The influence of approach side on facet preservation in microscopic bilateral decompression via a unilateral approach for degenerative lumbar scoliosis

2010 ◽  
Vol 13 (6) ◽  
pp. 758-765 ◽  
Author(s):  
Akira Matsumura ◽  
Takashi Namikawa ◽  
Hidetomi Terai ◽  
Tadao Tsujio ◽  
Akinobu Suzuki ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Recovery Rate ◽  
Japanese Orthopaedic Association ◽  
Spinal Instability ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Unilateral Approach ◽  
Scale Scores ◽  
The Mean

Object The authors compared the clinical outcomes of microscopic bilateral decompression via a unilateral approach (MBDU) for the treatment of degenerative lumbar scoliosis (DLS) and for lumbar canal stenosis (LCS) without instability. The authors also compared postoperative spinal instability in terms of different approach sides (concave or convex) following the procedure. Methods The authors retrospectively reviewed data obtained in 50 consecutive patients (25 in the DLS group and 25 in the LCS group) who underwent MBDU; the minimum follow-up period was 2 years. Patients with DLS were divided into 2 subgroups according to the surgical approach side: a concave group (23 segment) and a convex group (17 segments). The Japanese Orthopaedic Association Scale scores for the assessment of low-back pain were evaluated before surgery and at final follow-up. The Japanese Orthopaedic Association Scale scores and recovery rates were compared between the DLS and LCS groups, and between the convex and concave groups. Cobb angle and scoliotic wedging angle (SWA) were evaluated on standing radiographs before surgery and at final follow-up. Facet joint preservation (the percentage of preservation) was assessed on pre- and postoperative CT scans, compared between the LCS and DLS groups, and compared between the concave and convex groups. The influence of approach side on postoperative progression of segmental instability was also examined in the DLS group. Results The mean recovery rate was 58.7% in the DLS and 62.0% in the LCS group. The mean recovery rate was 58.6% in the convex group and 60.6% in the concave group. There were no significant differences in recovery rates between the LCS and DLS groups, or between the DLS subgroups. The mean Cobb angles in the DLS group were significantly increased from 12.7° preoperatively to 14.1° postoperatively (p < 0.05), and mean preoperative SWAs increased significantly from 6.2° at L3–4 and 4.1° at L4–5 preoperatively to 7.4° and 4.9°, respectively, at final follow-up (p < 0.05). There was no significant difference in percentage of preservation between the DLS and LCS groups. The mean percentages of preservation on the approach side in the DLS group at L3–4 and L4–5 were 89.0% and 83.1% in the convex group, and those in the concave group were 67.3% and 77.6%, respectively. The percentage of preservation at L3–4 was significantly higher in the convex than the concave group. The mean SWA had increased in the concave group (p = 0.01) but not the convex group (p = 0.15) at final follow-up. Conclusions The MBDU can reduce postoperative segmental spinal instability and achieve good postoperative clinical outcomes in patients with DLS. The convex approach provides surgeons with good visibility and improves preservation of facet joints.

scholarly journals The surgical outcome of decompression alone versus decompression with limited fusion for degenerative lumbar scoliosis

2018 ◽  
Vol 29 (3) ◽  
pp. 259-264 ◽  
Author(s):  
Kenji Masuda ◽  
Takayuki Higashi ◽  
Katsutaka Yamada ◽  
Tatsuhiro Sekiya ◽  
Tomoyuki Saito
Keyword(s):  
Decision Making ◽  
Cobb Angle ◽  
Japanese Orthopaedic Association ◽  
Spinal Instability ◽  
Degenerative Lumbar Scoliosis ◽  
Surgical Decision ◽  
Lumbar Scoliosis ◽  
Radiological Parameters ◽  
Surgical Decision Making

