Vertebral Body Rotational Osteotomy for Decompressing an Eccentrically Protruded Ossification of the Posterior Longitudinal Ligament

OBJECTIVEThe range of decompression in posterior decompression and fixation for ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) can be established using an index of spinal cord decompression based on the ossification-kyphosis angle (OKA) measured in the sagittal view on MRI. However, an appropriate OKA cannot be achieved in some cases, and posterior fixation is applied in cases with insufficient decompression. Moreover, it is unclear whether spinal cord decompression of the ventral side is essential for the treatment of OPLL. In this retrospective analysis, the efficacy of posterior decompression and fixation performed for T-OPLL was investigated after the range of posterior decompression had been set using the OKA.METHODSThe MRI-based OKA is the angle from the superior margin at the cranial vertebral body of the decompression site and from the lower posterior margin at the caudal vertebral body of the decompression site to the prominence of the maximum OPLL. Posterior decompression and fixation were performed in 20 patients. The decompression range was set so that the OKA was ≤ 23° or the minimum if this value could not be achieved. Cases in which an OKA ≤ 23° could and could not be achieved were designated as groups U (13 patients) and O (7 patients), respectively. The mean patient ages were 50.5 and 62.1 years (p = 0.03) and the mean preoperative Japanese Orthopaedic Association (JOA) scores were 5.9 and 6.0 (p = 0.9) in groups U and O, respectively. The postoperative JOA score, rate of improvement of the JOA score, number of levels fused, number of decompression levels, presence of an echo-free space during surgery, operative time, intraoperative blood loss, and perioperative complications were examined.RESULTSIn groups U and O, the mean rates of improvement in the JOA score were 50.0% and 45.6% (p = 0.3), the numbers of levels fused were 6.7 and 6.4 (p = 0.8), the numbers of decompression levels were 5.9 and 7.4 (p = 0.3), an echo-free space was noted during surgery in 92.3% and 42.9% of cases (p = 0.03), the operative times were 292 and 238 minutes (p = 0.3), and the intraoperative blood losses were 422 and 649 ml (p = 0.7), and transient aggravation of paralysis occurred as a perioperative complication in 2 and 1 patient, respectively.CONCLUSIONSThere was no significant difference with regard to the recovery rate of the JOA score between patients with (group U) and without (group O) sufficient spinal cord decompression. The first-line surgical procedure of posterior decompression and fixation with the range of posterior decompression set as an OKA ≤ 23° before surgery involves less risk of postoperative aggravation of paralysis and may result in a better outcome.

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“Skip” corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament

Journal of Neurosurgery Spine ◽

10.3171/2009.7.spine08965 ◽

2010 ◽

Vol 12 (1) ◽

pp. 33-38 ◽

Cited By ~ 26

Author(s):

Sedat Dalbayrak ◽

Mesut Yilmaz ◽

Sait Naderi

Keyword(s):

Vertebral Body ◽

Cervical Spondylotic Myelopathy ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Japanese Orthopaedic Association Score ◽

Cervical Lordosis ◽

The Mean ◽

Ossified Posterior Longitudinal Ligament ◽

Multilevel Cervical Spondylotic Myelopathy

Object The authors reviewed the results of “skip” corpectomy in 29 patients with multilevel cervical spondylotic myelopathy (CSM) and ossified posterior longitudinal ligament (OPLL). Methods The skip corpectomy technique, which is characterized by C-4 and C-6 corpectomy, C-5 osteophytectomy, and C-5 vertebral body preservation, was used for decompression in patients with multilevel CSM and OPLL. All patients underwent spinal fixation using C4–5 and C5–6 grafts, and anterior cervical plates were fixated at C-3, C-5, and C-7. Results The mean preoperative Japanese Orthopaedic Association score increased from 13.44 ± 2.81 to 16.16 ± 2.19 after surgery (p < 0.05). The cervical lordosis improved from 1.16 ± 11.74° to 14.36 ± 7.85° after surgery (p < 0.05). The complications included temporary hoarseness in 3 cases, dysphagia in 1 case, C-5 nerve palsy in 1 case, and C-7 screw pullout in 1 case. The mean follow-up was 23.2 months. The final plain radiographs showed improved cervical lordosis and fusion in all cases. Conclusions The authors conclude that the preservation of the C-5 vertebral body provided an additional screw purchase and strengthened the construct. The results of the current study demonstrated effectiveness and safety of the skip corpectomy in patients with multilevel CSM and OPLL.

