Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament: considerations for approach selection and review of surgical outcomes

Shin, John H.; Steinmetz, Michael P.; Benzel, Edward C.; Krishnaney, Ajit A.

doi:10.3171/2010.12.focus10270

Cited by 25 publications

(21 citation statements)

References 40 publications

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“…Because cervical spine curvature may be altered by surgery, patients with preoperative instability of the cervical spine and patients presenting with kyphosis are not suitable for posterior surgery. For these patients, posterior fixation is generally necessary to avoid kyphosis progress following posterior surgery [19][20][21], increasing risks to patients.…”

Section: Discussionmentioning

confidence: 99%

Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament

Liu

Chen

et al. 2013

Eur Spine J

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Objective Factors impacting surgical options and outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) were explored. Methods A retrospective analysis was conducted of 127 eligible cervical OPLL patients (61 males, 66 females) aged 41-70 years (mean 55.2 years) selected from 152 total OPLL patients treated from 2002 to 2006, with 5-10-year (mean 6.8 years) follow-up. Patients underwent anterior subtotal corpectomy with ossification ligament resection (anterior surgery, n = 68) or posterior cervical double-door laminoplasty (posterior surgery, n = 59). Radiographic assessments of cervical curvature, T2-weighted MRI (MRIT2) signal, and OPLL occupying ratio were correlated with surgical strategy before surgery and at 1, 5 weeks, and 5 years. Results Lordosis increased following anterior surgery, though kyphosis improved by 10.3 %. The canal stenosis occupying ratio was [50 %, and short-term improvement following anterior surgery was significantly higher than posterior surgery (P [ 0.0001). Superior neurological function was observed in patients with unchanged versus high spinal MRIT2 signals (P = 0.0434). No significant differences were observed in short-term outcomes between anterior and posterior surgeries in high spinal MRIT2 signal patients, but anterior surgery produced significantly better long-term outcomes at 1 week (P = 0.7564) and 1 year (P = 0.0071). Complications occurred in five anterior and three posterior surgeries. Conclusion Preoperative assessment of cervical curvature, MRIT2 signal, and occupying ratio can be used to guide clinical surgical approach selection to potentially produce better long-term outcomes in patients with OPLL.

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Section: Discussionmentioning

confidence: 99%

Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament

Liu

Chen

et al. 2013

Eur Spine J

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“…Fusion or non-fusion spinal cord decompression with anterior or posterior approach can be used as surgical treatment (22,41). Methods of cervical posterior decompression include cervical laminectomy, laminectomy and posterior instrumentation, hemilaminectomy, laminoplasty, and arcocristectomy (2,8,20,42).…”

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confidence: 99%

The comparison of hemilaminectomy and laminoplasty procedures in the surgical treatment of cervical spondylotic myelopathy

