Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient database

Morishita, Shingo; Yoshii, Toshitaka; Okawa, Atsushi; Fushimi, Kiyohide; Fujiwara, Takeo

doi:10.1016/j.spinee.2018.10.013

Cited by 29 publications

(38 citation statements)

References 39 publications

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“…It is technically less demanding, and can be applied to a broad range of OPLL patients regardless of disease severity or degree of systemic comorbidity. This is reflected in a study by Morishita et al [30], which found that, prior to propensity matching in over 8,000 patients treated surgically for OPLL as identified by the national Japanese Diagnosis Procedure Combination database, those patients undergoing posterior LAMP were significantly older and had significantly higher rates of comorbidities, including malignancy, cardiovascular disease, diabetes, renal failure, and cardiac failure. Additionally, some authors have posited that posterior approaches are generally associated with fewer complications and preserved ROM (e.g., LAMP), while also allowing the decompression of a larger number of segments in multilevel OPLL [18].…”

Section: Discussionmentioning

confidence: 99%

“…According to a 2016 meta-analysis of OPLL surgeries, the incidence of DT was estimated to be as high as 31% for anterior approaches, considerably higher than that of posterior approaches (9.3%; OR, 1.90; 95% CI, 1.08–3.36; p<0.05) [37]. A recent analysis of 1,192 propensity-score matched pairs of patients found the rate of CSF leak to be significantly higher in ADF (2.4%) procedures compared to posterior LAMP (0.4%, p<0.001) [30]. However the results are not entirely uniform, with some studies failing to demonstrate higher rates of DTs and CSF leaks during anterior approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Dysphagia, dysarthria, and hoarseness are well-known complications of anterior cervical procedures, and are related to manipulation and retraction of the esophagus, or direct injury to the recurrent laryngeal nerve. A recent analysis of 1,192 propensity-score matched pairs of patients with OPLL found the rate of dysphagia to be higher in ADF (2.4%) compared to LAMP procedures (0.4%, p<0.001) [30]. Wang et al [58] reported an incidence of dysphagia of 1.4%–58.1% with an average of 16.8% (95% CI, 13.6%–19.9%) across 38 studies of DCM.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Multiple mechanisms of cell damage are activated following spinal ischemia and reperfusion which can be a function of location in the spine as well as the time elapsed since the onset of ischemia [30,3,27,36,32]. Inflammatory responses are known as a major component of secondary injury of initial ischemic insult and play an important role in modulating the pathogenesis of C5 palsy [37,8,24,20]. Effects of reperfusion, also known as reperfusion injury, are the causative factors for spinal edema [38,25,8,18].…”

Section: Discussionmentioning

confidence: 99%

C5 palsy in the treatment of cervical spondylosis myelopathy with ossification of the posterior longitudinal ligament

Yan¹,

Zhang²,

Zhang³

2020

Preprint

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Background There are many factors that affect the C5 palsy in the treatment of cervical spondylosis myelopathy (CSM) with ossification of the posterior longitudinal ligament (OPLL), but the spinal compression degrees may be an important factor in affection on it. Objective The purpose of this study was to evaluate the effect of spinal cord compression degrees on the clinical outcomes of OPLL patients which been treated by anterior and posterior surgery. Methods From May 2010 to October 2017, 145 patients cervical spondylosis myelopathy with OPLL (spinal canal narrowing by the OPLL exceeded 30%) were enrolled in this study; 76 patients received anterior cervical corpectomy and fusion surgery (ACCF), and 69 patients had posterior cervical decompression and laminoplasty procedures (PCDL). The clinical outcomes of pain relief (visual analog scale, VAS), functional disability (neck disability index, NDI) were recorded at baseline and at the final follow-up. Results There were five patients with C5 palsy in this series cases (two in ACCF and three in PCDL), and the rate is 4.1% (3.2% in ACCF and 5.2% in PCDL, P > 0.05). Five C5 palsy cases had more than 50% compressed degrees of dural sac and flattened spinal cord, and the compressed dural sac and flattened spinal cord had totally expansion after operation. There were no patients resented with CSF leakage in PCDL group, and six patients presented with CSF leakage in ACCF. The mean postoperative canal diameter were significant better than preoperative in PDL patients (P < 0.01). The average spinal sagittal and axial compressive ratio were significantly decreased from preoperative in ACR and PDL groups (P < 0.01). The mean cervical ROM values were decreased in ACR and PDL groups (P< 0.05). Conclusions Based on the results of this study, anterior and posterior surgery was effective and safe in the treatment of the OPLL patients. The complication of C5 palsy were no related in the surgery methods, but may be related the degrees of spinal cord compressed.

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“…All 82 academic and voluntary general hospitals in Japan participate in the database [ 14 ]. All patient data in this study were obtained from the multi-institutional DPC database as stated in previous literature [ 15 – 18 ]. This database contains the following items: age, sex, body mass index (BMI), smoking index, admission type, emergency transport, hospital type, ADL scores for admission and discharge by the Ministry of Health, surgical procedure, diagnosis with International Classification of Diseases, Tenth Revision (ICD-10) codes, comorbidities at admission and complications after admission, and in-hospital deaths.…”

Section: Methodsmentioning

confidence: 99%

Risk factors related to perioperative systemic complications and mortality in elderly patients with osteoporotic vertebral fractures—analysis of a large national inpatient database

et al. 2020

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Background The surgical treatment of osteoporotic vertebral fractures (OVF) is generally associated with a high risk of complications due to an aging population with osteoporosis; however, the detailed risk factors for systemic complications and mortality have not been clarified. We evaluated the risk factors for systemic complications and mortality in surgically treated OVF patients using a large national inpatient database. Methods Patients over 65 years old who were diagnosed with OVF and received either anterior fusion (AF) or posterior fusion (PF), from 2012 to 2016, were extracted from the diagnosis procedure combination (DPC) database. In each of the perioperative systemic complications (+) or (−) group, and the in-hospital death (+) or (−) group, we surveyed the various risk factors related to perioperative systemic complications and in-hospital death. Results The significant factors associated with systemic complications were older age (OR 1.38, 95% CI 1.09–1.74), a lower activity of daily living score upon admission (OR 1.52, 95%CI 1.19–1.94), atrial fibrillation (OR 2.14, 95%CI 1.25–3.65), renal failure (OR 2.29, 95%CI 1.25–4.20), and surgical procedure (AF, OR 1.73, 95%CI 1.35–2.22). The significant explanatory variables for in-hospital death were revealed to be male sex (OR 3.26, 95%CI 1.20–8.87), a lower body mass index (OR 3.97, 95%CI 1.23–12.86), unscheduled admission (OR 3.52, 95%CI 1.17–10.63), atrial fibrillation (OR 8.31, 95%CI 2.25–30.70), renal failure (OR 7.15, 95%CI 1.32-38.77), and schizophrenia (OR 8.23, 95%CI 1.66–42.02). Conclusions Atrial fibrillation and renal failure as preoperative comorbidities were common factors between perioperative systemic complications and mortality in elderly patients for OVF.

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Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient database

Cited by 29 publications

References 39 publications

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

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

C5 palsy in the treatment of cervical spondylosis myelopathy with ossification of the posterior longitudinal ligament

Risk factors related to perioperative systemic complications and mortality in elderly patients with osteoporotic vertebral fractures—analysis of a large national inpatient database

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