Surgical results and complications of anterior controllable antedisplacement fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament

2018 ◽  
Vol 56 ◽  
pp. 21-27 ◽  
Author(s):  
Haisong Yang ◽  
Yongfei Guo ◽  
Jiangang Shi ◽  
Jingchuan Sun ◽  
Yuan Wang ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Cervical Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Surgical Results ◽  
Posterior Surgery

scholarly journals Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament

2017 ◽  
Vol 26 (4) ◽  
pp. 466-473 ◽  
Author(s):  
Seiichi Odate ◽  
Jitsuhiko Shikata ◽  
Tsunemitsu Soeda ◽  
Satoru Yamamura ◽  
Shinji Kawaguchi
Keyword(s):  
Revision Surgery ◽  
Cervical Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deterioration ◽  
Surgical Results ◽  
Improvement Rate ◽  
Posterior Surgery ◽  
Initial Surgery ◽  
The Mean

OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL. After posterior surgery, some patients require revision surgery because of late neurological deterioration due to kyphotic changes in cervical alignment or OPLL progression. Here, the authors retrospectively investigated the surgical results and complications of revision ACDF after initial posterior surgery for OPLL. METHODS This was a single-center, retrospective study. Between 2006 and 2013, 19 consecutive patients with cervical OPLL who underwent revision ACDF at the authors' institution after initial posterior surgery were evaluated. The mean age at the time of revision ACDF was 66 ± 7 years (± SD; range 53–78 years). The mean interval between initial posterior surgery and revision ACDF was 63 ± 53 months (range 3–235 months). RESULTS The mean follow-up period after revision ACDF was 41 ± 26 months (range 24–108 months). Before revision ACDF, the mean maximum thickness of the ossified posterior longitudinal ligament was 7.2 ± 1.5 mm (range 5–10 mm), and the mean C2–7 angle was 1.3° ± 14° (range −40° to 24°). The K-line was plus (OPLL did not exceed the K-line) in 8 patients and minus in 11 (OPLL exceeded the K-line). The mean Japanese Orthopaedic Association score improved from 10 ± 3 (range 3–15) before revision ACDF to 11 ± 4 (range 4–15) at the last follow-up, and the mean improvement rate was 18% ± 18% (range 0%–60%). A total of 16 surgery-related complications developed in 12 patients (63%). The main complication was an intraoperative CSF leak in 8 patients (42%). Neurological function worsened in 5 patients (26%). The deterioration was due to spinal cord herniation through a defective dura mater in 1 patient, unidentified in 1 patient, and C-5 palsy that gradually recovered in 3 patients. Reintubation, delirium, and hoarseness were observed in 1 patient each (5%). No patient required reoperation for reconstruction failure, and all patients eventually had a solid bony fusion. CONCLUSIONS ACDF as revision surgery after initial posterior surgery for cervical myelopathy due to OPLL is associated with a high incidence of intraoperative CSF leakage and an extremely low improvement rate. The authors think that while the use of revision ACDF must be limited, it is indispensable in special cases, such as progressing myelopathy following posterior surgery due to a very large beak-type OPLL that exceeds the K-line. Postoperative OPLL progression and/or kyphotic changes can possibly cause later neurological deterioration. Fusion should be recommended at the initial surgery for many cases of cervical OPLL to prevent such a challenging revision surgery.

Patient satisfaction with surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament

2011 ◽  
Vol 14 (6) ◽  
pp. 726-733 ◽  
Author(s):  
Takahito Fujimori ◽  
Motoki Iwasaki ◽  
Shinya Okuda ◽  
Yukitaka Nagamoto ◽  
Hironobu Sakaura ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Cervical Myelopathy ◽  
Rank Correlation ◽  
Posterior Longitudinal Ligament ◽  
Stepwise Logistic Regression ◽  
Surgical Results ◽  
Spearman Rank Correlation ◽  
Stepwise Logistic Regression Analysis ◽  
Spearman Rank ◽  
Lower Maximum

