaoping Zhong
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
| | - Yan Zheng
- Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, China
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Koo J, Hwang S, Yoon SH, Shin HJ, Cho BK. Progression of Ossification of Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion in Military Patients Exposed to Minor Trauma. Korean J Neurotrauma 2022; 18:254-267. [PMID: 36381449 PMCID: PMC9634320 DOI: 10.13004/kjnt.2022.18.e55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Ossification of the posterior longitudinal ligament (OPLL) can progress even after cervical spine surgery and may cause neurological injury as a result of minor trauma. The purpose of this study was to investigate the preventive factors associated with OPLL progression after anterior cervical discectomy and fusion (ACDF), a procedure commonly performed in clinical practice. Methods We retrospectively investigated 295 male soldiers who underwent ACDF surgery between 2012 and 2017. Patients who were followed up for >12 months using dynamic radiography and computed tomography (CT) were included in the study. Radiological parameters investigated included OPLL progression, C2-C7 angles on dynamic radiography, segmental angles, C2-C7 cervical sagittal vertical axis (C2-C7 SVA), and the T1 slope. These parameters were measured preoperatively and 1 year postoperatively. Results A total of 49 patients were enrolled, and 10 patients were confirmed to have OPLL progression. Comparison between the OPLL progression and non-progression groups showed no statistically significant differences in pre- and postoperative cervical range of motion. However, statistically significant differences were observed in the postoperative neutral C2-C7 angle (progression -3.9°±6.4° vs. non-progression -13.4°±7.9°, p=0.001) and the SVA change (progression 5.8±7.9 mm vs. non-progression -3.7±6.3 mm, p=0.00). The cutoff values were -8.01° for the postoperative neutral C2-C7 angle and 1.4 mm for SVA changes. Conclusion Increased SVA (>1.4 mm) and a small postoperative neutral C2-C7 angle (>-8.01°) 1 year after ACDF were associated with OPLL progression. It is important to be mindful of these factors during follow-up after ACDF, because additional surgical treatment may be necessary for OPLL progression due to neurological injury caused by minor trauma.
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Affiliation(s)
- Jungmyung Koo
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - SungHwan Hwang
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Hoon Yoon
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
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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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Davies BM, Francis JJ, Butler MB, Mowforth O, Goacher E, Starkey M, Kolias A, Wynne-Jones G, Hutton M, Selvanathan S, Thomson S, Laing RJC, Hutchinson PJ, Kotter MRN. Current surgical practice for multi-level degenerative cervical myelopathy: Findings from an international survey of spinal surgeons. J Clin Neurosci 2021; 87:84-88. [PMID: 33863541 DOI: 10.1016/j.jocn.2021.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 12/15/2022]
Abstract
Degenerative cervical myelopathy (DCM) results from compression of the cervical spine cord as a result of age related changes in the cervical spine, and affects up to 2% of adults, leading to progressive disability. Surgical decompression is the mainstay of treatment, but there remains significant variation in surgical approaches used. This survey was conducted in order to define current practice amongst spine surgeons worldwide, as a possible prelude to further studies comparing surgical approaches. METHODS An electronic survey was developed and piloted by the investigators using SurveyMonkey. Collected data was categorical and is presented using summary statistics. Where applicable, statistical comparisons were made using a Chi-Squared test. The level of significance for all statistical analyses was defined as p < 0.05. All analysis, including graphs was performed using R (R Studio). RESULTS 127 surgeons, from 30 countries completed the survey; principally UK (66, 52%) and North America (15, 12%). Respondents were predominantly Neurosurgeons by training (108, 85%) of whom 84 (75%) reported Spinal Surgery as the principal part of their practice. The majority indicated they selected their surgical procedure for multi-level DCM on a case by case basis (62, 49%). Overall, a posterior approach was more popular for multi-level DCM (74, 58%). Region, speciality or annual multi-level case load did not influence this significantly. However, there was a trend for North American surgeons to be more likely to favour a posterior approach. CONCLUSIONS A posterior approach was favoured and more commonly used to treat multi-level DCM, in an international cohort of surgeons. Posterior techniques including laminectomy, laminectomy and fusion or laminoplasty appeared to be equally popular.
