Cervical Expansive Laminoplasty versus Laminectomy with Fusion for Cervical Ossification of the Posterior Longitudinal Ligament (OPLL) (original) (raw)
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Medicine, 2018
To investigate factors associated with surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL). This retrospective study included patients (662 males and 251 females; mean age 55.8 years) with symptomatic OPLL. All patients had been diagnosed with OPLL based on cervical magnetic resonance imaging and computed tomography scans. Demographic, surgical outcome was measured using visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scale scores. The results of our study indicated radicular pain was more common in segmental and circumscribe OPLL subtypes (P < 0.05). An anterior approach was favored in patients with less than 3 involved vertebral levels (P < 0.05). All surgical methods showed good outcomes (P < 0.05). Continuous and mixed OPLL subtypes showed worse surgical outcome with higher VAS and JOA scores (P < 0.05). Laminoplasty and anterior cervical discectomy and fusion were significantly associated with a higher recover...
2021
This prospective multicenter study formed by the Japanese Ministry of Health, Labour and Welfare at 27 institutions aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL). Controversy exists regarding the role of instrumented fusion in the context of posterior surgical decompression for OPLL. Among the 479 patients enrolled, 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, patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, and increased signal intensity change on magnetic ...
Frontiers in Surgery, 2022
Objective: Cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) is not uncommon among Asian ethnic groups. Despite reports comparing the pros and cons of anterior-and posterior-only approaches, the optimal management remains debatable. This study aimed to evaluate the outcomes of patients who underwent a combined anterior and posterior approach, simultaneous circumferential decompression and fixation, for cervical OPLL. Method: The study retrospectively reviewed patients with OPLL and who underwent circumferential decompression and fixation, combined anterior corpectomy and posterior laminectomy. The clinical outcomes were evaluated by the Visual Analog Scale of neck and arm pain, the Japanese Orthopedic Association scores, Neck Disability Index, and Nurick scores at each time-point of evaluation. Radiological evaluations included plain and dynamic radiographs and computed tomography for every patient within 2 years post-operation. Subgroup analyses were further performed between the groups, with and without intra-operative cerebrospinal fluid (CSF) leakage. Results: A total of 41 patients completed the follow-up for more than 2 years (mean = 39.8 months) and were analyzed. Continuous-type OPLL was the most common (44%), followed by segmental (27%), mixed (22%), and localized types (7%) in the cohort. Myelopathy and all other functional outcomes improved significantly at 2 years post-operation (all p < 0.05). There were 13 (32%) patients who had intra-operative CSF leakage. At 2 years post-operation, there were no differences in the demographics, functional outcomes, and complication rates between the CSF-leakage and no-leakage groups. The CSF-leakage group had more patients with continuous-type OPLL than the no-leakage group (77 vs. 29%, p = 0.004 < 0.05). During the follow-up, there was no secondary or revision surgery for pseudomeningocele, pseudarthrosis, or other surgery-related complications. Kuo et al. Circumferential Surgery for OPLL Conclusions: Simultaneous circumferential decompression and fixation combine the surgical benefits of sufficient decompression by the posterior approach and direct decompression of OPLL by the anterior approach. It is an effective surgical option for patients with cervical myelopathy caused by OPLL, given that myelopathy unanimously improved without neurological complications in this study. The fusion rates were high, and reoperation rates were low. Despite higher rates of CSF leakage, there were no related long-term sequelae, and minimal wound complications.
Neurology India, 2005
Aims: To determine the surgical approach in patients with multisegmental (four or more segments) OPLL of the cervical spine. Methods and Materials: Data of 27 patients who had undergone either an anterior (corpectomy with excision of OPLL and interbody fusion=14 patients) or posterior approach (laminectomy=12, laminoplasty=1 patient) for the multisegmental cervical OPLL was analyzed retrospectively. The patients in each group were statistically similar in respect to preoperative factors such as age, duration of symptoms, preoperative modified Japanese orthopedic association score, OPLL thickness, effective canal diameter, and antero-posterior cord compression ratio. The clinical outcome was assessed by the Harsh grading system and recovery rate was assessed by Hirabayashi method. Results: There was no statistical difference in the outcome, and recovery rate. Nine patients developed complications after anterior approach in contrast to one after posterior approach. Conclusions: In patients with multisegmental cervical OPLL, there was no significant difference in the short-term recovery rate and outcome between two groups. The immediate postoperative complications were less in patients who had undergone posterior approach. From our analysis, it appears that the posterior approach is probably the preferred method of treatment in a multisegmental OPLL in absence of preoperative kyphosis.