Karademir¹,

Küçük²,

Ulutabanca³

et al. 2015

Turkish Neurosurgery

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ABSTRACTously spreads to surrounding bone and soft tissues (11,23). The spinal canal narrows in a circular fashion due to development of a spondylotic bar in the front, uncovertebral joints in the front-side, facet joint hypertrophy, and ligamentum flavum hypertrophy on the rear-side (12,29,37,38). Degenerative altering of one or more segments of the spinal cord and nerve █ INTRODUCTION C ervical spondylosis is a progressive process that is characterized by degeneration of intervertebral discs and loss of the liquid component together with decrease of the intervertebral disc height, resulting in spinal deformation. The degeneration that starts in the intervertebral disc insidiAIm: To compare cervical hemilaminectomy with cervical laminoplasty to determine the prognostic significance of both methods in cervical spondylotic myelopathy (CSM). This study is first in the literature to compare the hemilaminectomy and laminoplasty procedures mATERIAl and mEThODS: A total of 42 patients who underwent surgery due to CSM and followed for at least 24 months were included in the study. Thirty-four out of 42 patients were males, while 8 were females; the mean age of the patients was 63.6 years (range 41-80). The visual analog scale (VAS) was used in the evaluation of postoperative axial neck pain. Factors known to affect prognosis of CSM such as patients' age, gender, duration of symptoms, pressure level, and T2-hyperintense appearance on magnetic resonance imaging (MRI) were evaluated. Patients were compared in terms of sagittal alignment of the vertebrae (instability), anterior-posterior diameter of the spinal canal, transsectional spinal canal area, axial neck pain, and recovery rate based on the preoperative and postoperative Japanase Orthopaedic Association (JOA) scores. RESUlTS:The recovery rate in patients who underwent hemilaminectomy was 60.8%±18.8, while in patients that underwent laminoplasty it was 52.8%±11.9. The comparison of both surgical techniques in terms of postoperative recovery rates did not show any significant difference between the techniques (p>0.05).CONClUSION: There were no significant differences in terms of recovery rate, preoperative and postoperative canal diameter, preoperative and postoperative spinal canal area, and postoperative sagittal alignment (p>0.05). The VAS evaluating axial neck pain was significantly lower in patients from the hemilaminectomy group compared to patients from the laminoplasty group.

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“…However, anterior surgery is plagued by a high risk of neurologic decline, CSF leakage, and pseudarthrosis because spinal cord was severely compressed, and the dura was frequently attached to OPLL. 36 Despite this potential risk, the incidence of complications in patients with OPLL has not been fully established because of the relatively small number of patients included in previous studies. 37 A previous report addressed that paraplegia occurred from 0% to 14.3% after ADF.…”

Section: Discussionmentioning

confidence: 99%

“…The posterior approach provides a relatively simple and safe means to decompressing the entire cervical spinal cord. 10,36 However, patients may experience late deterioration because of pro-gressive kyphosis, and expansion of the ossification, especially in patients with preexisting kyphosis. 36 Some studies reported that neurological recovery following ADF was superior to that following posterior decompression.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An Updated Systematic Review and Meta-Analysis

Kim

Lee

et al. 2019

Neurospine

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Objective: Theoretically, the optimal approach is determined by the status of ossification of the posterior longitudinal ligament (OPLL) and sagittal alignment. However, there have long been disputes about the optimum surgical approach of OPLL. This study is to compare risk-effectiveness between anterior decompression and fusion (ADF) and laminoplasty and laminectomy with fusion (LP/LF) for the patient with cervical myelopathy due to multilevel cervical OPLL. Methods: We searched core databases, and compared complication and outcomes between ADF and LP/LF for patients with multiple OPLL for the cervical spine. The incidence of complications such as neurologic deterioration, C5 palsy, and dura tear was assessed. Changes in JOA score between baseline and final evaluations were assessed for 2 groups. The minimal clinically important difference (MCID) was utilized for evaluating clinical significance. We calculated Peto odds ratio (POR) and mean difference for the incidence and continuous variables, respectively. Results: We included data from 21 articles involving 3,872 patients with cervical myelopathy with OPLL. Major neurologic deficits such as paraplegia, quadriplegia developed 2.17% in the ADF group and 1.11% in the LP/LF group, and POR was 2.16. Mean difference of JOA score improvement of 2 groups was 1.30, and the mean difference showed a statistical significance. However, 1.3 points of JOA improvement cannot reach 2.5 points of the MCID. Conclusion: Anterior surgery often led to rare but critical complications, and the difference of neurological improvement between 2 groups was below a clinically meaningful level. Posterior surgeries may be appropriate in the treatment of multilevel cervical myelopathy with OPLL.

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Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament: considerations for approach selection and review of surgical outcomes

Cited by 25 publications

References 40 publications

Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament

Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament

The comparison of hemilaminectomy and laminoplasty procedures in the surgical treatment of cervical spondylotic myelopathy

The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An Updated Systematic Review and Meta-Analysis

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