Impacts of postoperative changes of segmental mobility on neurological improvement after laminoplasty for cervical ossification of the posterior longitudinal ligament

AbstractAlthough favourable surgical outcomes for myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) have been reported, factors significantly associated with post-operative neck pain attenuation still remain unclear. The primary aim of the present study was to determine factors significantly associated with post-operative neck pain attenuation in patients with cervical OPLL using a prospective multi-centre registry of surgically treated cervical OPLL. Significant postoperative neck pain reduction (50% reduction of neck pain) was achieved in 31.3% of patients. There was no significant difference in neck pain attenuation between surgical procedures. Statistical analyses with univariate analyses followed by stepwise logistic regression revealed neurological recovery as a factor having a significant positive association with post-operative neck pain attenuation (p = 0.04, odds ratio 5.68 (95% confidence interval: 1.27–22.2)). In conclusion, neurological recovery was an independent factor having a significant positive association with post-operative neck pain attenuation in patients with cervical myelopathy caused by OPLL who underwent cervical spine surgery.

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Differences in Postoperative Changes of Cervical Sagittal Alignment and Balance After Laminoplasty Between Cervical Spondylotic Myelopathy and Cervical Ossification of the Posterior Longitudinal Ligament

Global Spine Journal ◽

10.1177/2192568218784951 ◽

2018 ◽

Vol 9 (3) ◽

pp. 266-271 ◽

Cited By ~ 5

Author(s):

Hironobu Sakaura ◽

Atsunori Ohnishi ◽

Akira Yamagishi ◽

Tetsuo Ohwada

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Sagittal Alignment ◽

Posterior Longitudinal Ligament ◽

Kyphotic Deformity ◽

Sagittal Imbalance ◽

Patient Age ◽

Neurologic Recovery ◽

Postoperative Changes ◽

Cervical Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: To compare postoperative changes of cervical sagittal alignment (CSA) and cervical sagittal balance (CSB) after laminoplasty between cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) and to examine impacts of these radiologic changes on neurologic outcomes. Methods: A total of 168 consecutive patients with CSM (CSM group) and 51 consecutive patients with OPLL (OPLL group) were included. As indicators of CSA and CSB, the C2-7 angle and C1-C7 sagittal vertical axis (SVA) were, respectively, measured before surgery and at 2-year follow-up. Neurologic status was assessed using the Japanese Orthopaedic Association score before surgery and at 2-year follow-up. Results: Whereas both postoperative loss of C2-7 angle and increase of C1-C7 SVA were significantly greater in the elderly subgroup of the CSM group, patient age did not significantly affect these changes in the OPLL group. Preservation of C7 maintained C1-C7 SVA at postoperative 2 years only in the CSM group. Postoperative cervical kyphosis and sagittal imbalance significantly decreased neurologic improvement in the CSM group but not in the OPLL group. Conclusions: Elderly patients with CSM have significantly greater postoperative loss of lordosis and increase in C1-C7 SVA than nonelderly patients, and both postoperative kyphotic deformity and sagittal imbalance significantly deteriorate neurologic recovery. On the other hand, although patients with OPLL, irrespective of patient age and preservation of C7, have significantly more loss of lordosis and increase in C1-C7 SVA than CSM patients, neither postoperative kyphotic deformity nor sagittal imbalance significantly deteriorates neurologic recovery in OPLL patients.

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New double-door laminoplasty procedure for the axis to preserve all muscular attachments to the spinous process

Neurosurgical FOCUS ◽

10.3171/foc.2002.12.1.10 ◽

2002 ◽

Vol 12 (1) ◽

pp. 1-3 ◽

Cited By ~ 15

Author(s):

Tateru Shiraishi ◽

Yoshiyuki Yato

Keyword(s):

Cervical Myelopathy ◽

Spinal Canal ◽

Spinous Process ◽

Posterior Longitudinal Ligament ◽

Neurological Improvement ◽

Radiological Evidence

To prevent the occurrence of postoperative cervical malalignment, which is often a complication of conventional axial laminectomy or laminoplasty, the authors developed a new double-door laminoplasty procedure in which the C-2 spinal canal is expanded while all the muscular attachments to each split half of the spinous process remain undisturbed. In conjunction with laminoplasties at other levels, this procedure was performed in five patients with ossification of the posterior longitudinal ligament and cervical myelopathy. Neurological improvement was demonstrated in each patient, and there was no radiological evidence of cervical malalignment. The technique for this procedure is described and its usefulness in preventing postoperative spinal malalignment is discussed.

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A Case Report of Ossification of the Posterior Longitudinal Ligament of the Cervical Spine. Postoperative Changes in the Cervical Spinal Cord.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.43.199 ◽

1994 ◽

Vol 43 (1) ◽

pp. 199-201

Author(s):

Mitsuhiro Kimura ◽

Shinya Kawai ◽

Minoru Saika ◽

Kouzou Nomura ◽

Yousuke Ikeda ◽

...

Keyword(s):

Spinal Cord ◽

Case Report ◽

Cervical Spine ◽

Cervical Spinal Cord ◽

Posterior Longitudinal Ligament ◽

Postoperative Changes

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Post-operative neurological improvement is associated with significant neck pain attenuation after surgery for cervical ossification of the posterior longitudinal ligament: a prospective multicenter registry study

10.21203/rs.3.rs-139889/v1 ◽

2021 ◽

Author(s):

Masao Koda ◽

Toshitaka Yoshii ◽

Satoru Egawa ◽

Kenichiro Sakai ◽

Kazuo Kusano ◽

...

