scholarly journals Usefulness of K-line in predicting prognosis of laminoplasty for cervical spondylotic myelopathy

2020 ◽  
Author(s):  
Terumasa Ikeda ◽  
Hiroshi Miyamto ◽  
Masao Akagi
Keyword(s):  
Recovery Rate ◽  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Kyphosis Angle ◽  
Straight Line ◽  
Local Kyphosis ◽  
Magnetic Resonance Imaging Mri ◽  
Better Than

Abstract Background: K-line is widely recognized as a useful index to evaluate alignment and size of the cervical ossification of the posterior longitudinal ligament (OPLL) in one parameter. The purpose of this study was to investigate that K-line could be a tool to predict the prognosis of LP for cervical spondylotic myelopathy (CSM) as well. Methods: Sixty-eight patients who underwent LP were enrolled. C2-7 angle, local kyphosis angle, and K-line which is the straight line connecting the midpoints of the spinal canal at C2 and C7 was evaluated on T2- weighted sagittal magnetic resonance imaging (MRI). The JOA score and the recovery rate of the JOA score were evaluated at pre-operation and at follow-up. C2/C7 angle, local kyphosis angle, the JOA score, and the recovery rate were compared between K-line (-) and K-line (+) groups. Results: The recovery rate of K-line (+) group (50.6%) was significantly better than that of K-line (-) (19.4%). In K-line (-), the disc type in which the protruded disc was absorbed during the follow-up showed statistically better recovery rate (27.6%) at follow-up compared to other K-line (-) in which anterior cord compression due to the osteophyte or the kyphotic beak was not absorbed (osseous type, 5.0%).Conclusion: The present study has indicated that K-line can be a factor to predict the clinical outcome of LP for CSM. In K-line (-), the disc type showed somewhat better outcomes compared to the osseous type. However, the results were not sufficient.

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

2018 ◽  
Vol 9 (3) ◽  
pp. 266-271 ◽  
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.

scholarly journals Clinical adjacent-segment pathology after central corpectomy for cervical spondylotic myelopathy: incidence and risk factors

2016 ◽  
Vol 40 (6) ◽  
pp. E12 ◽  
Author(s):  
Aditya Vedantam ◽  
Vedantam Rajshekhar
Keyword(s):  
Risk Factors ◽  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Adjacent Segment ◽  
Initial Surgery ◽  
The Mean

OBJECTIVE The goal of this study was to investigate the prevalence and risk factors of clinical adjacent-segment pathology (CASP) following central corpectomy for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL). METHODS The authors reviewed 353 cases involving patients operated on by a single surgeon with a minimum 12-month follow-up after central corpectomy for CSM or OPLL between 1995 and 2007. Patients with symptoms consistent with CASP at follow-up were selected for the study. The authors analyzed the prevalence and risk factors for CASP after central corpectomy for CSM/OPLL. RESULTS Fourteen patients (13 male, 1 female; mean age 46.9 ± 7.7 years) were diagnosed with symptoms of CASP (3.9% of 353 patients) at follow-up. The mean interval between the initial surgery and presentation with symptoms of CASP was 95.6 ± 54.1 months (range 40–213 months). Preoperative Nurick grades ranged from 2 to 5 (mean 3.5 ± 1.2), and the Nurick grades at follow-up ranged from 1 to 5 (mean 3.0 ± 1.3, p = 0.27). Twelve patients had myelopathic symptoms and 2 had radiculopathy at follow-up. Patients with poorer preoperative Nurick grades had a higher risk for development of CASP (HR 2.6 [95% CI 1.2–5.3], p = 0.01). CONCLUSIONS In the present study, CASP was seen in 3.9% of patients following central corpectomy for CSM/OPLL. The risk of CASP after central corpectomy for CSM/OPLL was higher in patients with poorer preoperative Nurick grades.

Bilateral multilevel laminectomy with or without posterolateral fusion for cervical spondylotic myelopathy: relationship to type of onset and time until operation

1996 ◽  
Vol 85 (3) ◽  
pp. 447-451 ◽  
Author(s):  
Chiaki Hamanishi ◽  
Seisuke Tanaka
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Posterolateral Fusion ◽  
Content Type ◽  
Insidious Onset ◽  
Relationship Of ◽  
The Relationship ◽  
Preoperative Factors

