Mid-term Surgical Outcome of Posterior Decompression With Instrumented Fusion in Patients With K-line (−) Type Cervical Ossification of the Posterior Longitudinal Ligament With a 5-Year Minimum Follow-up

2020 ◽  
Vol 33 (9) ◽  
pp. 333-338
Author(s):  
Takeo Furuya ◽  
Satoshi Maki ◽  
Takuya Miyamoto ◽  
Sho Okimatsu ◽  
Yasuhiro Shiga ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Posterior Longitudinal Ligament ◽  
Posterior Decompression ◽  
Instrumented Fusion ◽  
Line Type

Postoperative progression of ligamentum flavum ossification after posterior instrumented surgery for thoracic posterior longitudinal ligament ossification: long-term outcomes during a minimum 10-year follow-up

2021 ◽  
pp. 1-11
Keyword(s):  
Ligamentum Flavum ◽  
Posterior Longitudinal Ligament ◽  
Vertebral Compression Fractures ◽  
Long Term Outcomes ◽  
Posterior Decompression ◽  
Fusion Surgery ◽  
Fusion Level ◽  
Estimated Blood Loss

OBJECTIVE The authors sought to investigate clinical and radiological outcomes after thoracic posterior fusion surgery during a minimum of 10 years of follow-up, including postoperative progression of ossification, in patients with thoracic ossification of the posterior longitudinal ligament (T-OPLL). METHODS The study participants were 34 consecutive patients (15 men, 19 women) with an average age at surgery of 53.6 years (range 36–80 years) who underwent posterior decompression and fusion surgery with instrumentation at the authors’ hospital. The minimum follow-up period was 10 years. Estimated blood loss, operative time, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, and JOA score recovery rates were investigated. Dekyphotic changes were evaluated on plain radiographs of thoracic kyphotic angles and fusion levels pre- and postoperatively and 10 years after surgery. The distal junctional angle (DJA) was measured preoperatively and at 10 years after surgery to evaluate distal junctional kyphosis (DJK). Ossification progression at distal intervertebrae was investigated on CT. RESULTS The Cobb angles at T1–12 were 46.8°, 38.7°, and 42.6°, and those at the fusion level were 39.6°, 31.1°, and 34.1° pre- and postoperatively and at 10 years after surgery, respectively. The changes in the kyphotic angles from pre- to postoperatively and to 10 years after surgery were 8.0° and 7.2° at T1–12 and 8.4° and 7.9° at the fusion level, respectively. The DJA changed from 4.5° postoperatively to 10.9° at 10 years after surgery. There were 11 patients (32.3%) with DJK during follow-up, including 4 (11.8%) with vertebral compression fractures at lower instrumented vertebrae or adjacent vertebrae. Progression of ossification of the ligamentum flavum (OLF) on the caudal side occurred in 8 cases (23.6%), but none had ossification of the posterior longitudinal ligament (OPLL) progression. Cases with OLF progression had a significantly lower rate of DJK (0% vs 38.5%, p < 0.01), a lower DJA (3.4° vs 13.2°, p < 0.01), and a smaller change in DJA at 10 years after surgery (0.8° vs 8.1°, p < 0.01). CONCLUSIONS Posterior decompression and fusion surgery with instrumentation for T-OPLL was found to be a relatively safe and stable surgical procedure based on the long-term outcomes. Progression of OLF on the caudal side occurred in 23.6% of cases, but cases with OLF progression did not have DJK. Progression of DJK shifts the load in the spinal canal forward and the load on the ligamentum flavum is decreased. This may explain the lack of ossification in cases with DJK.

Risk Factors for Ineffectiveness of Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament: A Single Institute Study

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 800-808 ◽  
Author(s):  
Shiro Imagama ◽  
Kei Ando ◽  
Zenya Ito ◽  
Kazuyoshi Kobayashi ◽  
Tetsuro Hida ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Supine Position ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Intraoperative Ultrasonography ◽  
Posterior Decompression ◽  
Motor Paralysis ◽  
Severe Motor

Abstract BACKGROUND: Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is treated surgically with instrumented posterior decompression and fusion. However, the factors determining the outcome of this approach and the efficacy of additional resection of T-OPLL are unknown. OBJECTIVE: To identify these factors in a prospective study at a single institution. METHODS: The subjects were 70 consecutive patients with beak-type T-OPLL who underwent posterior decompression and dekyphotic fusion and had an average of 4.8 years of follow-up (minimum of 2 years). Of these patients, 4 (6%; group R) had no improvement or aggravation, were not ambulatory for 3 weeks postoperatively, and required additional T-OPLL resection; while 66 (group N) required no further T-OPLL resection. Clinical records, gait status, intraoperative ultrasonography, intraoperative neurophysiological monitoring (IONM), plain radiography, computed tomography and magnetic resonance imaging findings, and Japanese Orthopaedic Association (JOA) score were compared between the groups. RESULTS: Preoperatively, patients in group R had significantly higher rates of severe motor paralysis, nonambulatory status, positive prone and supine position test, no spinal cord floating in intraoperative ultrasonography, and deterioration of IONM at the end of surgery (P &lt; .05). In preoperative radiography, the OPLL spinal cord kyphotic angle difference in fused area, OPLL length, and OPLL canal stenosis were significantly higher in group R (P &lt; .05). At final follow-up, JOA scores improved similarly in both groups. CONCLUSION: Preoperative severe motor paralysis, nonambulatory status, positive prone and supine position test, radiographic spinal cord compression due to beak-type T-OPLL, and intraoperative residual spinal cord compression and deterioration of IONM were associated with ineffectiveness of posterior decompression and fusion with instrumentation. Our 2-stage strategy may be appropriate for beak-type T-OPLL surgery.