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Affiliation(s)
- Benjamin M Davies
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom.
| | - Jibin J Francis
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Max B Butler
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Oliver Mowforth
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Edward Goacher
- Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Michelle Starkey
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Angelos Kolias
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Guy Wynne-Jones
- Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Mike Hutton
- Royal Devon and Exeter Hospital, United Kingdom
| | | | | | - Rodney J C Laing
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Peter J Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Mark R N Kotter
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
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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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Kadone H, Kubota S, Abe T, Noguchi H, Miura K, Koda M, Shimizu Y, Hada Y, Sankai Y, Suzuki K, Yamazaki M. Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report. Front Neurol 2020; 11:102. [PMID: 32296380 PMCID: PMC7136555 DOI: 10.3389/fneur.2020.00102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/29/2020] [Indexed: 01/02/2023] Open
Abstract
Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.
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Affiliation(s)
- Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Liu S, Yang SD, Fan XW, Yang DL, Ma L, Sun JY, Ding WY. Analyses of effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL: a retrospective cohort study. J Orthop Surg Res 2019; 14:161. [PMID: 31138291 PMCID: PMC6540572 DOI: 10.1186/s13018-019-1208-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/20/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives This study aimed to investigate the effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL. Methods In this study, 194 patients, who underwent open-door laminoplasty for cervical OPLL from January 2009 to January 2016, were retrospectively reviewed. The Patient Satisfaction Index (PSI) was collected at discharge, 6 months, 1 year, and the last follow-up. According to the PSI, patients were divided into satisfied group and dissatisfied group. The possible effect factors included demographic variables and surgery-related variables. Results At discharge, 42 (21.6%) patients were in the dissatisfied group, as compared to the satisfied group, the hospitalization cost, hospital stay, postoperative depression, the axial neck pain, delayed wound healing, and VAS-neck had significant statistical differences. At 6-month follow-up, 25 (12.9%) patients were in the dissatisfied group. The axial neck pain and JOA score had significant statistical differences between the two groups, and no significant differences were found between the two groups in other items. At 1 year with 18 (9.3%) dissatisfied patients and last follow-up with 14 (7.2%) dissatisfied patients, the JOA score and symptom recurrence had significant statistical differences. For further analysis, the dissatisfied patients with axial neck pain at 6 months were significantly higher than that at other terms and the JOA score of the two groups increased gradually with prolonging of restoration years but compared with the dissatisfied group, the JOA scores were obviously better in the satisfied group at the last follow-up. Conclusions Overall, to patients undergoing open-door laminoplasty for cervical OPLL, hospitalization cost and neck pain might be mainly associated with patient dissatisfaction at the early and middle recovery. Patient dissatisfaction at the long-term treatment outcome might be mainly associated with the low improvement rate of JOA score and symptom recurrence.
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Affiliation(s)
- Sen Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Xi-Wen Fan
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Lei Ma
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Jia-Yuan Sun
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China. .,Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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Wang L, Jiang Y, Li M, Qi L. Postoperative Progression of Cervical Ossification of Posterior Longitudinal Ligament: A Systematic Review. World Neurosurg 2019; 126:593-600. [PMID: 30930321 DOI: 10.1016/j.wneu.2019.03.229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to provide a systematic and comprehensive review of the existing literature regrading postoperative ossification of posterior longitudinal ligament (OPLL) progression. METHODS Using the PRISMA guidelines, we conducted an exhaustive review of electronic databases. Potential articles were screened and related information was extracted and analyzed. Twenty-four articles with low-quality evidence were included in the review. The findings of the literature review were divided into several groups: the relationship of surgery to OPLL progression; incidence and risk factors; timing and process of OPLL progression; the effect of additional instrumentation on progression; and neurologic deterioration related with progression. RESULTS There was no definitive conclusion for whether surgery could accelerate OPLL progression compared with the natural course. The incidence of postoperative OPLL progression was reported from 3.3% to 74.5%. Younger age, involvement of multiple levels and mixed or continuous types are recognized as risk factors. OPLL could progress transversely and longitudinally and progression in length appeared more significant than progression in thickness. Although radiologic OPLL progression was observed significantly more frequently after laminoplasty than after fusion surgery, whether additional instrumented fusion could suppress progression needs further research. Radiographic progression of OPLL did not positively correspond with neurologic deterioration. CONCLUSIONS The lack of high-level evidence makes it difficult to draw definite conclusions and further research and long-term follow-up clinical studies are needed to better understand postoperative OPLL progression.