Neurosurgical Focus, 2013
Object There are little data on the effects of plated, or plate-only, open-door laminoplasty on cervical range of motion (ROM), neck pain, and clinical outcomes. The purpose of this study was to compare ROM after a plated laminoplasty in patients with ossification of posterior longitudinal ligament (OPLL) versus those with cervical spondylotic myelopathy (CSM) and to correlate ROM with postoperative neck pain and neurological outcomes. Methods The authors retrospectively compared patients with a diagnosis of cervical stenosis due to either OPLL or CSM who had been treated with plated laminoplasty in the period from 2007 to 2012 at the University of California, San Francisco. Clinical outcomes were measured using the modified Japanese Orthopaedic Association (mJOA) scale and neck visual analog scale (VAS). Radiographic outcomes included assessment of changes in the C2–7 Cobb angle at flexion and extension, ROM at C2–7, and ROM of proximal and distal segments adjacent to the plated la...
Journal of Spine Surgery
Background: The primary purpose of this study was to determine the association between pre-operative cervical sagittal alignment and the extent of cord decompression in the form of increased spinal cord width and cerebrospinal fluid (CSF) space in front of and behind the cord in patients undergoing laminectomy for cervical spondylotic myelopathy (CSM). Secondary objectives included an assessment of the correlation between increasing numbers of levels decompressed and the post-operative cervical spine sagittal alignment, the effect of laminectomy on the change in alignment, as well as effect of laminectomy on pre-existing spinal cord signal abnormality. Methods: This retrospective cohort study included patients who underwent cervical laminectomies, without fusion, between 2015 and 2020. Chart review was used to collect baseline variables. Cervical sagittal alignment, width of the spinal cord, and the CSF space in-front and behind the cord was measured preoperatively and post-operatively using magnetic resonance imaging (MRI) scans for each patient. The correlation between change in measured parameters and pre-operative cervical sagittal alignment was assessed using Spearman's correlation. Results: Thirty-five patients were included. Average age was 65.29±10.98 years old. The majority of patients (80%) underwent laminectomies at 3-4 levels. Average pre-operative sagittal alignment determined by the Cobb angle was 6.05°±14.17°, while the average post-operative Cobb angle was 3.15°±16.64°. The change in Cobb angle was not statistically significant (P=0.998). Eleven patients (32%) had pre-operative kyphotic sagittal alignment. The average time from surgery to post-operative MRI scan was 20.44± 13.18 months (range, 3-39; median, 18.5; IQR, 23.5). There was no statistically significant association between increasing levels of decompression and change in alignment (P=0.546). Cord signal abnormality persisted after decompression. There was a moderate correlation between lordotic pre-operative cervical sagittal alignment and change in space in-front of the cord (correlation coefficient 0.337, P=0.048) and change in cord width (correlation coefficient 0.388, P=0.021). Conclusions: Severity of pre-operative kyphotic sagittal alignment is associated with decreased spinal cord drift and extent of decompression. The pre-operative sagittal alignment is not significantly associated with the change in post-operative alignment. Increasing number of levels decompressed does not worsen a kyphotic cervical spine sagittal alignment.
The spine journal : official journal of the North American Spine Society, 2016
Previous studies have shown that compared with laminoplasty, anterior decompression with fusion (ADF) is superior for postoperative neurologic improvement in patients with massive cervical ossification of the posterior longitudinal ligament (OPLL) with a ≥50% canal occupying ratio. However, it is unknown which method, ADF or posterior decompression with fusion (PDF), is more effective for the treatment of massive OPLL. This study aimed to investigate the surgical outcomes of ADF and PDF for the treatment of massive OPLL. A multicenter retrospective case-control study was carried out. A total of 61 OPLL patients with a ≥50% canal occupying ratio were included in this study. The mean age of the patients was 60.9 years (49 males and 12 females); 39 patients (31 males and 8 females, average age 61.1 years) underwent ADF, and 22 patients underwent PDF (18 males and 4 females, average age 60.6 years). The data collected from both groups included age, gender, neurologic symptoms evaluated ...