OBJECTIVEThe aim of this study was to assess the usefulness of radiological parameters for surgical decision-making in patients with degenerative lumbar scoliosis (DLS) by comparing the clinical and radiological results after decompression or decompression and fusion surgery.METHODSThe authors prospectively planned surgical treatment for 298 patients with degenerative lumbar disease between September 2005 and March 2013. The surgical method used at their institution to address intervertebral instability is precisely defined based on radiological parameters. Among 64 patients with a Cobb angle ranging from 10° to 25°, 57 patients who underwent follow-up for more than 2 years postoperatively were evaluated. These patients were divided into 2 groups: those in the decompression group underwent decompression alone (n = 25), and those in the fusion group underwent decompression and short segmental fusion (n = 32). Surgical outcomes were reviewed, including preoperative and postoperative Cobb angles, lumbar lordosis based on radiological parameters, and Japanese Orthopaedic Association (JOA) scores.RESULTSThe JOA scores of the decompression group and fusion group improved from 5.9 ± 1.6 to 10.0 ± 2.8 and from 7.2 ± 2.0 to 11.3 ± 2.8, respectively, which was not significantly different between the groups. At the final follow-up, the postoperative Cobb angle in the decompression group changed from 14° ± 2.9° to 14.3° ± 6.4° and remained stable, while the Cobb angle in the fusion group decreased from 14.8° ± 4.0° to 10.0° ± 8.5° after surgery.CONCLUSIONSThe patients in both groups demonstrated improved JOA scores and preserved Cobb angles after surgery. The improvement in JOA scores and preservation of Cobb angles in both groups show that the evaluation of spinal instability using radiological parameters is appropriate for surgical decision-making.

scholarly journals The Long-term Clinical Outcomes of Magerl's Technique Combined with Single Laminar Clamp Internal Fixation in Treatment of Reducible Atlantoaxial Dislocation

2020 ◽  
Author(s):  
Xiaoshuai Wang ◽  
Hua Wang ◽  
Guoliang Chen ◽  
Shangbin Cui ◽  
Lanzhe Yu ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Clinical Outcomes ◽  
Recovery Rate ◽  
Perioperative Complications ◽  
Japanese Orthopaedic Association ◽  
Atlantoaxial Dislocation ◽  
Cord Injury ◽  
The Mean

Abstract Background. To evaluate the long⁃term clinical outcomes of Magerl's technique combined with single laminar clamp internal fixation in treatment of reducible atlantoaxial dislocation. Methods. Data of 21 patients diagnosed with reducible atlantoaxial dislocation underwent Magerl’s technique(C1-2 posterior transarticular screw fixation) combined with single laminar clamp internal fixation and fusion were retrospectively reviewed from January 2004 to September 2015.The clinical and radiological outcomes were investigated according to the Symonand Lavender clinical standard, the score of Japanese Orthopaedic Association (JOA), and the imaging index space available for the cord (SAC), the atlas⁃dens interval (ADI), respectively. The perioperative complications, operative data, and status of bony fusion were also collected and analyzed. Results. All the patients were followed up successfully. All the patients achieved substantially bone fusion according to the X-ray and CT scan. There were no intra-operative complications observed. The ADI was corrected significantly with the mean preoperative 6.13±1.84 mm, initial postoperative 1.62±0.77 mm, and the final follow-up 2.02±1.01 mm respectively(P<0.05).The SAC was also improved significantly with the mean preoperative 10.42±2.53 mm, initial postoperative 17.83±2.41 mm, and the final follow-up 16.91±2.02 mm respectively (P<0.05).The clinical recovery rate according to the Symonand Lavender clinical standard and the JOA recovery rate was 90.5% and 81.2% respectively, which showed significantly improved following surgery (P<0.05). Conclusions. This study demonstrates that Magerl’s technique combined with single laminar clamp internal fixation is effective and reliable in management of reducible atlantoaxial dislocation, which can simplify the operative manipulation and decrease the risk of iatrogenic spinal cord injury.

