Surgical outcomes of cervical myelopathy due to ossification of posterior longitudinal ligament: Anterior decompression and fusion versus posterior laminoplasty

Object. The authors conducted a study to examine the incidence and causes of postoperative C-5 radiculopathy, and they suggest preventive methods for C-5 palsy after anterior corpectomy and fusion. Methods. The authors included in the study 18 patients with postoperative C-5 radiculopathy from 563 patients who underwent anterior decompression and fusion for cervical myelopathy. There were 10 cases of ossification of the posterior longitudinal ligament (OPLL) and eight cases of cervical spondylotic myelopathy (CSM). All patients received conservative treatment. Posttreatment full recovery was present in eight patients, and Grade 3/5 strength was documented in six in whom some weakness remained. Radiographic evaluation revealed that the C3–4 and C4–5 cord compression was significantly more severe in patients with paralysis than in those without paralysis. The incidence of paralysis was higher in patients with OPLL than in those with CSM (chi-square test, p = 0.03). The incidence of paralysis increased in parallel with the number of fusion levels (correlation coefficient r = 0.94). Multivariate analysis revealed that the final manual muscle testing (MMT) value was closely related to the preoperative MMT value (computed t value 4.17; p < 0.01) and preoperative Japanese Orthopaedic Association (JOA) score for cervical myelopathty (computed t value, 2.75; p < 0.05). Conclusions. Preexisting severe stenosis at C3–4 or C4–5 in patients with OPLL is a risk factor for paralysis. Preoperative muscle weakness and a low JOA score are factors predictive of poor recovery.

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Outcomes of fusion surgery for ossification of the posterior longitudinal ligament of the thoracic spine: a multicenter retrospective survey

Journal of Neurosurgery Spine ◽

10.3171/2011.6.spine10816 ◽

2011 ◽

Vol 15 (4) ◽

pp. 380-385 ◽

Cited By ~ 50

Author(s):

Morio Matsumoto ◽

Yoshiaki Toyama ◽

Hirotaka Chikuda ◽

Katsushi Takeshita ◽

Tsuyoshi Kato ◽

...

Keyword(s):

Scale Score ◽

Thoracic Spine ◽

Surgical Outcomes ◽

Recovery Rate ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

High Rate ◽

Anterior Decompression ◽

Fusion Surgery ◽

Surgical Methods

Object The aim of this study was to evaluate the outcomes of fusion surgery in patients with ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) and to identify factors significantly related to surgical outcomes. Methods The study included 76 patients (34 men and 42 women with a mean age of 56.3 years) who underwent fusion surgery for T-OPLL at 7 spine centers during the 5-year period from 2003 to 2007. The authors evaluated the patient demographic data, underlying disease, preoperative comorbidities, history of spinal surgery, radiological findings, surgical methods, surgical outcomes, and complications. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score for thoracic myelopathy (11 points) and the recovery rate. Results The mean JOA scale score was 4.6 ± 2.1 points preoperatively and 7.7 ± 2.5 points at the time of the final follow-up examination, yielding a mean recovery rate of 45.4% ± 39.1%. The recovery rates by surgical method were 38.5% ± 37.8% for posterior decompression and fusion, 65.0% ± 35.6% for anterior decompression and fusion via an anterior approach, 28.8% ± 41.2% for anterior decompression via a posterior approach, and 57.5% ± 41.1% for circumferential decompression and fusion. The recovery rate was significantly higher in patients without diabetes mellitus (DM) than in those with DM. One or more complications were experienced by 31 patients (40.8%), including 20 patients with postoperative neurological deterioration, 7 with dural tears, 5 with epidural hematomas, 4 with respiratory complications, and 10 with other complications. Conclusions The outcomes of fusion surgery for T-OPLL were favorable. The absence of DM correlated with better outcomes. However, a high rate of complications was associated with the fusion surgery.

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Recurrence of Cervical Myelopathy Secondary to a Strut Graft Fracture 20 Years after Anterior Decompression and Fusion: A Case Report

Journal of Orthopaedic Surgery ◽

10.1177/230949901502300229 ◽

2015 ◽

Vol 23 (2) ◽

pp. 247-250 ◽

Cited By ~ 1

Author(s):

Kazunobu Kida ◽

Shogo Takaya ◽

Nobuaki Tadokoro ◽

Masashi Kumon ◽

Katsuhito Kiyasu ◽

...

Keyword(s):

Case Report ◽

Cervical Myelopathy ◽

Anterior Decompression ◽

Strut Graft ◽

Anterior Decompression And Fusion ◽

Graft Fracture

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Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine

Journal of Neurosurgery ◽

10.3171/jns.1981.55.1.0108 ◽

1981 ◽

Vol 55 (1) ◽

pp. 108-116 ◽

Cited By ~ 84

Author(s):

Hiroshi Abe ◽

Mitsuo Tsuru ◽

Terufumi Ito ◽

Yoshinobu Iwasaki ◽

Mitsuyuki Koiwa

Keyword(s):

Cervical Spine ◽

Marked Improvement ◽

Anterior Approach ◽

Posterior Longitudinal Ligament ◽

Long Bone ◽

Anterior Decompression ◽

Content Type ◽

Operative Results ◽

Vertebral Bodies ◽

Anterior Decompression And Fusion

✓ Anterior decompression and fusion for treating ossification of the posterior longitudinal ligament of the cervical spine was performed in 12 patients. The central part of the vertebral body and the ossified area of the posterior longitudinal ligament were removed by means of a microrongeur and an air drill. The defect was filled with a long bone graft taken from the ilium. The operative results were excellent. Marked improvement of radicular and spinal cord signs was seen in all 12 cases. Three vertebral bodies were fused in one case, four in nine cases, and five in two cases. The highest level of fusion was C-2 and the lowest was T-1. It is considered that any ossification of the ligament below the C-2 level can be removed via an anterior approach as long as no more than five vertebral bodies are involved. Spinal computerized tomography was valuable in providing more detailed information about the stenotic spinal canal and the shape of the ossified ligament.

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