Anterior Controllable Antedisplacement and Fusion as Revision Surgery After Posterior Decompression Surgery in Patients with Ossification of the Posterior Longitudinal Ligament

2019 ◽  
Vol 123 ◽  
pp. e310-e317
Author(s):  
Haibo Wang ◽  
Jingchuan Sun ◽  
Ying Tan ◽  
Peng Li ◽  
Ximing Xu ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Posterior Longitudinal Ligament ◽  
Decompression Surgery ◽  
Posterior Decompression

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

2020 ◽  
Vol 49 (3) ◽  
pp. E11 ◽  
Author(s):  
Yoshifumi Kudo ◽  
Ichiro Okano ◽  
Tomoaki Toyone ◽  
Akira Matsuoka ◽  
Hiroshi Maruyama ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Decompression Surgery ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Posterior Decompression ◽  
Lateral Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

scholarly journals Recurrent ossification of the posterior longitudinal ligament in the upper thoracic region 10 years after initial decompression

2022 ◽  
Vol 13 ◽  
pp. 17
Author(s):  
Naoki Segi ◽  
Kei Ando ◽  
Hiroaki Nakashima ◽  
Masaaki Machino ◽  
Sadayuki Ito ◽  
...  
Keyword(s):  
Posterior Longitudinal Ligament ◽  
Posterior Fusion ◽  
Kyphotic Deformity ◽  
Decompression Surgery ◽  
Case Description ◽  
Thoracic Region ◽  
Posterior Decompression ◽  
Region 10 ◽  
Upper Thoracic

Background: Posterior decompression surgery consisting of laminoplasty is generally considered be the treatment of choice for upper thoracic OPLL. Here, we describe a patient who, 10 years following a C3–T4 level laminectomy, developed recurrent OPLL at the T2–3 level with kyphosis requiring a posterior fusion. Case Description: A 64-year-old male with CT documented OPLL at the C3–4, C6–7, and T1–4 levels, originally underwent a cervicothoracic laminectomy with good results. However, 10 years later, when T2–3 OPLL recurred along with kyphosis, he warranted an additional posterior fusion. Conclusion: Due to the long-term risks of developing kyphotic deformity/instability, more patients undergoing initial decompressive surgery alone for upper thoracic OPLL should be considered for primary fusions.

Factors for a Good Surgical Outcome in Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Thoracic Ossification of the Posterior Longitudinal Ligament: Prospective Single-Center Study

2017 ◽  
Vol 13 (6) ◽  
pp. 661-669 ◽  
Author(s):  
Shiro Imagama ◽  
Kei Ando ◽  
Kazuyoshi Kobayashi ◽  
Tetsuro Hida ◽  
Kenyu Ito ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Outcomes ◽  
Ligamentum Flavum ◽  
Posterior Longitudinal Ligament ◽  
Neurophysiological Monitoring ◽  
Posterior Decompression ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Estimated Blood Loss ◽  
Significant Factors

Abstract BACKGROUND Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown. OBJECTIVE To identify factors for good surgical outcomes with prospective and comparative study. METHODS Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on ≥50% and &lt;50% recovery rates for the Japanese Orthopaedic Association score. Preoperative, intraoperative, and postoperative findings were compared in the 2 groups, and significant factors for a good outcome were analyzed. RESULTS Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively; lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging; lower estimated blood loss; higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring; and lower rates of postoperative complications (P &lt; .0005). In multivariate logistic regression analysis, negative prone and supine position test (odds ratio [OR]: 17.00), preoperative ambulatory status (OR: 6.05), absence of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level (OR: 5.84), intraoperative spinal cord floating (OR: 4.98), and lower estimated blood loss (OR: 1.01) were significant factors for a good surgical outcome. CONCLUSION This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes.

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