scholarly journals Clinical and Radiological Outcomes after Microscopic Bilateral Decompression via a Unilateral Approach for Degenerative Lumbar Disease: Minimum 5-Year Follow-Up

2017 ◽  
Vol 11 (2) ◽  
pp. 285-293 ◽  
Author(s):  
Sho Dohzono ◽  
Hiromitsu Toyoda ◽  
Akira Matsumura ◽  
Hidetomi Terai ◽  
Akinobu Suzuki ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Facet Joint ◽  
Spinal Instability ◽  
Degenerative Lumbar Scoliosis ◽  
Facet Joints ◽  
Unilateral Approach ◽  
Lumbar Spinal ◽  
Bone Regrowth

<sec><title>Study Design</title><p>A retrospective study.</p></sec><sec><title>Purpose</title><p>To assess postoperative bone regrowth at surgical sites after lumbar decompression with &gt;5 years of follow-up. Postoperative preservation of facet joints and segmental spinal instability following surgery were also evaluated.</p></sec><sec><title>Overview of Literature</title><p>Previous reports have documented bone regrowth after conventional laminectomy or laminotomy and several factors associated with new bone formation.</p></sec><sec><title>Methods</title><p>Forty-nine patients who underwent microscopic bilateral decompression via a unilateral approach at L4–5 were reviewed. Primary outcomes included correlations among postoperative bone regrowth, preservation of facet joints, radiographic parameters, and clinical outcomes. Secondary outcomes included comparative analyses of radiographic parameters and clinical outcomes among preoperative diagnoses (lumbar spinal stenosis, degenerative spondylolisthesis, and degenerative lumbar scoliosis).</p></sec><sec><title>Results</title><p>The average value of bone regrowth at the latest follow-up was significantly higher on the dorsal side of the facet joint (3.4 mm) than on the ventral side (1.3 mm). Percent facet joint preservation was significantly smaller on the approach side (79.2%) than on the contralateral side (95.2%). Bone regrowth showed a significant inverse correlation with age, but no significant correlation was observed with facet joint preservation, gender, postoperative segmental spinal motion, or clinical outcomes. Subanalysis of these data revealed that bone regrowth at the latest follow-up was significantly greater in patients with degenerative lumbar scoliosis than in those with lumbar spinal stenosis. Postoperative segmental spinal motion at L4–L5 did not progress significantly in patients with degenerative spondylolisthesis or degenerative lumbar scoliosis compared with those with lumbar spinal stenosis.</p></sec><sec><title>Conclusions</title><p>Microscopic bilateral decompression via a unilateral approach prevents postoperative spinal instability because of satisfactory preservation of facet joints, which may be the primary reason for inadequate bone regrowth. Postoperative bone regrowth was not related to clinical outcomes and postoperative segmental spinal instability.</p></sec>

Results of degenerative spondylolisthesis treated with posterior decompression alone via a new surgical approach

2001 ◽  
Vol 95 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Tomoaki Kinoshita ◽  
Isao Ohki ◽  
Kenneth R. Roth ◽  
Kageharu Amano ◽  
Hideshige Moriya
Keyword(s):  
Japanese Orthopaedic Association ◽  
Degenerative Spondylolisthesis ◽  
Spinal Instability ◽  
Content Type ◽  
Significant Difference ◽  
Potential Alternative ◽  
The Mean ◽  
New Surgical Technique ◽  
Fine Print

Object. The purpose of this study was to assess radiologically demonstrated results and clinical outcomes in patients with degenerative spondylolisthesis who underwent posterior decompressive surgery via a new (unilateral) approach. This approach allows surgeons to perform central and bilateral decompression while only stripping the muscles unilaterally, thus preserving the posterior osteoligamentous complexes. Methods. The authors evaluated 51 consecutive patients in whom surgery was performed between 1987 and 1996. The mean follow-up period was 4.7 years. There was no statistically significant difference between the pre- and postoperative measurements in percentage of vertebral slippage. Postoperative dynamic angulation statistically decreased compared with its preoperative value (p < 0.05). Improvement of an average of 67% was shown on the Japanese Orthopaedic Association scale, and in 78% of these patients, good to excellent results were demonstrated. Secondary fusion was required in only three patients (5.9%). Conclusions. This new surgical technique offers a potential alternative for the treatment of degenerative spondylolisthesis in a minimally invasive manner, avoiding the risk of causing or aggravating postoperative spinal instability.