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Successful treatment of continuous ossification of the posterior longitudinal ligament in the lumbar spine using percutaneous transforaminal endoscopic spinal decompression: a case report

Journal of International Medical Research ◽

10.1177/03000605211004774 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110047

Author(s):

Yuexin Tong ◽

Zhangheng Huang ◽

Zhiyi Fan ◽

Chengliang Zhao ◽

Youxin Song

Keyword(s):

Case Report ◽

Lumbar Spine ◽

Vertebral Body ◽

Posterior Longitudinal Ligament ◽

Neurological Function ◽

Posterolateral Approach ◽

Lower Back ◽

Scale Scores ◽

History Of ◽

Lumbar Spinal

Ossification of the posterior longitudinal ligament (OPLL) of the lumbar spine is rare relative to that of the cervical spine but is often associated with more severe symptoms. Continuous lumbar OPLL is extremely rare. We herein describe a 48-year-old Chinese woman with lumbar spinal stenosis caused by continuous OPLL. She presented with a 5-year history of lower back pain and intermittent claudication. We performed percutaneous transforaminal endoscopic decompression by the posterolateral approach to achieve adequate decompression of the spinal canal up to the lower 1/3 level (0.9 cm) of the L1 vertebral body and down to the upper 1/2 level (1.3 cm) of the L2 vertebral body. After surgery, the patient’s neurological function substantially improved, and her visual analog scale scores for the lower back and both lower extremities and her Oswestry disability index were significantly lower than those in the preoperative period. During the 12-month clinical follow-up period, the patient’s neurological function was fully restored, and she regained her ability to walk normally. No surgery-related complications were observed. This case report describes a novel surgical approach that may be an effective treatment alternative for continuous lumbar OPLL.

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Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament

Global Spine Journal ◽

10.1177/2192568220975387 ◽

2020 ◽

pp. 219256822097538

Author(s):

Dong-Ho Lee ◽

Sehan Park ◽

Chul Gie Hong ◽

Shinseok Kim ◽

Jae Hwan Cho ◽

...

Keyword(s):

Vertebral Body ◽

Retrospective Cohort ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Complication Rates ◽

Cervical Lordosis ◽

Surgical Indications ◽

Score Improvement ◽

High Space ◽

Minimum Interval

Study Design: Retrospective cohort study. Objectives: Vertebral body sliding osteotomy (VBSO) has previously been reported as a technique to decompress ossification of the posterior longitudinal ligament (OPLL) by translating the vertebral body anteriorly. This study aimed to evaluate the radiological and clinical efficacies of VBSO and clarify the surgical indications of VBSO for treating myelopathy caused by OPLL. Methods: Ninety-seven patients with symptomatic OPLL-induced cervical myelopathy treated with VBSO or laminoplasty who were followed up for more than 2 years were retrospectively reviewed. Cervical alignment, range of motion, fusion, modified K-line (mK-line) status, and minimum interval between ossified mass and mK-line (INT(min)), and the Japanese Orthopaedic Association (JOA) score were assessed. Patients in the VBSO group were compared with those who underwent laminoplasty. Results: Cervical lordosis and INT(min) significantly increased in the VBSO group. All patients in the VBSO group assessed as mK-line (-) preoperatively were assessed as mK-line (+) postoperatively. However, in the LMP group, the mK-line status changed from (+) preoperatively to (−) postoperatively in 3 patients. Final JOA score (p = 0.02) and JOA score improvement (p = 0.01) were significantly higher in the VBSO group. JOA recovery ratio (p = 0.03) and proportion of patients with a recovery rate ≥50% were significantly higher in the VBSO group (p < 0.01). Conclusions: VBSO is an effective surgical option for OPLL-induced myelopathy, demonstrating favorable neurological recovery and lordosis restoration with low complication rates. It is best indicated for kyphotic alignment, OPLL with a high space-occupying ratio, and OPLL involving ≤3 segments.

