Indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine: is it possible to predict the surgical results?
Yukihiro MatsuyamaYoshihito SakaiYoshito KatayamaShiro ImagamaZenya ItoNorimitsu WakaoYasutsugu YukawaKeigo ItoMitsuhiro KamiyaTokumi KanemuraKoji SatoNaoki Ishiguro
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Keywords:
Posterior longitudinal ligament
Kyphosis
Laminoplasty
Objective
To observe the clinical efficacy of modified laminoplasty with C3 laminectomy and C7 spinous process retention in the treatment of cervical ossification of the posterior longitudinal ligament(OPLL).
Methods
From Febru-ary 2014 to March 2016, 133 cases of OPLL were admitted, and 42 OPLLs were included according to the inclusion and exclusion criteria. A case-control study was conducted. Twenty-two cases were included in modified group and 20 cases in traditional group. There were 13 males and 9 females in the modified surgery group, and the average age was 56.2±9.75 years (39-77 years).Modi-fied surgery was conducted with C3 laminectomy, C4-C6 laminoplasty, resection at the upper part of the C7 lamina and retaining the C7 spinous process. Meanwhile, there were 12 males and 8 females in the traditional surgery group, with an average age of 53.7±8.23 years (41-75 years). Patients in the traditional surgery group were treated with standard C3-C7 laminoplasty. The mean follow-up was 22.9±4.5 (15-29) months. The JOA, NDI scores of the two groups were recorded preoperatively and postoperatively. The physiological curvature and activity of the cervical spine before and after operation were observed, and the incidence of axonal symptoms and postoperative complications in both groups were recorded.
Results
The follow-up period was 15-28 months, with an average of (23.2 ± 4.8) months. There was no significant difference between the base line of two groups before operation. At the last follow-up, the JOA and NDI scores of the two groups were significantly improved. There was no difference of JOA scores be-tween the two groups at the last follow-up, while the NDI sores at the modified group(6.56±4.78) was superior to the traditional group(9.25±7.63). The VAS score at the first day after surgery in modified group was lower than that of the traditional group. The average cervical curvature of the patients in the modified surgery group and the standard surgery group were 12.32°±8.26° and 11.56°±8.05°, respectively. There was no significant difference between the two groups. The postoperative range of movement (ROM) of cervical spine was 39.68°±9.52° in modified group and 33.51°±10.39° in traditional group(P<0.05). Eight patients (19%) had augmentation of axial symptoms, including 3 patients in the modified surgery group(13.6%) and 5 patients in the stan-dard surgery group (30%). There was no significant difference between the two groups. During the follow-up period, there were no complications such as cerebrospinal fluid leakage, spinal cord injury, wound infection, laminar collapse, postoperative closure, in-ternal fixation loss or fracture.
Conclusion
The modified laminectomy with C3 laminectomy and C7 spinous process retentionis minimally invasive, whichachieved satisfactory decompression effect, reduced the incidence of postoperative axial symptoms and maintained the cervical ROM.
Key words:
Cervical vertebrae; Ossification of posterior longitudinal ligament; Decompression, surgical
Laminoplasty
Posterior longitudinal ligament
Spinous process
Cervical spondylosis
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Laminoplasty
Expansive
Posterior longitudinal ligament
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Study Design: Alignment of the cervical spine (C2 to C7 angle) after open-door laminoplasty, with the posterior cervical ligamentous complex and the insertion of an extensor reattach, was investigated retrospectively in patients with ossification of the posterior longitudinal ligament (OPLL) with disease extent reaching the epistropheus. Objective: Methods of posterior decompression and extensor reconstruction in the treatment of OPLL with disease extent reaching the epistropheus have been investigated in this paper. Methods: In 10 cases of OPLL with disease extent reaching C2, in which posterior cervical ligamentous complexes are retained, the C2 attachment point of the extensor was reattached and open-door cervical laminoplasty was performed, with the decompression range of laminoplasty being C2-C7. The average follow-up period was 14 months. Observation: The C2 effective vertebral canal sagittal diameter before and after surgery was determined using computed tomography in order to observe the decompression degree; the C2-C7 angle before and after the surgery was measured using an x-ray, and maintenance of the physiological curve was then observed; JOA scoring was carried out before and after the operation and during follow-up. Results: The average effective vertebral canal sagittal diameter before the surgery was 5.6 mm (4 to 8.8 mm), whereas that after the surgery was 13.4 mm (10 to 18.2 mm) (P<0.01, compared with that before the operation); the C2-C7 angle of the neutral position was 6.5 degrees (−2 to 12 degrees), whereas that after surgery was 7.4 degrees (3 to 14 degrees) and that during the last follow-up was 7.0 degrees (2 to 15 degrees) (P>0.05, compared with that before the operation); the JOA score before the surgery was between 6 and 12 with an average of 9.6, whereas that after the surgery was between 8 and 14 with an average of 10.9 and that during the last follow-up was between 10 and 17 with an average of 13.2 (P<0.05, compared with that before the operation). Conclusions: The open-door cervical laminoplasty in which posterior cervical ligamentous complexes are retained and the attachment point of extensor muscles is reconstructed is applicable to OPLL with disease extent reaching the epistropheus, and the objective of complete decompression and the maintenance of physiological curve of cervical vertebra can be achieved.
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Posterior longitudinal ligament
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Background: Cervical spondyloticmyelopathy is a degenerative disease of the intervertebral disc and vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. The rationale of this study is to analyze the myelomalacia and the ossification of posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty by Open-door or French-door techniques.