CHALLENGING DEGENERATIVE LUMBAR SCOLIOSIS WITH SEGMENTAL CORRECTIVE FUSION SURGERY

2006 ◽  
Vol 10 (03) ◽  
pp. 141-150 ◽  
Author(s):  
Takahiro Iizuka ◽  
S. Yamada
Keyword(s):  
Spinal Curvature ◽  
Degenerative Lumbar Scoliosis ◽  
Spinal Alignment ◽  
Poor Bone Quality ◽  
Fusion Surgery ◽  
Lumbar Scoliosis ◽  
Cobb’S Angle ◽  
Correction Surgery ◽  
The Mean

Changes in the curvature have not been reported in degenerative lumbar scoliosis (DLS) when the correction surgery was performed. The purpose of our study was to clarify the influence of the correction surgery of DLS. Twenty-one patients underwent corrective lumbar reconstruction surgery (1998–2003) only at the neurologically affected levels. The spinal curvature was retrospectively evaluated in these 21 patients with DLS using Cobb's methods. The mean preoperative Cobb's angle was 17.7° while the mean postoperative Cobb's angle was 6.1° (p < 0.0001) at 1 month after the surgery and 9.0° at the final follow-up. The correction rate was 65.2% at 1 month after the surgery and 50.2% at the final follow-up. Cobb's angle increased by 2.9°/43.4 months (mean, 0.80°/year) in these procedure. The surgical goals of DLS are the relief of neurological disorders and the cessation of the deterioration of spinal alignment. Strategies for DLS may include complete decompression, or correction of the spinal alignment in elderly patients with poor bone quality. Decompression and correction in the PLIF procedure only at neurologically affected levels may be one of the surgical procedures to challenge DLS.

Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period

2006 ◽  
Vol 4 (3) ◽  
pp. 198-205 ◽  
Author(s):  
Hiroshi Taneichi ◽  
Kota Suda ◽  
Tomomichi Kajino ◽  
Akira Matsumura ◽  
Hiroshi Moridaira ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Japanese Orthopaedic Association ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Anterior Column ◽  
Lumbar Interbody Fusion ◽  
Anterior Column Support ◽  
The Mean

Object There are no published reports of unilateral transforaminal lumbar interbody fusion (TLIF) in which two Brantigan I/F cages were placed per level through a single portal to achieve bilateral anterior-column support. The authors describe such a surgical technique and evaluate the clinical outcomes of this procedure. Methods Data obtained in 86 (93.5%) of the first 92 consecutive patients who underwent the procedure were retrospectively reviewed; the minimum follow-up duration was 2 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Disc height, disc angle, cage positioning in the axial plane, and fusion status were radiographically evaluated. The mean follow-up period was 33.8 months. The mean improvement in the JOA score was 77.2%. Fusion was successful in 93% of the cases. According to the Farfan method, the mean anterior and posterior disc heights increased from 20.2 and 16.9% preoperatively to 35.9 and 22.7% at follow up, respectively (p < 0.01). The mean disc angle increased from 4.8° preoperatively to 7.5° at last follow-up examination (p < 0.01). Two cages were correctly placed to achieve bilateral anterior-column support in greater than 85% of the cases. The following complications occurred: hardware migration in two patients and deep infection cured by intravenous antibiotic therapy in one patient. Conclusions Unilateral TLIF involving the placement of two Brantigan cages per level led to good clinical results. Two Brantigan cages were adequately placed via a single portal, and reliable bilateral anterior-column support was achieved. Although the less invasive unilateral approach was used, the outcomes were as good as those in many reported series of posterior lumbar interbody fusion in which the Brantigan cages were placed via the bilateral approach.

