Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament

Ma, Lei; Liu, Fengyu; Huo, Li-Shuang; Zhao, Zheng-Qi; Sun, Xian-Ze; Li, Feng; Ding, Wenyuan

doi:10.1097/md.0000000000011542

Cited by 52 publications

(63 citation statements)

References 27 publications

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“…One prospective nonrandomized study of 252 patients with multilevel cervical OPLL treated with either ACDF/ACCF or LAMP found overall complication rates as high as 41.33% in the anterior group and 50.98% in the LAMP cohort [27]. A recent meta-analysis comparing LF and LAMP procedures found the two to be equivocal in both clinical outcomes and surgical complications [39]. The clinical outcomes following traditional anterior and posterior approaches were adequate with patients demonstrating significant neurologic improvement with both approaches, but the greater risk for complications with these traditional approaches has sparked new considerations for patients with multilevel OPLL.…”

Section: Discussionmentioning

confidence: 99%

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

et al. 2019

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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 anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.

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Section: Discussionmentioning

confidence: 99%

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

et al. 2019

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“…2 ) or laminectomy with fusion [ 44 ]. Laminectomy with fusion has been shown to maintain cervical lordosis better [ 45 ] and may slow the progression of OPLL [ 46 ]. However, there are far fewer comparative studies for cervical OPLL management as compared to CSM.…”

Section: Anterior Vs Posterior Approachmentioning

confidence: 99%

Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches

Kwok

2020

BMC Musculoskelet Disord

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Background The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. Main body of the abstract A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives. Conclusion From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.

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“…Compared with traditional laminectomy, cervical laminoplasty is a well-established treatment for patients with cervical OPLL because it is associated with a low complication rate, good clinical outcomes and a high level of safety. Many clinical investigations have demonstrated satisfactory neurologic improvement following cervical laminoplasty in OPLL patients [2].…”

Section: Introductionmentioning

confidence: 99%

The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients

Zhang

Dong

et al. 2020

The Spine Journal

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BACKGROUND CONTEXT: Laminoplasty is a common surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although laminoplasty is preferred over traditional laminectomy, the factors affecting the complications and outcomes are unclear. Recently, sagittal balance indexes have been revealed to be predictors of clinical outcomes in patients with cervical degenerative diseases, but their relationships with laminoplasty-treated OPLL outcomes remains unknown. PURPOSE: The purpose of this study is to evaluate the relationship of preoperative cervical sagittal balance indexes and clinical outcome in laminoplasty treated OPLL patients. STUDY DESIGN: This is a retrospective case study. PATIENT POPULATION: Between January 2015 and January 2017, 181 consecutively included patients who underwent cervical laminoplasty for OPLL were enrolled (male:female ratio=126:75; mean age=60.2 years). Cervical spine lateral radiographs in neutral, flexion, and extension positions were taken before and 2 years after the surgery. OUTCOME MEASURES: The C2−C7 Cobb angle, T1 slope, C1−C7 sagittal vertical axis (SVA), C2−C7 SVA, CGH (center of gravity of the head)-C7 SVA, cervical JOA (Japanese Orthopedic Association) score, and neck VAS (visual analogue scale) score were measured preoperatively and postoperatively at the 2-year follow-up. METHODS: The patients were divided into two groups according to changes in the lordotic angle or the recovery rate of the JOA score. The relationships between the postoperative lordosis loss or the clinical outcome and the preoperative variables, including the patient's age, JOA score, C2-C7 Cobb angle, T1 slope, C1-C7 SVA, C2-C7 SVA, and CGH-C7 SVA, were investigated. RESULTS: The patients were divided into two groups according to the postoperative change in the C2-C7 Cobb angle. There were no differences in the age, preoperative C2-C7 Cobb angle, C1-C7 SVA, or C2-C7 SVA; there was only a difference in the preoperative CGH-C7 SVA and T1 slope level (p=.038, p=.042). The postoperative JOA and JOA recovery rate were related to the postoperative lordosis loss in cervical alignment (p=.048, p=.031). We again divided the patients into two groups according to the JOA recovery rate and found that only the preoperative CGH-C7 SVA and FSA device/drug status: Not applicable.

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Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament

Cited by 52 publications

References 27 publications

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches

The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients

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