✓ The authors retrospectively evaluated the relationship of several preoperative factors in 69 patients who had myelopathy due to multilevel cervical spondylosis without ossification of the posterior longitudinal ligament treated with Kirita's bilateral wide laminectomy. In 34 patients with focal instability or malalignments, posterolateral fusion was also combined. The clinical results at an average follow-up period of 3.5 years (range 1–10 years) after operation in the groups that had and had not undergone fusion were equally satisfactory, and preoperative focal instability was believed to be the sole useful indication for adding posterolateral fusion. The patients were classified in three groups according to the acuteness of the onset. The type of onset and time until operation were found to be the factors most strongly related to prognosis, and clinical outcome was correlated with the duration after onset when plotted as days in the acute, months in the subacute, and years in the insidious onset groups. Wide laminectomy with or without posterolateral fusion is a simple operation that is recommended, provided that it is performed early enough according to the type of onset.

scholarly journals Analysis of Related Factors on The Vertebral Height Restoration of Percutaneous Vertebral Augmentation

2019 ◽  
Vol 104 (7-8) ◽  
pp. 398-405
Author(s):  
Weixing Xie
Keyword(s):  
Vertebral Body ◽  
Compression Ratio ◽  
Univariate Analysis ◽  
Body Height ◽  
Height Loss ◽  
Loss Ratio ◽  
Vertebral Body Height ◽  
Kyphosis Angle ◽  
Local Kyphosis

Background Percutaneous vertebral augmentation (PVA) is widely applied for the treatment of osteoporotic vertebral fractures. The degree of vertebral body height restoration and deformity correction after the procedure is not consistent. Methods We retrospectively reviewed 97 patients who underwent PVA, because of osteoporotic vertebral compression fractures. The following data about the patients were recorded: age, sex, bone density, number of treated vertebrae, severity of fracture of the treated vertebrae, operative approach (PVP or PKP), volume of injected bone cement, preoperative vertebral compression ratio, preoperative local kyphosis angle, cement leakage, postoperative vertebral body height restoration ratio, follow-up period, and latest follow-up height loss ratio. Bivariate regression analysis and t-test were applied for univariate analysis, while multivariate linear regression analysis was applied for multivariate analysis. Results The postoperative vertebral body height restoration ratio was (14.7% ± 15.2%), and the last follow-up height loss ratio was (13.5% ± 11.5%). The multivariate analysis showed that the number of treated vertebrae, preoperative vertebral compression ratio, and preoperative local kyphosis angle are the main factors influencing the postoperative vertebral body height restoration. The univariate analysis also showed that only the postoperative vertebral body height restoration ratio is related to the last follow-up height loss ratio. Conclusions The number of treated vertebrae, preoperative vertebral compression ratio, and preoperative local kyphosis angle are the main influencing factors of patients' vertebral body height restoration after PVA, and the postoperative vertebral body height restoration ratio is the main factor influencing the last follow-up height loss ratio.

scholarly journals Anterior selective stabilization combined with laminoplasty for cervical myelopathy due to massive ossification of the posterior longitudinal ligament: report of early outcomes in 14 patients

2020 ◽  
Vol 33 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Yukitaka Nagamoto ◽  
Motoki Iwasaki ◽  
Shinya Okuda ◽  
Tomiya Matsumoto ◽  
Tsuyoshi Sugiura ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Recovery Rate ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Radiographic Parameters ◽  
Selective Stabilization ◽  
The Mean ◽  
Segmental Lordosis ◽  
Compression Level

OBJECTIVESurgical management of massive ossification of the posterior longitudinal ligament (OPLL) is challenging. To reduce surgical complications, the authors have performed anterior selective stabilization combined with laminoplasty (antSS+LP) for massive OPLL since 2012. This study aimed to elucidate the short-term outcome of the antSS+LP procedure.METHODSThe authors’ analysis was based on data from 14 patients who underwent antSS+LP for cervical myelopathy caused by massive OPLL and were followed up for at least 2 years after surgery (mean follow-up duration 3.3 years). Clinical outcome was evaluated preoperatively, at 6 months and 1 year postoperatively, and at the final follow-up using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy and the recovery rate of the JOA score. The following radiographic parameters were measured preoperatively, immediately after surgery, at 1 year after surgery, and at the final follow-up: the C2–7 angle, measured on lateral plain radiographs, and the segmental lordosis angle (SLA), measured on sagittal CT scans. The correlation between radiographic parameters and clinical outcomes was evaluated.RESULTSThe mean JOA score increased from 10.4 before surgery to 13.6 and 13.8 at 6 months and 1 year after surgery, respectively; at the final follow-up the mean score was 13.4. This postoperative recovery was significant (p = 0.004) and was maintained until the final follow-up. No patient required revision surgery due to postoperative neurological deterioration. However, the C2–7 angle gradually deteriorated postoperatively. Similarly, the SLA was significantly increased immediately after surgery, but the improvement was not maintained. The recovery rate at the final follow-up correlated positively with the change in C2–7 angle (r = 0.60, p = 0.03) and the change in SLA (r = 0.72, p < 0.01).CONCLUSIONSAntSS+LP is safe and effective and may be an alternative to anterior decompression and fusion for the treatment of patients with massive OPLL. No postoperative neurological complications or significant postoperative exacerbation of neck pain were observed in our case series. Not only reducing intervertebral motion and decompressing the canal at the maximal compression level but also acquiring segmental lordosis at the maximal compression level are crucial factors for achieving successful outcomes of antSS+LP.