scholarly journals Comparison between dynamic stabilization and instrumented fusion in the treatment of spinal stenosis with degenerative lumbar scoliosis

2019 ◽  
Author(s):  
Lei Luo ◽  
Lang Fang ◽  
Qiang Zhou ◽  
Chen Zhao ◽  
Pei Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Perioperative Complications ◽  
Dynamic Stabilization ◽  
Degenerative Lumbar Scoliosis ◽  
Instrumented Fusion ◽  
Lumbar Scoliosis ◽  
Significant Difference ◽  
Posterior Instrumented Fusion

Abstract Background Posterior instrumented fusion is the most widely accepted surgical treatment for spinal stenosis with degenerative lumbar scoliosis (DLS). However, long fusion can affect daily activities due to lumbar stiffness. Several clinical studies have shown that Dynesys dynamic stabilization in addition to laminectomy could lead to significant improvements in clinical outcomes. This study aimed to compare the outcomes of Dynesys dynamic stabilization with posterior instrumented fusion for the management of spinal stenosis with DLS. Methods Between August 2010 and Deccember 2015, a total of 46 patients with spinal stenosis and degenerative lumbar scoliosis were enrolled in this study. 26 patients (Dynesys group) had fenestration decompression, selective intervertebral fusion and Dynesys stabilizationin. 20 patients (fusion group) underwent posterior instrumented fusion. Clinical outcomes, radiographic data, and perioperative complications were compared between the two groups. The average duration of follow-up for the Dynesys group and fusion group was 38 and 33 months respectively. Results The mean number of fixed segments were 3.3±0.8 in Dynesys group and 4.3±0.8 in fusion group. Lower average values of operative duration and blood loss were observed in the dynamic group than in the fusion group. VAS for back and leg pain improved in both groups of patients. There were significant difference in ODI and LSDI (lumbar stiffness disability index) between Dynesys group and fusion group at the last follow-up. The scoliosis Cobb's angle and lumbar lordosis significantly improved in both groups after surgery, and no significant difference were observed between the groups at the last follow-up (P＞0.05). Dynesys stabilization resulted in significantly higher preservation of motion at the implanted segments. Conclusions This study demonstrated that both Dynesys dynamic stabilization and instrumented fusion can improve clinical outcomes of patients with degenerative lumbar scoliosis. Compared to instrumented fusion, Dynesys stabilizationin have advantages on blood loss, operation time, perioperative complications. In addition, Dynesys stabilization partially preserves the ROM of the stabilized segments that may reduce the limitation on daily activities caused by lumbar stiffness. Dynesys stabilizationin can also correct scoliosis, prevent progression of the curve, and maintain lumbar lordosis in mild to moderate lumbar scoliosis without sagittal imbalance.

scholarly journals Adult spinal deformity and its relationship with height loss: A 34-year longitudinal cohort study

2020 ◽  
Author(s):  
Mutsuya Shimizu ◽  
Tetsuya Kobayashi ◽  
Hisashi Chiba ◽  
Issei Senoo ◽  
Hiroshi Ito ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Epidemiological Studies ◽  
Height Loss ◽  
Degenerative Lumbar Scoliosis ◽  
Physical Change ◽  
Lumbar Scoliosis ◽  
Pelvic Parameters ◽  
The Mean

