Cervical ossification of the posterior longitudinal ligament: factors affecting the effect of posterior decompression

Nishida, Norihiro; Kanchiku, Tsukasa; Kato, Yoshihiro; Imajo, Yasuaki; Suzuki, Hitomi; Yoshida, Yuichiro; Ohgi, Junji; Chen, Xian; Taguchi, Toshihiko

doi:10.1080/10790268.2016.1140392

Cited by 14 publications

(8 citation statements)

References 29 publications

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“…It has been reported before, based on tensile tests conducted on the white and gray matter of YBSC that the gray matter of the cervical spinal cord was more rigid and fragile than the white matter. ( 2 ) A possible pathogenesis of CSM based on this FEM analyses has also been proposed ( 6 , 11 – 16 ). Although the analyses appeared to support other clinical reports, the study focused only on one physical property.…”

Section: Discussionmentioning

confidence: 92%

Age‑related changes of the spinal cord: A biomechanical study

et al. 2018

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Although it is known that aging plays an important role in the incidence and progression of cervical spondylotic myelopathy (CSM), the underlying mechanism is unclear. Studies that used fresh bovine cervical spinal cord report the gray matter of the cervical spinal cord as being more rigid and fragile than the white matter. However, there are no reports regarding the association between aging an tensile and Finite Element Method (FEM). Therefore, FEM was used based on the data pertaining to the mechanical features of older bovine cervical spinal cord to explain the pathogenesis of CSM in elderly patients. Tensile tests were conducted for white and gray matter separately in young and old bovine cervical spinal cords, and compared with their respective mechanical features. Based on the data obtained, FEM analysis was further performed, which included static and dynamic factors to describe the internal stress distribution changes of the spinal cord. These results demonstrated that the mechanical strength of young bovine spinal cords is different from that of old bovine spinal cords. The gray matter of the older spinal cord was significantly softer and more resistant to rupture compared with that of younger spinal cords (P<0.05). Among the old, although the gray matter was more fragile than the white matter, it was similar to the white matter in terms of its rigidity (P<0.05). The in vitro data were subjected to three compression patterns. The FEM analysis demonstrated that the stress level rises higher in the old spinal cords in response to similar compression, when compared with young spinal cords. These results demonstrate that in analyzing the response of the spinal cord to compression, the age of patients is an important factor to be considered, in addition to the degree of compression, compression speed and parts of the spinal cord compression factor.

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Section: Discussionmentioning

confidence: 92%

Age‑related changes of the spinal cord: A biomechanical study

et al. 2018

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“…3,4 Laminoplasty, one of the widely used posterior procedure, has been reported effective and safe when dealing with multilevel OPLL. However, the clinical outcomes of laminoplasty are not satisfactory for cases with K-line negative or occupying ratio (OR) more than 60% 5 . For severe multilevel OPLL, the posterior approach has the problems of insufficient decompression and limited neural functional recovery, and the anterior approach also confronts the risky operation during decompression and the difficulties of cervical reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Anterior Controllable Antedisplacement and Fusion (ACAF) vs Posterior Laminoplasty for Multilevel Severe Cervical Ossification of the Posterior Longitudinal Ligament: Retrospective Study Based on a Two‐Year Follow‐up