Object Surgical results in cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) evaluated with a patient-based method have not yet been reported. The purpose of this study was to examine patient satisfaction with surgery for cervical myelopathy due to OPLL and to clarify factors related to satisfaction. Methods Clinical data in 103 patients (74 male and 29 female) who underwent surgery for cervical OPLL were retrospectively reviewed. The average age at surgery was 57 years, and the average follow-up period was 9.3 years. Outcomes were assessed using an original satisfaction questionnaire, the conventional Japanese Orthopaedic Association (JOA) scoring system, the JOA Cervical Myelopathy Evaluation Questionnaire, the 36-Item Short Form Health Survey, and the hospital anxiety and depression scale. Spearman rank correlation coefficients for 5-scale patient satisfaction against outcome measures were calculated to test relationships between variables. All variables were compared between the satisfied (responses of very satisfied or satisfied) and dissatisfied (responses of dissatisfied or very dissatisfied) groups. Parameters exhibiting a significant Spearman rank correlation or difference between the groups were entered in a stepwise logistic regression analysis model, with satisfaction as the dependent variable. Results Sixty-nine patients were included in the analysis. There was not a significant difference in clinical data between these 69 study patients and the other 34 patients. Fifty-five patients (80%) were satisfied with the results of the surgery, and 58 patients (84%) reported that their condition was improved by the surgery. All patients who reported being very improved were either very satisfied or satisfied with the results of surgery. Quality of life (QOL), physical function (PF), and role physical (RP) were significantly correlated with patient satisfaction. The dissatisfied group had significantly more severe pain; lower maximum conventional JOA scores; lower maximum recovery rates; worse lower-extremity function (LEF); reduced QOL; and lower PF, RP, and vitality scores. Stepwise logistic regression analysis showed that PF, QOL, LEF, and maximum recovery rate based on JOA score were correlated with satisfaction. Conclusions Eighty percent of patients were satisfied with the surgical results after treatment of cervical myelopathy due to OPLL. Surgery for cervical OPLL was effective, as evaluated by both doctor- and patient-based methods. Patient satisfaction was related to QOL, PF (especially LEF), and improvement.

scholarly journals Does Anterior Controllable Antidisplacement and Fusion Technique Improve Quality of Life in Revision Treatment for Cervical Ossification of the Posterior Longitudinal Ligament? Three-Year Follow-Up Study

2021 ◽  
Author(s):  
Hai-Dong Li ◽  
Ji-Kang Min
Keyword(s):  
Quality Of Life ◽  
Revision Surgery ◽  
Posterior Longitudinal Ligament ◽  
Health Related Quality ◽  
Posterior Surgery ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related

Abstract Background: The laminoplasty and laminectomy are two comparatively safe posterior procedures for the treatment of OPLL. The long-term outcomes of posterior surgery seem to be favorable, however it is also criticized for C5 nerve root palsy, progression OPLL and bad cervical lordosis. An additional revision surgery was required for those patients who had the poor clinical improvement after the initial posterior surgery.Methods: This study was to identify the mid-term clinical results and the health-related quality of life (HRQoL) after anterior controllable antidisplacement and fusion (ACAF) technique for revision treatment of cervical ossification of the posterior longitudinal ligament (OPLL). All the patients were followed up for more than 3 years. The Japanese Orthopaedic Association (JOA) scales, Neck Disability Index (NDI) and Short-Form 36 (SF-36) were recorded to evaluate the health-related quality of life. And the neck and arm pain scale as an expression of visual analog scale (VAS) were also collected. Intraoperative parameters, clinical features, radiological investigations and the surgery-related complications were performed to analysis. Results: There were 20 patients who underwent ACAF revision surgery between March 2017 and January 2019. Clinical improvements were observed in all outcomes; significant improvements on the NDI, VAS, SF-36, and JOA scores were maintained at 3 years (P < 0.05). All the patients showed a better cervical alignment, and the average cervical lordosis was 17±4.6° after revision surgery. There was only one case of cerebrospinal fluid (CSF) leakage, no instance of C5 root platy, postoperative hematoma or esophageal injury occured. No instrumented failure or pseudarthrosis case was observed during the follow-up.Conclusions: This study suggested that ACAF is an effective and safe procedure for the revision treatment of cervical OPLL. Such a surgical technique can offer the postoperative improvement on pain levels and health-related quality of life.

scholarly journals Cervical myelopathy due to ossification of the posterior longitudinal ligament in the aged patients.

1990 ◽  
Vol 39 (1) ◽  
pp. 264-266
Author(s):  
Yutaka Itou ◽  
Shinya Kawai ◽  
Kouzou Sunago ◽  
Minoru Saika ◽  
Tosihiko Taguchi ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Aged Patients

scholarly journals Comparison of Laminoplasty and Posterior Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament

2021 ◽  
Author(s):  
Hiroaki Nakashima ◽  
Shiro Imagama ◽  
Toshitaka Yoshii ◽  
Satoru Egawa ◽  
Kenichiro Sakai ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Perioperative Complications ◽  
Clinical Status ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Posterior Fusion ◽  
Postoperative Outcomes ◽  
Intensity Change ◽  
Multivariable Logistic Regression Analysis ◽  
Significant Difference

Abstract This prospective multicenter study formed by the Japanese Ministry of Health, Labour and Welfare at 27 institutions aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL). Controversy exists regarding the role of instrumented fusion in the context of posterior surgical decompression for OPLL. Among the 479 patients enrolled, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, and increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments showed no significant differences. The overall risk of perioperative complications was lower in LM (odds ratio [OR] 0.40, p = 0.006), and C5 palsy was significantly lower in LM (OR 0.11, p = 0.0002) than in PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients with PF was significantly smaller than in those with LM. However, multivariable logistic regression analysis showed no significant difference in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in LM group than in the PF group (OR 2.73, p = 0.0002). LM and PF for cervical myelopathy due to OPLL resulted in comparable postoperative outcomes at two years after surgery.

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