scholarly journals Evaluation of outcome of posterior decompression and instrumented fusion in thoracolumbar fractures

2020 ◽  
Vol 6 (3) ◽  
pp. 546
Author(s):  
Akshay Jain ◽  
Utkarsh Agrawal ◽  
Pronnat Jain ◽  
Arjun Jain ◽  
R. K. Jain
Keyword(s):  
Scoring System ◽  
Knee Extensors ◽  
P Value ◽  
Thoracolumbar Fractures ◽  
Kyphotic Angle ◽  
Posterior Decompression ◽  
Instrumented Fusion ◽  
Thoracolumbar Injury ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The fractures of the thoracolumbar junction are the most common injuries of the vertebral column. Fall from a height and road traffic accidents are the main causes of injury. The present study aims to evaluate the functional, neurological and radiological outcome of the posterior decompression and instrumented fusion in operated patients with thoracolumbar fractures.</p><p class="abstract"><strong>Methods:</strong> In this retrospective and prospective study, a cohort of 30 patients with thoracolumbar fractures, classified by thoracolumbar injury classification and severity (TLICS) scoring system, underwent posterior decompression and pedicle screw fixation from January 2013 to August 2018 were included. Patients were assessed functionally (ODI score), neurologically (MRC grading) and radiologically (kyphotic angle) preoperatively and at 6 weeks, 3 months, 6 months and 12 months post-operatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean ODI score improved from 87.40 pre-operatively to 13.33 at final follow-up (p value 0.001). The mean kyphotic angle decreased from 24.37 degrees preoperatively to 9.87 degrees postoperatively (p value 0.001) with mean loss of correction of 1.16 degrees at final follow-up. Hip flexors and knee extensors improved from a mean preoperative value of 2.60 to 4.83 at final follow-up (p value 0.001). Similarly, ankle dorsiflexors, long toe extensors and ankle plantar flexors improved from mean preoperative value of 2.53, 2.50 and 2.60 to 3.93, 3.80 and 4.73 at final follow-up, respectively (p value 0.001).</p><p class="abstract"><strong>Conclusions:</strong> Posterior decompression and instrumented fusion is a safe and effective surgical option in patients with thoracolumbar fractures. TLICS scoring system has a prognostic value and helps in determining the prognosis in these patients.</p>

Intraoperative ultrasonographic evaluation of posterior decompression via laminoplasty in patients with cervical ossification of the posterior longitudinal ligament: correlation with 2-year follow-up results

2010 ◽  
Vol 13 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Atsushi Seichi ◽  
Hirotaka Chikuda ◽  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
Shurei Sugita ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Characteristic Curve ◽  
Posterior Longitudinal Ligament ◽  
Intraoperative Ultrasonography ◽  
Posterior Decompression ◽  
First Choice ◽  
Maximal Thickness ◽  
Type 3

Object The aim in this prospective study was to determine the morphological limitations of laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL) by using intraoperative ultrasonography and to investigate correlations between ultrasonographic findings and 2-year follow-up results. Methods Included in this study were 40 patients who underwent double-door laminoplasty for cervical myelopathy due to OPLL. Intraoperative ultrasonography was used to evaluate posterior shift of the spinal cord after the posterior decompression procedure. To determine the decompression status of the cord, the authors classified ultrasonographic findings into 3 types on the basis of the presence or absence of spinal cord contact with OPLL after decompression: Type 1, noncontact; Type 2, contact and apart; and Type 3, contact. Patients were divided accordingly into Group 1, showing Type 1 or 2 findings, representing sufficient decompression; and Group 2, showing Type 3 findings with insufficient decompression. Preoperative sagittal alignment of the cervical spine (C2–7 angle) and preoperative maximal thickness of OPLL were compared between groups. The authors also investigated the morphological limitations of laminoplasty and 2-year follow-up results by using the Japanese Orthopedic Association (JOA) scoring system. Results According to receiver operating characteristic curve analysis, an OPLL maximal thickness > 7.2 mm was a cutoff value for insufficient decompression. However, sufficient or insufficient decompression did not correlate with 2-year results, as determined by JOA scores. The C2–7 angle had no impact on ultrasonographic findings. Conclusions Laminoplasty has a morphological limitation for thick OPLLs, and a thickness > 7.2 mm represents a theoretical cutoff for residual cord compression after laminoplasty. According to 2-year results, however, laminoplasty can remain the first choice for any type of multiple-level OPLL.

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