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Analysis of progression of cervical OPLL using computerized tomography: typical sign of maturation of OPLL mass

Journal of Neurosurgery Spine ◽

10.3171/2015.1.spine131167 ◽

2015 ◽

Vol 23 (5) ◽

pp. 539-543 ◽

Cited By ~ 6

Author(s):

Byung-Wan Choi ◽

Dong-Hoon Baek ◽

Lindsey C. Sheffler ◽

Han Chang

Keyword(s):

Vertebral Body ◽

Mixed Type ◽

Posterior Longitudinal Ligament ◽

Younger Age ◽

Show Evidence ◽

Group A ◽

The Mean ◽

Multiple Levels ◽

Group B

OBJECT The progression of cervical ossification of the posterior longitudinal ligament (OPLL) can lead to increase in the size of the OPLL mass and aggravation of neurological symptoms. In the present study, the authors aimed to analyze the progression of cervical OPLL by using CT imaging, elucidate the morphology of OPLL masses, and evaluate the factors associated with the progression of cervical OPLL. METHODS Sixty patients with cervical OPLL were included. All underwent an initial CT examination and had at least 24 months’ follow-up with CT. The mean duration of follow-up was 29.6 months. Fourteen patients (Group A) had CT evidence of OPLL progression, and 46 (Group B) did not show evidence of progression on CT. The 2 groups were compared with respect to the following variables: sex, age, number of involved segments, type of OPLL, and treatment methods. The CT findings, such as the connection of an OPLL mass with the vertebral body and formation of trabeculation in the mass, were evaluated. RESULTS Sex and treatment modality were not associated with OPLL progression. The mean age of the patients in Group A was significantly lower than that in Group B (p = 0.03). The mean number of involved segments was 5.3 in Group A and 3.6 in Group B (p = 0.002). Group A had a higher proportion of cases with the mixed type of OPLL, whereas Group B had a higher proportion of cases with the segmental type (p = 0.02). A connection between the vertebral body and OPLL mass and trabeculation formation were more common in Group B (p < 0.01). CONCLUSIONS Progression of cervical OPLL is associated with younger age, involvement of multiple levels, and mixed-type morphology. OPLL masses that are contiguous with the vertebral body and have trabecular formation are useful findings for identifying masses that are less likely to progress.

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Cervical Vertebral Strain Measurements Under Axial and Eccentric Loading

Journal of Biomechanical Engineering ◽

10.1115/1.2794210 ◽

1995 ◽

Vol 117 (4) ◽

pp. 474-478 ◽

Cited By ~ 45

Author(s):

F. A. Pintar ◽

N. Yoganandan ◽

M. Pesigan ◽

J. Reinartz ◽

A. Sances ◽

...

Keyword(s):

Vertebral Body ◽

Compressive Loading ◽

Maximum Load ◽

Posterior Longitudinal Ligament ◽

Load Carrying Capacity ◽

Strain Gages ◽

Common Site ◽

Strain Measurements ◽

Anterior Aspect ◽

Load Carrying

The mid to lower cervical spine is a common site for compression related injury. In the present study, we determined the patterns of localized strain distribution in the anterior aspect of the vertebral body and in the lateral masses of lower cervical three-segment units. Miniature strain gages were mounted to human cadaveric vertebrae. Each preparation was line-loaded using a knife-edge oriented in the coronal plane that was moved incrementally from anterior to posterior to induce compression-flexion or compression-extension loading. Uniform compressive loading and failure runs were also conducted. Failure tests indicated strain shifting to “restabilize” the preparation after failure of a component. Under these various compressive loading vectors, the location which resulted in the least amount of deformation for a given force application (i.e., stiffest axis) was quantified to be in the region between 0.5–1.0 cm anterior to the posterior longitudinal ligament. The location in which line-loading produced no rotation (i.e., balance point) was in this region; it was also close to where the vertebral body strains change from compressive to tensile. Strain values from line loading in this region produced similar strains as recorded under uniform compressive loading, and this was also the region of minimum strain. The region of minimum strain was also more pronounced under higher magnitudes of loading, suggesting that as the maximum load carrying capacity is reached the stiffest axis becomes more well defined.