Abstract Background: Age-related height loss is a normal physical change that occurs in all individuals over 50 years of age. Although many epidemiological studies on height loss have been conducted worldwide, none have been long-term longitudinal epidemiological studies spanning over 30 years. This study was designed to investigate changes in adult spinal deformity and examine the relationship between adult spinal deformity and height loss.Methods: Fifty-three local healthy subjects (32 men, 21 women) from Furano, Hokkaido, Japan, volunteered for this longitudinal cohort study. Their heights were measured in 1983 and again in 2017. Spino-pelvic parameters were compared between measurements obtained in 1983 and 2017. Individuals with height loss were then divided into two groups, those with degenerative spondylosis and those with degenerative lumbar scoliosis, and different characteristics were compared between the two groups.Results: The mean age of the subjects was 44.4 (31-55) years at baseline and 78.6 (65-89) years at the final follow-up. The mean height was 157.4 cm at baseline and 153.6 cm at the final follow-up, with a mean height loss of 3.8 cm over 34.2 years. All parameters except for thoracic kyphosis were significantly different between measurements taken in 1983 and 2017 (p<0.05). Height loss in both sexes was related to changes in pelvic parameters including pelvic incidence-lumbar lordosis (R=0.460 p=0.008 in men, R=0.553 p=0.012 in women), pelvic tilt (R=0.374 p=0.035 in men, R=0.540 p=0.014 in women), and sagittal vertical axis (R=0.535 p=0.002 in men, R=0.527 p=0.017 in women). Greater height loss was more commonly seen in women (p=0.001) and in patients with degenerative lumbar scoliosis (p=0.02).Conclusions: This longitudinal study revealed that height loss is more commonly observed in women and is associated with adult spinal deformity and degenerative lumbar scoliosis. Height loss is a normal physical change with aging, but excessive height loss is due to spinal kyphosis and scoliosis leading to spinal malalignment. Our findings suggest that height loss might be an early physical symptom for spinal malalignment.

scholarly journals Adult spinal deformity and its relationship with height loss: A 34-year longitudinal cohort study

2020 ◽  
Author(s):  
Mutsuya Shimizu ◽  
Tetsuya Kobayashi ◽  
Hisashi Chiba ◽  
Issei Senoo ◽  
Hiroshi Ito ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Epidemiological Studies ◽  
Height Loss ◽  
Degenerative Lumbar Scoliosis ◽  
Physical Change ◽  
Lumbar Scoliosis ◽  
Pelvic Parameters ◽  
The Mean

Abstract Background Age-related height loss is a normal physical change that occurs in all individuals over 50 years of age. Many epidemiological studies were conducted on height loss worldwide, however, over the 30 years longitudinal epidemiological studies have not been conducted. This study was designed to investigate changes in adult spinal deformity and examine the relationship between adult spinal deformity and height loss. Methods Fifty-three local healthy subjects (32 men, 21 women) from Furano, Hokkaido, Japan, volunteered for this longitudinal cohort study. Their heights were measured in 1983 and again in 2017. Spino-pelvic parameters were compared between 1983 and 2017. Individuals with height loss were then divided into two groups, those with degenerative spondylosis and those with degenerative lumbar scoliosis, and different characteristics were compared between the two groups. Results The mean age of the subjects was 44.4 (31-55) years at baseline and 78.6 (65-89) years at the final follow-up. The mean height was 157.4 cm at baseline and 153.6 cm at the final follow-up, with a mean height loss of 3.8 cm over 34.2 years. All parameters except for thoracic kyphosis were significantly different between 1983 and 2017 (p<0.05). Height loss was related to changes in pelvic parameters including pelvic incidence-lumbar lordosis (R=0.553 p<0.0001), pelvic tilt (R=0.462 p<0.0001), and sagittal vertical axis (R=0.514 p<0.0001). Greater height loss was more commonly seen in women (p=0.001) and in patients with degenerative lumbar scoliosis (p=0.02). Conclusions This longitudinal study revealed that height loss is more commonly observed in women and is associated with adult spinal deformity and degenerative lumbar scoliosis. Height loss is a normal physical change with aging, but excessive height loss is due to spinal kyphosis and scoliosis leading to spinal malalignment. Our findings suggest that height loss might be an early physical symptom for spinal malalignment.

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.

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