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Affiliation(s)
- Liang Wang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yunpeng Jiang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Mu Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Lei Qi
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Clinical Impact of Ossification of the Posterior Longitudinal Ligament Progression After Cervical Laminoplasty. Clin Spine Surg 2019; 32:E133-E139. [PMID: 30475240 DOI: 10.1097/bsd.0000000000000747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVES (1) To analyze the incidence of second surgery after initial laminoplasty for ossification of the posterior longitudinal ligament (OPLL) due to disease progression, (2) to examine factors associated with poor surgical outcome. SUMMARY OF BACKGROUND DATA Neurological deterioration after laminoplasty is frequently encountered due to OPLL progression. PATIENTS AND METHODS Of 201 OPLL patients treated by laminoplasty at a single-institution, the 153 monitored for >3 years postsurgery were included in this analysis. Neurological findings were graded by the Japanese Orthopaedic Association (JOA) score. We retrospectively examined the incidence of second surgery due to OPLL progression. We also evaluated the clinical characteristics and the surgical outcomes after second operation to identify potential risk factors for poor outcome. RESULTS Eight patients required a second surgery due to OPLL progression. Neurological recovery was achieved in 5 of these patients, whereas 3 exhibited continued dysfunction. Patients with poor recovery showed kyphotic changes of spinal alignment and high-intensity regions in the spinal cord on T2-weighted magnetic resonance images (T2-MRI). CONCLUSIONS Only a small fraction of OPLL patients required a second surgery due to OPLL progression. Recovery was poor in those with clear high-intensity T2-MRI signals in the spinal cord.
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12
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Radiological Characteristics and Clinical Outcome of Ossification of Posterior Longitudinal Ligament Involving C2 After Posterior Laminoplasty and Instrumented Fusion Surgery. Spine (Phila Pa 1976) 2019; 44:E150-E156. [PMID: 30044366 DOI: 10.1097/brs.0000000000002807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To analyze the radiological characteristics and surgical outcome of cervical ossification of posterior longitudinal ligament (OPLL) involving C2 level. SUMMARY OF BACKGROUND DATA The study and report focused on the OPLL involving C2 level are rare. Therefore, the radiological characteristics and surgical outcome remain unclear. METHODS The records of the patients with OPLL involving C2 level who underwent posterior surgery from July 2006 through October 2015 were retrospectively reviewed. The types, longitudinal and transverse extent, occupation ratio, K-line classification of OPLL, and high-intensity zone of spine cord on magnetic resonance imaging were analyzed to evaluate the radiological characteristics. All the cases received posterior open-door laminoplasty and instrumented fusion surgery. The Japanese Orthopedic Association (JOA) score and recovery rate (RR) were used to evaluate neurological function after surgery. RESULTS A total of 45 patients with OPLL involving C2 level were enrolled in the study. Their radiological data were carefully analyzed. The mixed (73.3%) and continuous type (24.5%) were observed. The mean number of involved segments was 5.1. The narrowest spinal canal mostly located in the level of C3-C4 and mean occupying ratio was 65.3%. Thirty-two patients were followed up for at least 2 years and the mean follow-up time was 46.2 months. The mean JOA score was 10.3 preoperatively and 15.2 at the final follow-up and the mean RR was 70.7%. The K-line (+) and (-) subgroups showed similar preoperative JOA score and RR. The high-intensity zone (+) subgroup showed lower preoperative JOA score but equal RR with (-) subgroup. CONCLUSION When OPLL involve C2 level, it often presented different radiological characteristics. The posterior open-door laminoplasty and instrumented fusion surgery could achieve favorable clinical outcomes. Further researches and long-term clinical follow-up are needed to better appreciate the OPLL involving C2 level. LEVEL OF EVIDENCE 4.