scholarly journals Effect of microscopically assisted decompression with micro-hook scalpel in the surgical treatment of ossification of the posterior longitudinal ligament

2019 ◽  
Vol 47 (10) ◽  
pp. 5120-5129 ◽  
Author(s):  
Sheng Yang ◽  
Jianmin Lu ◽  
Dapeng Fu ◽  
Depeng Shang ◽  
Fei Zhou ◽  
...  
Keyword(s):  
Recovery Rate ◽  
Spinal Canal ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Clinical Effects ◽  
Posterior Surgery ◽  
Vas Score ◽  
Group A ◽  
Group B

Objective This study was performed to investigate the effect of microscopically assisted decompression using a micro-hook scalpel on ossification of the posterior longitudinal ligament (OPLL). Methods Sixty-one patients with OPLL were divided into Group A (posterior surgery with laminectomy of the responsible segment and lateral mass screw fixation) and Group B (anterior cervical corpectomy with intervertebral titanium cage fusion). Neurological function was assessed by the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and recovery rate. The fixation status and the result of spinal canal decompression were radiographically assessed. Results In Groups A and B, the JOA score was significantly higher and the VAS score was significantly lower at 1 week postoperatively and at the final follow-up than during the preoperative period. The mean recovery rate in Group A and B was 59.92% ± 13.46% and 62.28% ± 14.00%, respectively. Postoperative radiographs showed good positioning and no damage to the internal fixation materials. The spinal canal was also fully decompressed. Conclusions Microscopically assisted decompression with a micro-hook scalpel in both anterior and posterior surgeries achieved good clinical effects in patients with OPLL.

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

2010 ◽  
Vol 12 (1) ◽  
pp. 33-38 ◽  
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.

scholarly journals Surgical Management of Cervical Spondylotic Myelopathy

2012 ◽  
Vol 52 (188) ◽  
Author(s):  
S Sah ◽  
L Wang ◽  
M Dahal ◽  
P Acharya ◽  
R Dwivedi
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Cord Compression ◽  
High Signal ◽  
X Ray ◽  
Surgical Methods ◽  
Physical Examinations ◽  
Anterior Posterior

Introduction: The surgical procedure by the anterior, posterior and combined antero-posterior approaches had applied for the treatment of cervical spondylotic myelopathy.  Methods: During the treatment process, all patients were pre-operatively as well post-operatively graded according to Japanese Orthopaedics Association. Several surgical methods such as anterior approach, posterior approach, and combined antero-posterior approach have been addressed for CSM patients, with the choice based on the pathogenesis of the myelopathy. The main indications for surgery were evidence of myelopathy on physical examinations, a JOA score below 13 points help with spinal cord compression observed on plain X-ray, CT scan, MRI studies.  Results: The pre-operative JOA scores were 7.60±1.23 in laminoplasty, 8.30±1.03 in diskectomy and corpectomy and 7.10±1.20 in combined antero-posterior approach patients. At the follow-up after three months the JOA scores were laminoplasty 13.30±1.30, diskectomy and corpectomy 13.55±1.15 and combined antero-posterior 13.50±1.08. The JOA recovery rate averaged, 61.08±11.25% in laminoplasty, 60.67±10.60% in diskectomy and corpectomy and 64.67±10.72% in combined anteroposterior approach. The high- signal intensity changed to normal in 18 out of 28 and no any kyphotic change and instability were found in cervical spine at the follow up.  Conclusions: Patients with OPLL (continuous, segmental and mixed type), stenosis of cervical spinal canal, multilevel cervical spondylosis, large and high ossification of IVDP with stenosis were improved with laminoplasty. Patients with PIVD, CSM with kyphosis, post laminectomy , OPLL herniated type, unstable vertebral alignment, stenosis by osteophytes, were improved with anterior approach . Ossified or deformed OPLL, unstable vertebral with stenosis ,OPLL or OYL with cervical meandearing (swan-neck) were improved with Combined anterior and posterior approach. Keywords: cervical spondylotic mylopathy, anterior cervical diskectomy and fusion, corpectomy.

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.

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