Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a ≥50% canal occupying ratio: a multicenter retrospective study

Yoshii, Toshitaka; Sakai, Kenichiro; Hirai, Takashi; Yamada, Takatsugu; Inose, Hiroyuki; Kato, Tsuyoshi; Enomoto, Mitsuhiro; Tomizawa, Shoji; Kawabata, Shigenori; Arai, Yoshiyasu; Okawa, Atsushi

doi:10.1016/j.spinee.2016.07.532

Cited by 64 publications

(77 citation statements)

References 35 publications

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“…Thirty-six studies [20,22–24,27,28,34,35,38,39,42,45,47,48,56,57,60–62,65,66,69–71,73,74,79,81,82,84–86,88,90,91,116] containing 129 patients with CSF of 5007 patients after cervical surgery were included. Figure 15 shows that the incidence was 1.9% (95% CI 1.3%–2.4%), with substantial heterogeneity of incidence observed.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

et al. 2017

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Purpose:We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan.Methods:An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3.Results:A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%–22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%–6.2%), 1.9% (95% CI 1.3%–2.4%), 2.8% (95% CI 1.7%–4.0%), 15.6% (95% CI 11.7%–19.5%), 16.8% (95% CI 13.6%–19.9%), 4.0% (95% CI 2.3%–5.7%), 2.6% (95% CI 0.2%–4.9%), 3.7% (95% CI 2.0%–5.5%), 3.4% (95% CI 2.0%–4.8%), 1.1% (95% CI 0.7%–1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%).Conclusions:Based on our meta-analysis, patients with OPLL have a higher incidence of C5 palsy and CSF. Patients after LF have a higher incidence of C5 palsy, ACCDF have a higher incidence of dysphagia, ACCF have a higher incidence of CSF and infection and ACDF have a higher incidence of hoarseness. These figures may be useful in the estimation of the probability of complications following cervical surgery.

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Section: Resultsmentioning

confidence: 99%

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

et al. 2017

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“…Although researchers have investigated several issues related to ossification, including prevalence [1][2][3] , distribution of the ossified lesions [1][2][3][4][5][6] , and neurologic outcomes after surgical treatment [7][8][9][10] , there has been no study documenting in detail the subjective symptoms and self-reported ability to perform activities of daily living (ADL) in patients with OPLL. The aims of this study were to investigate the relationship between severity of pain and neurologic status in patients with OPLL and to identify whether there are any specific clinical symptoms in patients with cervical OPLL that are not present in those with cervical spondylosis (CS), which often leads to myelopathy similar to that occurring in cervical OPLL.…”

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confidence: 99%

Clinical characteristics in patients with ossification of the posterior longitudinal ligament: A prospective multi-institutional cross-sectional study

Hirai

Yoshii

Ushio

et al. 2020

Sci Rep

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Ossification of the posterior longitudinal ligament (OPLL) can occur throughout the entire spine and can sometimes lead to spinal disorder. Although patients with OPLL sometimes develop physical limitations because of pain, the characteristics of pain and effects on activities of daily living (ADL) have not been precisely evaluated in OPLL patients. Therefore, we conducted a multi-center prospective study to assess whether the symptoms of cervical OPLL are different from those of cervical spondylosis (CS). A total of 263 patients with a diagnosis of cervical OPLL and 50 patients with a diagnosis of CS were enrolled and provided self-reported outcomes, including responses to the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), JOA Back Pain Evaluation Questionnaire (JOABPEQ), visual analog scale (VAS), and SF-36 scores. The severity of myelopathy was significantly correlated with each domain of the JOACMEQ and JOABPEQ. There was a negative correlation between the VAS score for each domain and the JOA score. There were significantly positive correlations between the JOA score and the Mental Health, Bodily Pain, Physical Functioning, Role Emotional, and Role Physical domains of the SF-36.

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“…Long term of OPLL compression spinal cord in CSM patients lead the nerve tissue is starved of vital nutrients such as oxygen and glucose [35,33,26,34]. Multiple mechanisms of cell damage are activated following spinal ischemia and reperfusion which can be a function of location in the spine as well as the time elapsed since the onset of ischemia [30,3,27,36,32].…”

Section: Discussionmentioning

confidence: 99%

C5 palsy in the treatment of cervical spondylosis myelopathy with ossification of the posterior longitudinal ligament

Yan¹,

Zhang²,

Zhang³

2020

Preprint

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Background There are many factors that affect the C5 palsy in the treatment of cervical spondylosis myelopathy (CSM) with ossification of the posterior longitudinal ligament (OPLL), but the spinal compression degrees may be an important factor in affection on it. Objective The purpose of this study was to evaluate the effect of spinal cord compression degrees on the clinical outcomes of OPLL patients which been treated by anterior and posterior surgery. Methods From May 2010 to October 2017, 145 patients cervical spondylosis myelopathy with OPLL (spinal canal narrowing by the OPLL exceeded 30%) were enrolled in this study; 76 patients received anterior cervical corpectomy and fusion surgery (ACCF), and 69 patients had posterior cervical decompression and laminoplasty procedures (PCDL). The clinical outcomes of pain relief (visual analog scale, VAS), functional disability (neck disability index, NDI) were recorded at baseline and at the final follow-up. Results There were five patients with C5 palsy in this series cases (two in ACCF and three in PCDL), and the rate is 4.1% (3.2% in ACCF and 5.2% in PCDL, P > 0.05). Five C5 palsy cases had more than 50% compressed degrees of dural sac and flattened spinal cord, and the compressed dural sac and flattened spinal cord had totally expansion after operation. There were no patients resented with CSF leakage in PCDL group, and six patients presented with CSF leakage in ACCF. The mean postoperative canal diameter were significant better than preoperative in PDL patients (P < 0.01). The average spinal sagittal and axial compressive ratio were significantly decreased from preoperative in ACR and PDL groups (P < 0.01). The mean cervical ROM values were decreased in ACR and PDL groups (P< 0.05). Conclusions Based on the results of this study, anterior and posterior surgery was effective and safe in the treatment of the OPLL patients. The complication of C5 palsy were no related in the surgery methods, but may be related the degrees of spinal cord compressed.

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Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a ≥50% canal occupying ratio: a multicenter retrospective study

Cited by 64 publications

References 35 publications

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

Clinical characteristics in patients with ossification of the posterior longitudinal ligament: A prospective multi-institutional cross-sectional study

C5 palsy in the treatment of cervical spondylosis myelopathy with ossification of the posterior longitudinal ligament

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