Single Stage Circumferential Cervical Surgery (Selective Anterior Cervical Corpectomy with Fusion and Laminoplasty) for Multilevel Ossification of the Posterior Longitudinal Ligament with Spinal Cord Ischemia on MRI

Abstract

Objective : Anterior cervical corpectomy with fusion (ACF) or laminoplasty may be associated with substantial number of complications for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with significant cord compression. For more safe decompression and stabilization in multilevel cervical OPLL with prominent cord compression, we propose circumferential cervical surgery (selective ACF and laminoplasty) based on our favorable experience. Methods : Twelve patients with cervical myelopathy underwent circumferential cervical surgery and all patients showed multilevel OPLL with signal change of the spinal cord on magnetic resonance imaging (MRI). A retrospective review of clinical, radiological, and surgical data was conducted. Results : There were 9 men and 3 women with mean age of 56.7 years and a mean follow up period of 15.6 months. The average corpectomy level was 1.16 and laminoplasty level was 4.58. The average Japanese Orthopedic Association score for recovery was 5.1 points and good clinical results were obtained in 11 patients (92%) (p < 0.05). The average space available for the cord improved from 58.2% to 87.9% and the average Cobb's angle changed from 7.63 to 12.27 at 6 months after operation without failure of fusion (p < 0.05). Average operation time was 8.36 hours, with an estimated blood loss of 760 mL and duration of bed rest of 2.0 days. There were no incidences of significant surgical complications, including wound infection. Conclusion : Although the current study examined a small sample with relatively short-term follow-up periods, our study results demonstrate that circumferential cervical surgery is considered favorable for safety and effectiveness in multilevel OPLL with prominent cord compression. KEY WORDS :Ossification of the posterior longitudinal ligament˙ Anterior cervical corpectomy with fusion˙ Laminoplasty˙ Japanese Orthopedic Association score.

A Systematic Review of Classification Systems for Cervical Ossification of the Posterior Longitudinal Ligament

“…Ten studies used hill, plateau, mushroom, irregular, or round shaped to classify the type of OPLL (Figure 4). 27,47,51-53,76,117,118,129,157 Plateau-shaped ossification is characterized by a relatively narrow spinal canal without any localized massive ossification. 52 In contrast, hill-shaped OPLL appears as a massive beak-shaped ossification localized to certain levels.…”

“…In a study by Otake et al, OPLL was classified into 3 types based on its shape on axial MR images: (1) square with parallel lines tangential to the bilateral margins of the ossified lesion, (2) mushroom with ventrally crossing lines, and (3) hill with dorsally crossing lines. 118 Mushroom shaped was also used to define the type of OPLL in a study by Son et al 129 Finally, Ono et al used mushroom, irregular, and round to categorize the shape of ossification. 117…”

Ossification of the Posterior Longitudinal Ligament: Etiology, Diagnosis, and Outcomes of Nonoperative and Operative Management

“…In a series of 12 patients with multilevel OPLL and spinal cord signal change, multilevel open-door laminoplasty was performed followed by anterior corpectomy at the most stenotic level. 45 The laminoplasty was performed first to allow the spinal cord to drift back and decrease the risk associated with anterior-based decompression. 45 If corpectomy of two or more levels is performed, then a posterior-based instrumentation and fusion should also be performed to minimize the risk of graft or cage complications.…”

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

“…43 Previous researchers also reported that laminoplasty remained as the initial treatment for the surgical treatment of cervical OPLL, and in patients with neurological deterioration and newly developed clinical symptoms during follow-up, ADF is considered as a salvage procedure. 45,46 Our study is restrained by the following limitations. First, like all meta-analyses, the results need to be interpreted acknowledging that surgical outcomes vary based on characteristics of the individual patient such as level of OPLL, occupying ratio, and sagittal alignment.…”