Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament: a retrospective, multi-institutional study

Kimura, Atsushi; Seichi, Atsushi; Hoshino, Yuichi; Yamazaki, Masashi; Mochizuki, Macondo; Aiba, Atsuomi; Kato, Tsuyoshi; Uchida, Kenzo; Miyamoto, Kei; Nakahara, Shiro; Taniguchi, Shinichirou; Neo, Masashi; Taguchi, Toshihiko; Endo, Kenji; Watanabe, Masahiko; Takahashi, Masahito; Kaito, Takashi; Chikuda, Hirotaka; Fujimori, Takahito; Ito, Takui; Ono, Atsushi; Abumi, Kuniyoshi; Yamada, Kei; Nakagawa, Yukihiro; Toyama, Yoshiaki

doi:10.1007/s00776-012-0271-3

Cited by 44 publications

(37 citation statements)

References 14 publications

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“…26,34,41 The sample used in the studies by Hasegawa et al and Kaneyama et al consisted of surgical patients with various forms of degenerative cervical myelopathy, including CSM, OPLL, and cervical disc herniation (CDH). Both studies found that patients with OPLL as the primary diagnosis were at a markedly higher risk of experiencing upper extremity palsy than those with other forms of degenerative myelopathy (Hasegawa et al,OR 19.0, p < 0.0001; Kaneyama et al, OR 43.8, p < 0.05).…”

Section: Results Of Individualmentioning

confidence: 99%

“…Of these studies, only 9 (3 prospective, 6 retrospective) conducted a multivariate analysis and controlled for potential confounding variables. 3,13,19,21,26,34,36,37,41 Sample sizes ranged from 81 to 58,118 surgical patients, with mean ages between 57 and 64.1 years. All patients were diagnosed with some form of degenerative cervical myelopathy, with the majority presenting with either CSM or OPLL.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All patients were diagnosed with some form of degenerative cervical myelopathy, with the majority presenting with either CSM or OPLL. The main outcome was postoperative complications in 4 studies, 3,13,19,21 C-5 or upper extremity palsy in 3, 26,34,41 major intraoperative blood loss in 1, 37 and axial pain in 1. 36 As indicated by Table 2, several clinical, imaging, and surgical predictors were evaluated in these studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

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A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Tetreault

Ibrahim

Côté

et al. 2016

SPI

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OBJECT Although generally safe and effective, surgery for the treatment of cervical spondylotic myelopathy (CSM) is associated with complications in 11%–38% of patients. Several predictors of postoperative complications have been proposed but few are used to detect high-risk patients. A standard approach to identifying “at-risk” patients would improve surgeons’ ability to prevent and manage these complications. The authors aimed to compare the complication rates between various surgical procedures used to treat CSM and to identify patient-specific, clinical, imaging, and surgical predictors of complications. METHODS The authors conducted a systematic review of the literature and searched MEDLINE, MEDLINE in Process, EMBASE, and Cochrane Central Register of Controlled Trials from 1948 to September 2013. Cohort studies designed to evaluate predictors of complications and intervention studies conducted to compare different surgical approaches were included. Each article was critically appraised independently by 2 reviewers, and the evidence was synthesized according to the principles outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS A total of 5472 citations were retrieved. Of those, 60 studies met the inclusion criteria and were included in the review. These studies included 36 prognostic cohort studies and 28 comparative intervention studies. High evidence suggests that older patients are at a greater risk of perioperative complications. Based on low evidence, other clinical factors such as body mass index, smoking status, duration of symptoms, and baseline severity score, are not predictive of complications. With respect to surgical factors, low to moderate evidence suggests that estimated blood loss, surgical approach, and number of levels do not affect rates of complications. A longer operative duration (moderate evidence), however, is predictive of perioperative complications and a 2-stage surgery is related to an increased risk of major complications (high evidence). In terms of surgical techniques, higher rates of neck pain were found in patients undergoing laminoplasty compared with anterior spinal fusion (moderate evidence). In addition, with respect to laminoplasty techniques, there was a lower incidence of C-5 palsy in laminoplasty with concurrent foraminotomy compared with nonforaminotomy (low evidence). CONCLUSIONS The current review suggests that older patients are at a higher risk of perioperative complications. A longer operative duration and a 2-stage surgery both reflect increased case complexity and can indirectly predict perioperative complications.

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Section: Results Of Individualmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Tetreault

Ibrahim

Côté

et al. 2016

SPI

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“…In a multicenter retrospective study by Kimura et al of 150 patients who underwent ADF for OPLL, upper-and lower-extremity motor deterioration occurred in 13.3% and 2% of patients, respectively. 27 In contrast, in a study by Seichi et al that reported outcomes of 581 patients with OPLL who underwent laminoplasty, postoperative upper-and lower-extremity motor deterioration were reported in only 4% and 3.1% of patients, respectively. 50 In the current study, we found no statistically significant difference in the incidence of total complications in the decompression and fusion and the decompression-only populations.…”

Section: Complications and Revision Surgeries In Patients Who Underwementioning

confidence: 91%

“…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%

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.

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Corpectomy: Floating Method for OPLL

Yoshii

Yuasa

Okawa

2019

Cervical Spine Surgery: Standard and Advanced Techniques

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Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament: a retrospective, multi-institutional study

Cited by 44 publications

References 14 publications

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

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

Corpectomy: Floating Method for OPLL

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