Long-term outcome of laminectomy and instrumented fusion for cervical ossification of the posterior longitudinal ligament

Object Although laminectomy is an effective surgical technique for the treatment of multilevel cervical stenotic lesions, postoperative kyphosis and neurological deterioration have been frequently reported after laminectomy. Hence, laminectomy without fusion is seldom performed nowadays. However, the clinical impression from the long-term follow-up of patients who had undergone laminectomy does not support that postoperative kyphosis is common in patients with ossification of the posterior longitudinal ligament (OPLL). In this paper, the authors assessed the long-term outcome of laminectomy for cervical OPLL in terms of the changes in the cervical curvature and in the neurological status. Methods The authors retrospectively reviewed medical records and radiological images in patients who had undergone cervical laminectomy between 1999 and 2009. The preoperative and the final follow-up status recovery rate were assessed using the Japanese Orthopaedic Association (JOA) scale. The cervical global angle and range of motion (ROM) were measured preoperatively and at the last follow-up. The cervical spine was classified into 3 types: lordotic, straight, and kyphotic. Results A total of 34 patients were available for medical record review and telephone interviews. There were 28 men and 6 women, whose mean age at the time of surgery was 57.8 years. The mean follow-up period was 57.5 months. The mean preoperative JOA score was 10.7, and the JOA score at the last follow-up was significantly improved to 14.3 (p < 0.001) with a recovery rate of 56.3%. The JOA score at each postoperative follow-up point increased until 6 years postoperatively; thereafter, it gradually decreased. The mean preoperative global angle was −11.3° and the most recent global angle was −8.4°. The preoperative ROM was 33.9° and the most recent ROM was 27.4°. There was no statistical significance in the change of cervical curvature or ROM. Preoperatively, 29 of the 34 patients had a lordotic cervical curvature and 5 patients had a straight spine. At last follow-up, 24 patients had a lordotic curvature, 3 patients changed from lordosis to kyphosis, and 7 patients had a straight spine. One patient whose cervical curvature changed from lordosis to kyphosis during the follow-up period underwent cervical fusion 9 years after the laminectomy procedure. Conclusions The long-term outcome of laminectomy for cervical OPLL is satisfactory in terms of the clinical and radiological aspects. The risk of postlaminectomy kyphosis was not high, raising the possibility that the OPLL itself may serve as a support for the spinal column.

Download Full-text

Long-term Outcome of Anterior Cervical Decompression With Fusion for Cervical Ossification of Posterior Longitudinal Ligament Including Postsurgical Remnant Ossified Spinal Lesion

Spine ◽

10.1097/brs.0000000000003173 ◽

2019 ◽

Vol 44 (24) ◽

pp. E1452-E1460

Author(s):

Hideaki Nakajima ◽

Shuji Watanabe ◽

Kazuya Honjoh ◽

Ippei Kitade ◽

Daisuke Sugita ◽

...

Keyword(s):

Posterior Longitudinal Ligament ◽

Term Outcome ◽

Long Term Outcome ◽

Anterior Cervical Decompression ◽

Spinal Lesion

Download Full-text

Long-term follow-up review of suspension laminotomy for cervical compression myelopathy

Journal of Neurosurgery ◽

10.3171/jns.1996.85.5.0817 ◽

1996 ◽

Vol 85 (5) ◽

pp. 817-823 ◽

Cited By ~ 33

Author(s):

Hidenori Inoue ◽

Kazuo Ohmori ◽

Yoshihiro Ishida ◽

Kazuhiro Suzuki ◽

Tetsuro Takatsu

Keyword(s):

Posterior Longitudinal Ligament ◽

Neurological Status ◽

Long Term Results ◽

Term Outcome ◽

Long Term Outcome ◽

Content Type ◽

Long Term Follow Up ◽

Fine Print

This study compared the long-term outcome of cervical spondylotic myelopathy (CSM) with that of the ossification of the posterior longitudinal ligament of the cervical spine (OPLL) after suspension laminotomy, which was developed in the authors' clinic. Seventy-six patients who received follow-up care for more than 5 years were available for analysis. The duration of the follow-up period averaged 97.8 months (range 61–160 months). Radiological and neurological analyses were performed in these 76 patients (50 with CSM and 26 with OPLL). There were no differences in sex, age, follow-up period, and preoperative neurological status between the two groups. In the quantitative study of the dural configuration, 43 patients (86%) with CSM and 17 patients (65.4%) with OPLL attained complete decompression 1 month after surgery. At long-term follow-up review, complete decompression was maintained in 42 patients (84%) with CSM but in only seven patients (26.9%) with OPLL. The neurological evaluation improved markedly at early follow up in both groups but declined insignificantly at the last follow-up review, particularly in the OPLL group. Of 12 patients (24%) with CSM and 10 patients (38.5%) with OPLL whose neurological recovery grades later deteriorated, four (8%) with CSM and nine (34.6%) with OPLL demonstrated reconstriction causing spinal cord compression at long-term follow-up review. For the remaining eight patients (16%) with CSM, who were older than 70 years on average at last follow-up review, no radiological explanation was found. These long-term results indicate that OPLL does not resolve as well as CSM after suspension laminotomy; they both may have late deterioration due to reconstriction that occurs occasionally in CSM and frequently in OPLL.

Download Full-text