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Takeuchi K, Yokoyama T, Numasawa T, Wada KI, Itabashi T, Yamasaki Y, Kudo H, Ota S. Fixed Neck Position in Multilevel Cervical Posterior Decompression and Fusion to Reduce Postoperative Disturbances of Cervical Spine Function. Spine Surg Relat Res 2018; 2:253-262. [PMID: 31435531 PMCID: PMC6690097 DOI: 10.22603/ssrr.2017-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/15/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction Difficulties with neck mobility often interfere with patients' activities of daily living (ADL) after cervical posterior spine surgery. The range of motion of the cervical spine decreases markedly after multilevel cervical posterior decompression and fusion (PDF). However, details regarding the limitations of cervical spine function due to postoperative reduced neck mobility after multilevel PDF are as yet unclarified. The present study aimed to clarify the quality of life and its related factors after PDF, and the optimal fixed neck position in multilevel PDF that minimizes the limitations of ADL accompanying markedly reduced postoperative neck mobility. Methods Limitations of ADL involving neck extension, rotation, and flexion were investigated in 32 consecutive patients who underwent C2-T1 PDF using the responses to the cervical spine function domain of the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The EuroQol 5 Dimension, Japanese Orthopedic Association score, and five domains of the JOACMEQ were also investigated. We investigated the risk factors regarding the fixed neck position in PDF for the impossibility to perform ADL involving each of three movements using cut-off values obtained from receiver-operating characteristic curves. Results Postoperative comprehensive quality of life was significantly related to neurological improvements and to poor outcomes of cervical spine function after PDF. The significant risk factors for impossibility to perform ADL involving neck rotation were a C2-C7 lordotic angle ≥ 6° (P = 0.0057) or a proportion coefficient of C2-T1 tilt angle/C2-C7 lordotic angle ≤ 1.8 (P = 0.0024). There were no significant risk factors for impossibility to perform ADL involving neck extension or flexion. Conclusions The optimal fixed neck position in C2-T1 PDF to reduce postoperative limitations of ADL involving neck mobility is a C2-C7 lordotic angle of less than 6°, or a C2-T1 tilt angle (°) of greater than 1.8 × the C2-C7 lordotic angle (°).
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Affiliation(s)
- Kazunari Takeuchi
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Toru Yokoyama
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Takuya Numasawa
- Department of Orthopedic Surgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Kan-Ichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Taito Itabashi
- Department of Orthopedic Surgery, Towada City Hospital, Towada, Japan
| | | | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
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Bronheim RS, Oermann EK, Bronheim DS, Caridi JM. Revised Cardiac Risk Index versus ASA Status as a Predictor for Noncardiac Events After Posterior Lumbar Decompression. World Neurosurg 2018; 120:e1175-e1184. [PMID: 30218801 DOI: 10.1016/j.wneu.2018.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Revised Cardiac Risk Index (RCRI) was designed to predict risk for cardiac events after noncardiac surgery. However, there is a paucity of literature that directly addresses the relationship between RCRI and noncardiac outcomes after posterior lumbar decompression (PLD). The objective of this study is to determine the ability of RCRI to predict noncardiac adverse events after PLD. METHODS The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients undergoing PLD from 2006 to 2014. Multivariate and receiver operating characteristic analysis was used to identify associations between RCRI and postoperative complications. RESULTS A total of 52,066 patients met the inclusion criteria. Membership in the RCRI=1 cohort independently predicted unplanned intubation, ventilation >48 hours, progressive renal insufficiency, acute renal failure, urinary tract infection (UTI), sepsis, septic shock, and readmission. Membership in the RCRI=2 cohort independently predicted for superficial surgical site infection, pneumonia, unplanned intubation, ventilation >48 hours, bleeding transfusion, progressive renal insufficiency, acute renal failure, UTI, sepsis, septic shock, and readmission. Membership in the RCRI=3 cohort independently predicted unplanned intubation (odds ratio [OR], 11.8), ventilation >48 hours (OR, 23.0), acute renal failure (OR, 84.5), and UTI (OR, 3.6). RCRI had a poor discriminative ability (DA) (area under the curve = 0.623), and American Society of Anesthesiologists status had a fair DA (area under the curve = 0.770) to predict a composite of noncardiac complications. CONCLUSIONS RCRI was predictive of a wide range of noncardiac complications after PLD but had a diminished DA to predict a composite of any noncardiac complication than did American Society of Anesthesiologists score. Consideration of the RCRI as a component of preoperative surgical risk stratification can minimize patient morbidity and mortality after lumbar decompression.