Keyword(s):

Neck Pain ◽

Positive Association ◽

Posterior Longitudinal Ligament ◽

Neurological Recovery ◽

Registry Study ◽

Significant Positive Association ◽

Cervical Spine Surgery ◽

Neurological Improvement ◽

Significant Difference ◽

Multicenter Registry

Abstract Although favourable surgical outcomes for myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) have been reported, factors significantly associated with post-operative neck pain attenuation still remain unclear. The primary aim of the present study was to determine factors significantly associated with post-operative neck pain attenuation in patients with cervical OPLL using a prospective multi-centre registry of surgically treated cervical OPLL. Significant postoperative neck pain reduction (50% reduction of neck pain) was achieved in 84 patients (30.9%). There was no significant difference in neck pain attenuation between surgical procedures. Statistical analyses revealed neurological recovery as a factor having a significant positive association with post-operative neck pain attenuation (p = 0.04). Neurological recovery was an independent factor having a significant positive association with post-operative neck pain attenuation in patients with cervical myelopathy caused by OPLL who underwent cervical spine surgery.

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Predictors of neurologic outcome after surgery for cervical ossification of the posterior longitudinal ligament differ based on myelopathy severity: a multicenter study

Journal of Neurosurgery Spine ◽

10.3171/2020.8.spine20504 ◽

2021 ◽

pp. 1-10

Author(s):

Jun Jae Shin ◽

Hyeongseok Jeon ◽

Jong Joo Lee ◽

Hyung Cheol Kim ◽

Tae Woo Kim ◽

...

Keyword(s):

Multicenter Study ◽

Signal Intensity ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Older Age ◽

Neurological Recovery ◽

High Signal ◽

Neurological Improvement ◽

The Mean

OBJECTIVE The purpose of this retrospective multicenter study was to compare prognostic factors for neurological recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL) based on their presenting mild, moderate, or severe myelopathy. METHODS The study included 372 consecutive patients with OPLL who underwent surgery for cervical myelopathy between 2006 and 2016 in East Asian countries with a high OPLL prevalence. Baseline and postoperative clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) myelopathy score and recovery ratio. Radiographic assessment included occupying ratio, cervical range of motion, and sagittal alignment parameters. Patient myelopathy was classified as mild, moderate, or severe based on the preoperative JOA score. Linear and multivariate regression analyses were performed to identify patient and surgical factors associated with neurological recovery stratified by baseline myelopathy severity. RESULTS The mean follow-up period was 45.4 months (range 25–140 months). The mean preoperative and postoperative JOA scores and recovery ratios for the total cohort were 11.7 ± 3.0, 14.5 ± 2.7, and 55.2% ± 39.3%, respectively. In patients with mild myelopathy, only age and diabetes correlated with recovery. In patients with moderate to severe myelopathy, older age and preoperative increased signal intensity on T2-weighted imaging were significantly correlated with a lower likelihood of recovery, while female sex and anterior decompression with fusion (ADF) were associated with better recovery. CONCLUSIONS Various patient and surgical factors are correlated with likelihood of neurological recovery after surgical treatment for cervical OPLL, depending on the severity of presenting myelopathy. Older age, male sex, intramedullary high signal intensity, and posterior decompression are associated with less myelopathy improvement in patients with worse baseline function. Therefore, myelopathy-specific preoperative counseling regarding prognosis for postoperative long-term neurological improvement should include consideration of these individual and surgical factors.

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Decisive Diagnosis of Infected Mandibular Osteoradionecrosis with a Tc-99m-labelled Anti-granulocyte Fab′-fragment

Nuklearmedizin ◽

10.1055/s-0038-1632227 ◽

1999 ◽

Vol 38 (07) ◽

pp. 309-311 ◽

Cited By ~ 3

Author(s):

W. Brenner ◽

H. Terheyden ◽

K. H. Bohuslavizki ◽

E. Henze ◽

W. U. Kampen

Keyword(s):

Blood Pool ◽

Bone Scanning ◽

Acute Osteomyelitis ◽

Elevated Blood ◽

Fab Fragment ◽

Postoperative Changes ◽

Three Phase ◽

Golden Standard ◽

Blood Pool Activity ◽

Bone Inflammation

SummaryThe accepted golden standard for detection of inflammatory bone disease is conventional three-phase bone scanning. Hyperperfusion, a high blood-pool activity and elevated bone metabolism are typical signs for an acute osteomyelitis. However, in case of subacute, chronic inflammation, neither elevated blood flow nor high blood-pool activity may be seen. This may cause difficulties in differentiating such cases from neoplastic or postoperative changes. This case report verifies the possible advantage of immunoscintigraphy with Tc-99m-labelled antigranulocyte Fab′-fragments (LeukoScan®) in a patient with infected mandibular osteoradionecrosis, who had equivocal clinical symptomes and questionable radiographic results. LeukoScan® is shown to be more sensitive in case of subacute bone inflammation compared with three-phase bone scanning. However, acquisition of delayed images after 24 hours including SPECT is inevitable in case of negative scans during the first hours of investigation.

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