Neurosurgical FOCUS, 2011
Object Ossification of the posterior longitudinal ligament (OPLL) is a complex multifactorial disease process combining both metabolic and biomechanical factors. The role for surgical intervention and choice of anterior or posterior approach is controversial. The object of this study was to review the literature and present a single-institution experience with surgical intervention for OPLL. Methods The authors performed a retrospective review of their institutional experience with surgical intervention for cervical OPLL. They also reviewed the English-language literature regarding the epidemiology, pathophysiology, natural history, and surgical intervention for OPLL. Results Review of the literature suggests an improved benefit for anterior decompression and stabilization or posterior decompression and stabilization compared with posterior decompression via laminectomy or laminoplasty. Both anterior and posterior approaches are safe and effective means of decompression of cervical ...
The Professional Medical Journal
… Background and Objectives: To analyze the functional outcome of open door laminoplasty (ODL) for the treatment of Cervical Ossified Posterior Longitudinal Ligament (OPLL). Study Design: Case series study. Setting: Civil Hospital Karachi. Period: 05 years, 2013 to 2017. Material & Methods: 18 patients (15 Male, 3 Female) underwent ODL for cervical OPLL, over a period of 5 years. Pre-operative & post-operative degree of myelopathy was assessed using Nurick grading score. Patients with Nurick grade > 2 were included in study. MRI compatible titanium micro plates & screws were used. Instability was assessed by X-ray Cervical Spine obtained 6 weeks post-operatively. Results: Mean age of presentation was 52 years. 2 to 3 levels were involved in most cases. Mean operative time was 2 hours 30 minutes. Following Nurick grading 94.4% (n=17) improved by grade 1 or more, while in only 5.6% (n=1) it remained same. No instability or kyphotic deformity was seen on follow up X-rays. Conclusion: ODL is a safe & effective procedure for the treatment of multiple level OPLL. It can avoid complications related to the anterior approach (like unintentional durotomy & spinal cord injury) and diminished the possibility of instability & kyphotic deformity associated with laminectomy alone.
Ossification of the posterior longitudinal ligament in the cervical spine
O ssificatiOn of the posterior longitudinal ligament is a condition of abnormal calcification of the posterior longitudinal ligament. The most common location is at the cervical spine region. The spinal cord can be compressed by this lesion, which can cause neurological deficits. The treatment of choice for patients with symptomatic OPLL is surgery to relieve spinal cord compression. However, there are many unresolved controversies concerning OPLL: the exact pathogenesis and natural history of OPLL are still unclear, there is no standard treatment for patients with asymptomatic OPLL, and there is disagreement about the best surgical approach for OPLL surgery. In this study, we review the current literature including the incidence, pathology, pathogenesis, natural history, clinical presentation, classification, radiological evaluation, and management of OPLL. Methods The PubMed databases were searched for publications from January 2000 through August 2010 using the MeSH terms "OPLL" and "ossification of posterior longitudinal ligament." The search was limited to articles in the English language. Related reference sections of recent articles were reviewed and pertinent articles identified. Full-texts manuscripts of all articles were obtained and reviewed. Radiographic images from the senior author's institution are also included. Results Incidence The incidence of OPLL was reported by Tsuyama et al. 126 The incidence is 2.4% in Asian populations and 0.16% in non-Asian populations, with the highest rates in Japan. OPLL is twice as common in men as in women, and symptomatic OPLL usually presents in the 5th to 6th decade of life. Most studies of OPLL are reported from Asian countries, but anecdotal reports of OPLL cases in European countries also exist in the literature. Maiuri et al. 72 reported on 8 Italian patients with cervical spine stenosis due to OPLL.