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Affiliation(s)
- Rachel S Bronheim
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric K Oermann
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David S Bronheim
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John M Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Ma L, Liu FY, Huo LS, Zhao ZQ, Sun XZ, Li F, Ding WY. Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11542. [PMID: 30024545 PMCID: PMC6086468 DOI: 10.1097/md.0000000000011542] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Laminoplasty (LP) and laminectomy with fusion (LF) were recognized as two reliable and effective way in treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL). However, there was no clear conclusion on which method is better. A meta-analysis was conducted to evaluate the clinical results between LP and LF in the treatment of multilevel cervical OPLL. METHODS An extensive search of literature was performed in PubMed, Embase, the Cochrane library, CNKI (Chinese database), and WANFANG (Chinese database). The following outcomes were extracted: the Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS), cervical lordosis, cervical range of motion (ROM), complications, blood loss, and operation time. Data analysis was conducted with RevMan 5.3. RESULTS A total of 11 studies were included in the final analysis. The results indicated that no significant differences between LP and LF group in terms of preoperative JOA scores (P = .58), postoperative JOA scores (P = .60), JOA scores improvement rate (P = 0.64), preoperative VAS (P = .34), postoperative VAS (P=.20), preoperative range of motion (ROM) (P = .10), postoperative ROM (P = .18), preoperative cervical lordosis (P = .56), C5 palsy (P = .16), and axial pain (P = .21). LF group showed larger postoperative cervical lordosis than LP group [standardized mean difference (SMD) = 1.13 (2.03, 0.24), P = .01]. However, LP group showed lower operation time [mean difference (MD) = 19.42 (26.87, 11.97), P < .001] and blood loss [MD = 94.78 (179.05, 10.51), P = .03] than LF group. CONCLUSION Both LP and LF can achieve clinical improvement in the treatment of multilevel cervical OPLL. LF was superior to LP in maintaining cervical lordosis. However, LP showed lower surgical trauma than LF. Kyphosis line (K-line) may be a good criterion in the selection of posterior surgery. LP was performed for the patients with K-line (+) and LF for K-line (-).
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Affiliation(s)
- Lei Ma
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
| | - Feng-Yu Liu
- Department of Spine Surgery, The Third Hospital of Shijiazhang
| | - Li-Shuang Huo
- Department of Endocrinology, The First Hospital of Shijiazhang
| | - Zheng-Qi Zhao
- Department of Spine Surgery, The Third Hospital of Shijiazhang
| | - Xian-Ze Sun
- Department of Spine Surgery, The Third Hospital of Shijiazhang
| | - Feng Li
- Department of Spine Surgery, The Third Hospital of Shijiazhang
| | - Wen-Yuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
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Puentes S, Kadone H, Kubota S, Abe T, Shimizu Y, Marushima A, Sankai Y, Yamazaki M, Suzuki K. Reshaping of Gait Coordination by Robotic Intervention in Myelopathy Patients After Surgery. Front Neurosci 2018; 12:99. [PMID: 29551960 PMCID: PMC5840280 DOI: 10.3389/fnins.2018.00099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/08/2018] [Indexed: 11/13/2022] Open
Abstract
The Ossification of the Posterior Longitudinal Ligament (OPLL) is an idiopathic degenerative spinal disease which may cause motor deficit. For patients presenting myelopathy or severe stenosis, surgical decompression is the treatment of choice; however, despite adequate decompression residual motor impairment is found in some cases. After surgery, there is no therapeutic approach available for this population. The Hybrid Assistive Limb® (HAL) robot suit is a unique powered exoskeleton designed to predict, support, and enhance the lower extremities performance of patients using their own bioelectric signals. This approach has been used for spinal cord injury and stroke patients where the walking performance improved. However, there is no available data about gait kinematics evaluation after HAL therapy. Here we analyze the effect of HAL therapy in OPLL patients in acute and chronic stages after decompression surgery. We found that HAL therapy improved the walking performance for both groups. Interestingly, kinematics evaluation by the analysis of the elevation angles of the thigh, shank, and foot by using a principal component analysis showed that planar covariation, plane orientation, and movement range evaluation improved for acute patients suggesting an improvement in gait coordination. Being the first study performing kinematics analysis after HAL therapy, our results suggest that HAL improved the gait coordination of acute patients by supporting the relearning process and therefore reshaping their gait pattern.