Methods and Findings: We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-square test to analyze prognostic factors for patientsâ postoperative evolution in the Nurick scale, after Opendoor or French-door laminoplasty. The comparison between pre and postoperative showed an improvement of 71.43% of cases that did not have ligament ossification compared to 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% improvement in those with myelomalacia.
Conclusion: There is a need for further studies with larger samples to expressively buy soma usa prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors of worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.
Laminoplasty
Posterior longitudinal ligament
Spinal cord compression
Spinal canal stenosis
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Laminoplasty
Spinal Deformity
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Posterior longitudinal ligament ossification is a progressive disease resulting in severe multilevel spinal stenosis with myelopathy. Decompression via anterior or posterior approach is the main treatment option. Decompressive laminoplasty is currently considered the most effective and safest method. This procedure provides favorable outcomes with low trauma and short surgery time. Redo surgeries are rare and most often performed within 2 years after primary laminoplasty. The most common causes are progressive spinal stenosis following posterior longitudinal ligament ossification, insufficient primary decompression and progressive cervical spine kyphosis. Considering few data on redo laminoplasty, we present a patient with progressive ossification of posterior longitudinal ligament who underwent redo surgery at the same level in 10 years after primary laminoplasty.Оссификация задней продольной связки (ОЗПС) — прогрессирующее заболевание, исходом которого является тяжелый многоуровневый спинальный стеноз с миелопатией. Основным методом лечения заболевания является декомпрессия из переднего либо заднего доступа. В настоящее время наиболее эффективным и безопасным способом считается декомпрессивная ляминопластика. Выполнение этого вмешательства позволяет добиться хороших результатов при малой травматичности и продолжительности операции. Ревизионные вмешательства редки, чаще всего проводятся в течение первых двух лет после первичной ляминопластики и связаны либо с прогрессирующим стенозом на фоне ОЗПС, либо с недостаточной декомпрессией во время первичного вмешательства, или с нарастающим кифозом шейного отдела позвоночника. С учетом малого количества информации о ревизионных ляминопластиках, мы представляем случай пациента с прогрессирующей ОЗПС с повторным оперативным вмешательством на том же уровне через 10 лет после первичной ляминопластики.
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Posterior longitudinal ligament
Kyphosis
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Laminectomy was performed on 14 patients with cervical radiculomyelopathy and ossification of the posterior longitudinal ligament (OPLL). Since 1978, simple open-door laminoplasties have been performed on 75 patients. A retrospective study was done to determine if there was any difference between the results of laminectomy and laminoplasty. Overall results of laminectomy were as follows: The preoperative Japanese Orthopaedic Association (JOA) score was 7.0 points and the postoperative score was 15.0 points. Overall results of laminoplasty were as follows: the preoperative JOA score was 7.0 points and the postoperative score was 15.0 points. The percentage improvement in laminectomy was 81.1%, and in laminoplasty was 81.4%. There was no significant difference in the results of these two procedures for the treatment of patients with cervical radiculomyelopathy and OPLL.
Laminoplasty
Posterior longitudinal ligament
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Cervical Ossification of Posterior Longitudinal Ligament Treated by Expansive Open Door Laminoplasty
Objective To discuss suitable surgical approaches and techniques for treating the ossification of posterior longitudinal ligament (OPLL) of cervical spine. Methods 302 cases with OPLL treated by expansive open door laminoplasty were reviewed and analysed. Some relevant imaging examination data, which were taken pre or post operatively, including plain X-ray film, CT scan and MRI were compared. Results The neurological function score of 302 cases increased obviously after operation and the mean rate of improvement of 46%was obtained 2-3 weeks after surgery and a mean rate of improvement of 68%was found at 1-9 years later. Plain X-ray film showed the increase of sagittal diameter of cervical spinal canal and CT scan showed the enlargement of cervical spinal canal while MRI showed the backward movement and decompression of spinal cord. Conclusion Both enlargement of cervical spinal canal and decompression of spinal cord can be obtained by expansive open door laminoplasty. Clinical result was satisfactory following the above mentioned procedure.
Laminoplasty
Expansive
Posterior longitudinal ligament
Spinal cord compression
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Cervical ossification of the posterior longitudinal ligament (OPLL) results in myelopathy. Conservative treatment is usually ineffective, thus, surgical treatment is required. One of the reasons for the poor surgical outcome following laminoplasty for cervical OPLL is kyphosis. In the present study, a 3-dimensional finite element method (3D-FEM) was used to analyze the stress distribution in preoperative, posterior decompression and kyphosis models of OPLL. The 3D-FEM spinal cord model established in this study consisted of gray and white matter, as well as pia mater. For the preoperative model, 30% anterior static compression was applied to OPLL. For the posterior decompression model, the lamina was shifted backwards and for the kyphosis model, the spinal cord was studied at 10, 20, 30, 40 and 50° kyphosis. In the preoperative model, high stress distributions were observed in the spinal cord. In the posterior decompression model, stresses were lower than those observed in the preoperative model. In the kyphosis model, an increase in the angle of kyphosis resulted in augmented stress on the spinal cord. Therefore, the results of the present study indicated that posterior decompression was effective, but stress distribution increased with the progression of kyphosis. In cases where kyphosis progresses following surgery, detailed follow-ups are required in case the symptoms worsen.
Kyphosis
Laminoplasty
Posterior longitudinal ligament
Spinal cord compression
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Laminoplasty
Posterior longitudinal ligament
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Citations (33)