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Finite Element Analysis of the Indirect Reduction of Posterior Pedicle Screw Fixation for a Thoracolumbar Burst Fracture

10.21203/rs.3.rs-129868/v1 ◽

2020 ◽

Author(s):

Yuanzheng Song ◽

Wei Li ◽

Fahao Zhu

Keyword(s):

Intervertebral Disc ◽

Vertebral Body ◽

Spinal Canal ◽

Burst Fracture ◽

Posterior Longitudinal Ligament ◽

Neurological Dysfunction ◽

Indirect Reduction ◽

Thoracolumbar Burst Fracture ◽

Maximum Displacement ◽

Burst Fractures

Abstract Background: Because burst fractures often involve damage to the column and posterior structures of the spine, the fracture block may invade the spinal canal and compress the spinal cord or the cauda equina, causing corresponding neurological dysfunction. When a thoracolumbar burst fracture is accompanied by the presence of bone in the spinal canal, whether posterior surgery requires spinal canal incision decompression remains controversial.Methods: Computed tomography (CT) images of the thoracolumbar spine of a 31-year-old male with an L1 burst fracture and Mimics 10.0 were used to establish a three-dimensional fracture model for simulating the indirect reduction process. The model was imported into Ansys 10.0, and a 1-10 mm displacement was loaded 10° behind the Z-axis on the upper endplate of the L1 vertebral body to simulate position reduction and open reduction. The displacement and stress changes in the intervertebral disc, fractured vertebral body and posterior longitudinal ligament were observed during reduction.Results: Under a displacement loaded 10° behind the Z-axis, the maximum stress in the vertebral body was concentrated on the upper disc of the injured vertebrae. The maximum displacement corresponded to the anterior edge of the vertebral body of the injured vertebrae, and the vertebral body height and the anterior lobes were essentially restored. When the displacement load was applied in the positive Z-axis direction, the maximum displacement corresponded to the posterior longitudinal ligament behind the injured vertebrae. Under a 6 mm load, the posterior longitudinal ligament displacement was 11.3 mm. Under an 8 mm load, this displacement significantly increased to 15.0 mm, and the vertebral stress was not concentrated on the intervertebral disc.Conclusions: The reduction of thoracolumbar burst fractures by positioning and distraction allowed the injured vertebrae to be restored to the normal height and kyphotic angle. The reduction of the posterior longitudinal ligament can move the bone block in the spinal canal into the reset space and yield good reset results.

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A novel anterior decompression technique (vertebral body sliding osteotomy) for ossification of posterior longitudinal ligament of the cervical spine

The Spine Journal ◽

10.1016/j.spinee.2018.02.022 ◽

2018 ◽

Vol 18 (6) ◽

pp. 1099-1105 ◽

Cited By ~ 12

Author(s):

Dong-Ho Lee ◽

Jae Hwan Cho ◽

Choon Sung Lee ◽

Chang Ju Hwang ◽

Sung Hoon Choi ◽

...

Keyword(s):

Cervical Spine ◽

Vertebral Body ◽

Posterior Longitudinal Ligament ◽

Anterior Decompression

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Microsurgical Anterior Controllable Antedisplacement Fusion to Treat Cervical Ossified Posterior Longitudinal Ligament: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa376 ◽

2020 ◽

Author(s):

Wanru Duan ◽

Dean Chou ◽

Fengzeng Jian ◽

Zan Chen

Keyword(s):

Decision Making ◽

Vertebral Body ◽

Patient Selection ◽

Posterior Longitudinal Ligament ◽

The Other ◽

Anterior Decompression ◽

Surgical Decision ◽

Surgical Options ◽

Ossified Posterior Longitudinal Ligament ◽

Surgical Decision Making

Abstract The anterior decompression technique, including vertebral body sliding osteotomy1 and anterior controllable antedisplacement fusion (ACAF),2 treats ossified posterior longitudinal ligament (OPLL) without actual excision of the OPLL.3 The fundamental strategy is to separate the mid-portion of the vertebral body along with the OPLL using bilateral anterior osteotomies followed by controllable antedisplacement. These techniques restore the space of the spinal canal anteriorly by anterior translation of the OPLL, avoiding excision and dural manipulation.4 We illustrate the case of a patient who had failed laminoplasty and the surgical decision making for ACAF. We discuss the other surgical options regarding patient selection, present preoperative and postoperative imaging, to demonstrate the efficacy of ACAF and show strategies of ACAF to make it a safe and effective procedure. We demonstrate our technique of ACAF using the intraoperative microscope and models in this video to illustrate the steps of ACAF. A written consent to the procedure was obtained from the patient.

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