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Affiliation(s)
- Sandra Puentes
- Faculty of Engineering, Information and Systems, University of Tsukuba, Ibaraki, Japan.,Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
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Rustagi T, Alonso F, Schmidt C, Oskouian RJ, Chapman JR, Tubbs RS, Fisahn C. Rapid Progression of Ossification of the Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion. World Neurosurg 2017; 110:11-16. [PMID: 29107718 DOI: 10.1016/j.wneu.2017.10.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ossification of the posterior longitudinal ligament (OPLL) has a reported incidence of 1.9%-4.3%. Disease progression is associated with surgery, with most studies focusing on OPLL progression after laminoplasty. The continued range of motion following surgery is believed to place strain on adjacent levels, driving calcification of the ligament. We present a case of marked progression of OPLL at levels adjacent to a previous anterior cervical discectomy and fusion. CASE REPORT A 59-year-old man initially presented for progressive loss of balance and dexterity and underwent a C4-6 anterior cervical discectomy and fusion procedure. Computed tomography performed 1 year postoperatively showed fusion across C4-6 with no evidence of OPLL at any level. Two years following index surgery, the patient reported right-side arm pain. Computed tomography revealed new minimal OPLL opposite the C3-4 level that was not causing cord compression. A sparing midline bilateral C3-7 laminotomy was performed to correct stenosis seen on magnetic resonance imaging. At 7 years after the index procedure, the patient presented with myelopathic symptoms exceeding symptoms at his index presentation. Computed tomography revealed marked progression of OPLL. The patient underwent C2-T2 posterior fusion with laminectomy from C2-C7 and responded well with gradual improvements in balance and arm pain after surgery. CONCLUSIONS Our report demonstrates that OPLL progression, which is largely reported following laminoplasty, may similarly occur following anterior cervical discectomy and fusion and supports the concept of motion-related OPLL progression.
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Affiliation(s)
- Tarush Rustagi
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Department of Spine Surgery, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
| | - Fernando Alonso
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Cameron Schmidt
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA.
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Christian Fisahn
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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Odate S, Shikata J, Soeda T, Yamamura S, Kawaguchi S. Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament. J Neurosurg Spine 2017; 26:466-473. [DOI: 10.3171/2016.9.spine16430] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL. After posterior surgery, some patients require revision surgery because of late neurological deterioration due to kyphotic changes in cervical alignment or OPLL progression. Here, the authors retrospectively investigated the surgical results and complications of revision ACDF after initial posterior surgery for OPLL.
METHODS
This was a single-center, retrospective study. Between 2006 and 2013, 19 consecutive patients with cervical OPLL who underwent revision ACDF at the authors' institution after initial posterior surgery were evaluated. The mean age at the time of revision ACDF was 66 ± 7 years (± SD; range 53–78 years). The mean interval between initial posterior surgery and revision ACDF was 63 ± 53 months (range 3–235 months).
RESULTS
The mean follow-up period after revision ACDF was 41 ± 26 months (range 24–108 months). Before revision ACDF, the mean maximum thickness of the ossified posterior longitudinal ligament was 7.2 ± 1.5 mm (range 5–10 mm), and the mean C2–7 angle was 1.3° ± 14° (range −40° to 24°). The K-line was plus (OPLL did not exceed the K-line) in 8 patients and minus in 11 (OPLL exceeded the K-line). The mean Japanese Orthopaedic Association score improved from 10 ± 3 (range 3–15) before revision ACDF to 11 ± 4 (range 4–15) at the last follow-up, and the mean improvement rate was 18% ± 18% (range 0%–60%). A total of 16 surgery-related complications developed in 12 patients (63%). The main complication was an intraoperative CSF leak in 8 patients (42%). Neurological function worsened in 5 patients (26%). The deterioration was due to spinal cord herniation through a defective dura mater in 1 patient, unidentified in 1 patient, and C-5 palsy that gradually recovered in 3 patients. Reintubation, delirium, and hoarseness were observed in 1 patient each (5%). No patient required reoperation for reconstruction failure, and all patients eventually had a solid bony fusion.
CONCLUSIONS
ACDF as revision surgery after initial posterior surgery for cervical myelopathy due to OPLL is associated with a high incidence of intraoperative CSF leakage and an extremely low improvement rate. The authors think that while the use of revision ACDF must be limited, it is indispensable in special cases, such as progressing myelopathy following posterior surgery due to a very large beak-type OPLL that exceeds the K-line. Postoperative OPLL progression and/or kyphotic changes can possibly cause later neurological deterioration. Fusion should be recommended at the initial surgery for many cases of cervical OPLL to prevent such a challenging revision surgery.
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