Kong

Luo

Tan

et al. 2021

Orthopaedic Surgery

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Objectives: To compare the clinical outcomes of anterior controllable antedisplacement fusion (ACAF), a new surgical technique, with laminoplasty for the treatment of multilevel severe cervical ossification of the posterior longitudinal ligament (OPLL) based on a 2-year follow-up. Methods: Clinical data of 53 patients (21 by ACAF and 32 by laminoplasty) who have accepted surgery for treatment of cervical myelopathy caused by multilevel severe OPLL (occupying rate ≥ 50%) from March 2015 to March 2017 were retrospectively reviewed and compared between ACAF group and laminoplasty group. Operative time, blood loss, and complications of the two groups were recorded. Radiographic parameters were evaluated pre-and postoperatively: cervical lordosis on X-ray, space available for the cord (SAC) and the occupying ratio (OR) on computed tomography (CT), and the anteroposterior (AP) diameter of the spinal cord at the narrowest level and the spinal cord curvature on magnetic resonance imaging (MRI). Japanese Orthopaedic Association (JOA) scoring was used to evaluate neurologic recovery. Statistical analysis was conducted to analyze the differences between two groups. The Mann-Whitney U test and chi square test were used to compare categorical variables. unpaired t test was used to compare continuous data. Results: All patients were followed up for at least 24 months. The operative time was longer in ACAF group (286.5 vs 178.2 min, P < 0.05). The blood loss showed no significant difference (291.6 vs 318.3 mL, P > 0.05). Less complications were observed in ACAF group than in laminoplasty group (one case [4.7%] of C5 palsy and one case [4.7%] of cerebrospinal fluid [CSF] leakage in ACAF group; four cases [12.5%] of C5 palsy, two cases [6.3%] of CSF leakage, and four cases [12.5%] of axial symptoms in laminoplasty group). The mean JOA score at last follow-up (14.6 vs 12.8, P < 0.05) and the improvement rate (IR) (63.8% vs 47.8%, P < 0.05) in ACAF group were superior to those in laminoplasty group significantly. The postoperative OR (16.7% vs 40.9%, P < 0.05), SAC (150.8 vs 110.5 mm 2 , P < 0.05), AP spinal cord diameter (5.5 vs 4.2 mm, P < 0.05), and cervical lordosis (12.7 vs 4.7 , P < 0.05) were improved more considerably in ACAF group, with significant differences between two groups. Notably, the spinal cord on MRI showed a better curvature in ACAF group. Conclusions: This study showed that ACAF is considered superior to laminoplasty for the treatment of multilevel severe OPLL as anterior direct decompression and better curvature of the spinal cord led to satisfactory neurologic outcomes and low complication rate.

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“…Although there have been reports of finite element analysis of the spine as discussed elsewhere [5, 6], because the facet joints are small, constructing a model of the spine from medical images requires more time than constructing models of the knee and hip joints. However, we have analyzed disorders of the spine, examined the physical properties of the organs that are necessary for simulation, and elucidated the pathology of the disorders through simulation as discussed elsewhere [7, 8]. In recent years, advances in computer technology have led to an increase in reports of analysis of the spine as discussed elsewhere [9–14].…”

Section: Discussionmentioning

confidence: 99%

Finite Element Method Analysis of Compression Fractures on Whole-Spine Models Including the Rib Cage

Nishida

Ohgi

Jiang

et al. 2019

Computational and Mathematical Methods in Medicine

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Spinal compression fractures commonly occur at the thoracolumbar junction. We have previously constructed a 3-dimensional whole-spine model from medical images by using the finite element method (FEM) and then used this model to develop a compression fracture model. However, these models lacked the rib cage. No previous study has used whole-spine models including the rib cage constructed from medical images to analyze compression fractures. Therefore, in this study, we added the rib cage to whole-spine models. We constructed the models, including a normal spine model without the rib cage, a whole-spine model with the rib cage, and whole-spine models with compression fractures, using FEM analysis. Then, we simulated a person falling on the buttocks to perform stress analysis on the models and to examine to what extent the rib cage affects the analysis of compression fractures. The results showed that the intensity of strain and the vertebral body with minimum principle strain differed between the spine model including the rib cage and that excluding the rib cage. The strain on the spine model excluding the rib cage had approximately twice the intensity of the strain on the spine model including the rib cage. Therefore, the rib cage contributed to the stability of the thoracic spine, thus preventing deformation of the upper thoracic spine. However, the presence of the rib cage increased the strain around the site of compression fracture, thus increasing the possibilities of a refracture and fractures of adjacent vertebral bodies. Our study suggests that the analysis using spine models including the rib cage should be considered in future investigations of disorders of the spine and internal fracture fixation. The development of improved models may contribute to the improvement of prognosis and treatment of individual patients with disorders of the spine.

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Cervical ossification of the posterior longitudinal ligament: factors affecting the effect of posterior decompression

Cited by 14 publications

References 29 publications

Age‑related changes of the spinal cord: A biomechanical study

Age‑related changes of the spinal cord: A biomechanical study

Anterior Controllable Antedisplacement and Fusion (ACAF) vs Posterior Laminoplasty for Multilevel Severe Cervical Ossification of the Posterior Longitudinal Ligament: Retrospective Study Based on a Two‐Year Follow‐up

Finite Element Method Analysis of Compression Fractures on Whole-Spine Models Including the Rib Cage

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