Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament: considerations for approach selection and review of surgical outcomes (original) (raw)
Related papers
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 ...
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 ...
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...
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.
Asian Journal of Pain, 2018
Objective: The purpose was to comparatively assess cervical sagittal alignment and health-related quality of life (HRQOL) outcomes, between patients who underwent cervical expansive laminoplasty (EL) and those who underwent cervical laminectomy with fusion (LF) for cervical ossification of the posterior longitudinal ligament (OPLL) in more than three levels. Methods: We retrospectively evaluated consecutive patients with cervical OPLL undergoing posterior cervical decompression from 2013-2015. We analyzed radiological measurements (C2-7 sagittal vertical axis [C2-7 SVA], C0-2 angle, C2-7 lordotic angle, T1 slope, and range of motion [ROM]) and clinical outcomes (visual analog scale, neck disability index, Short Form-36, and Japanese Orthopaedic Association scores), preoperatively and at the last follow-up. Results: There were 84 patients (63 men; 21 women). Mean follow-up period was 27.7 months (range: 24-48.8). Compared with preoperative C2-7 SVA, postoperative C2-7 SVA was significantly increased in patients in the LF (13.46 mm) and EL (2.11 mm) groups. Losses of the cervical lordotic angle and ROM were larger in cervical LF patients than in cervical EL patients. The change in the C2-7 SVA was negatively correlated with the change in the C2-7 lordotic angle and positively correlated with changes in the T1 slope and C0-2 angle. Improvements in health-related quality of life were similar between the two groups, except for patient-reported neck pain. Conclusion: Cervical EL and LF were effective surgical techniques to improve the patient-reported outcomes and HRQOL of patients with OPLL in more than three levels. Cervical EL can preserve sagittal alignment and improve clinical results and neck pain, more than cervical LF. Cervical sagittal imbalance after posterior decompression was related to axial neck pain.
Neurospine, 2019
Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an a...
Cervical Ossification of the Posterior Longitudinal Ligament: Anterior or Posterior surgery
2014
Ossification of the posterior longitudinal ligament (OPLL) is a complex multifactorial disease process combining both metabolic and biomechanical factors, most commonly found in men, the elderly and Asian patients. There are many diseases. There are many diseases associated with OPLL, such as diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and other spondyloarthropathies. Several factors have been reported to be associated with OPLL formation and progression, including genetic, hormonal, environmental, and lifestyle factors. However, the pathogenesis of OPLL is still unclear. Plain radiography, CT, and MR imaging are used to evaluate OPLL extension and the area of spinal cord compression. Management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be made case by case, depending on the patient's condition, level of pathology, type of OPLL, and the surgeon's experience. I...
Spine, 2012
Study Design. Prospective, comparative clinical study. Objective. To compare the clinical outcome of anterior decompression and fusion with fl oating method and laminoplasty in the treatment of cervical myelopathy caused by ossifi cation of the posterior longitudinal ligament (OPLL). Summary of Background Data. There have been no reports that have accurately and prospectively compared surgical outcomes after anterior decompression and posterior decompression. Methods. For cervical myelopathy caused by OPLL, we performed anterior decompression and fusion with fl oating method (ADF) in
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.