Five-year Follow-up Evaluation of Surgical Treatment for Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament

Sakai, Kenichiro; Okawa, Atsushi; Takahashi, Makoto; Arai, Yoshiyasu; Kawabata, Shigenori; Enomoto, Mitsuhiro; Kato, Tsuyoshi; Hirai, Takashi; Shinomiya, Kenichi

doi:10.1097/brs.0b013e31821f4a51

Cited by 176 publications

(162 citation statements)

References 22 publications

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“…24,31,36,44,48 There were a total of 5 cases of OPLL progression among a total of 1222 patients (0.41%) in the decompression and fusion population and a total of 48 cases of OPLL progression among a total of 745 patients (6.4%) in the posterior decompression-only population.…”

Section: Progression Of Opllmentioning

confidence: 99%

“…5,8,10,14,25,27,35,44,46,48,50,52 Some of the most commonly reported complications after cervical decompression and fusion surgery include CSF leaks and pseudarthrosis, whereas posterior decompression is more commonly associated with neurological deterioration, persistent neuropathic pain in the extremities, and progression of kyphotic change. 6,14 Previous studies have demonstrated an increased incidence of complications after decompression and fusion compared with decompression only.…”

Section: Complications and Revision Surgeries In Patients Who Underwementioning

confidence: 99%

“…There were 10 studies that contained both decompression and fusion and decompression-only patient populations. 2,6,7,14,16,20,23,25,48,59 Three studies in the fusion category contained patient populations that underwent either ADF or PDF. 6,7,31 The total sample size for patients who received ADF or PDF or who received decompression only was 1222 and 745, respectively.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Surgical decompression and stabilization via cervical fusion is widely accepted as the optimal treatment for patients with cervical radiculopathy or myelopathy caused by OPLL. 21,34 Although anterior decompression and fusion (ADF) is associated with better maintenance of cervical lordosis, 38,48 it is also associated with higher rates of dysphagia and dural tears. 39 It is also a more technically difficult procedure than a decompression alone.…”

mentioning

confidence: 99%

“…To date, several studies have compared outcomes of ADF or PDF versus decompression alone in patients with OPLL and associated cervical myelopathy, with a variety of outcomes measures and results. 6,7,14,16,20,25,32,44,48,59 In the current study, we provide a systematic review of the literature and a meta-analysis of patient outcomes following either ADF or PDF surgery or posterior decompression alone (inclusive of laminectomy and laminoplasty) for OPLL causing cervical myelopathy, to better define outcomes after each procedure. In doing so, we hope to better educate patients and surgeons and to help guide the surgical decision-making process.…”

mentioning

confidence: 99%

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Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis

Mehdi

Alentado

Lee

et al. 2016

FOC

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OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL. METHODS A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I2 values. Forest plots were constructed for each analysis group. RESULTS Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior decompression alone in patients with OPLL. These results indicate that surgical decompression and fusion lead to a faster recovery, improved postoperative neurological functioning, and a lower incidence of OPLL progression compared with posterior decompression only. Furthermore, decompression and fusion did not lead to a greater incidence of complications compared with posterior decompression only.