Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine

2004 ◽  
Vol 1 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Yuto Ogawa ◽  
Yoshiaki Toyama ◽  
Kazuhiro Chiba ◽  
Morio Matsumoto ◽  
Masaya Nakamura ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Long Term Results ◽  
Open Door ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

Object. Numerous surgical procedures have been developed for treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, and these can be performed via three approaches: anterior, posterior, or combined anterior—posterior. The optimal approach in cases involving OPLL-induced cervical myelopathy, however, remains controversial. To address this issue, the authors assessed the benefits and limitations of expansive open-door laminoplasty for OPLL-related myelopathy by evaluating mid- and long-term clinical results. Methods. Clinical results obtained in 72 patients who underwent expansive open-door laminoplasty between 1983 and 1997 and who were followed for at least 5 years were assessed using the Japanese Orthopaedic Association (JOA) scoring system. The mean preoperative JOA score was 9.2 ± 0.4; at 3 years postoperatively, the JOA score was 14.2 ± 0.3 and the recovery rate (calculated using the Hirabayashi method) was 63.1 ± 4.5%, both having reached their highest level. These favorable results were maintained up to 5 years after surgery. An increase in cervical myelopathy due to progression of the ossified ligament was observed in only two of 30 patients who could be followed for more than 10 years. Severe surgery-related complications were not observed. Preoperative JOA score, age at the time of surgery, and duration between onset of initial symptoms and surgery affected clinical results. Conclusions. Mid-term and long-term results of expansive open-door laminoplasty were satisfactory. Considering factors that affected surgical results, early surgery is recommended for OPLL of the cervical spine.

Long-term results after expansive open-door laminoplasty for the segmental-type of ossification of the posterior longitudinal ligament of the cervical spine: a comparison with nonsegmental-type lesions

2005 ◽  
Vol 3 (3) ◽  
pp. 198-204 ◽  
Author(s):  
Yuto Ogawa ◽  
Kazuhiro Chiba ◽  
Morio Matsumoto ◽  
Masaya Nakamura ◽  
Hironari Takaishi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Long Term Results ◽  
Open Door ◽  
Intergroup Difference ◽  
Content Type ◽  
Fine Print ◽  
Group 1

Object. The segmental-type of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is distinct from other types in its morphological features. Whether the results of expansive open-door laminoplasty for the segmental-type are different from those for other types remains unclear. To clarify this issue, the long-term results after surgical treatment of segmental-type OPLL were compared with those of other types. Methods. Clinical results were documented in 57 patients who underwent expansive open-door laminoplasty and were followed for a minimum of 7 years, results were quantified using the Japanese Orthopaedic Association (JOA) scoring system to determine function. Segmental-type OPLL was observed in 10 patients (Group 1) and other types in 47 patients (Group 2). Preoperative JOA scores were not significantly different between the two groups. As many as 5 years after surgery, clinical results were favorable and maintained in both groups, and no significant intergroup difference in postoperative JOA scores was observed; however, after 5 years postoperatively, JOA scores decreased in both groups. The decrease was greater in Group 1, and a significant intergroup difference in JOA scores was demonstrated when analyzing final follow-up data. In Group 1, the authors found that the degree of late-onset deterioration relating to cervical myelopathy positively correlated with the cervical range of motion. Conclusions. The long-term results of expansive open-door laminoplasty in the treatment of segmental-type OPLL were inferior to those for other types. Cervical mobility may contribute to the development of late deterioration of cervical myelopathy.

Long-term follow-up results of laminectomy for cervical myelopathy caused by ossification of the posterior longitudinal ligament

1998 ◽  
Vol 89 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Yasuji Kato ◽  
Motoki Iwasaki ◽  
Takeshi Fuji ◽  
Kazuo Yonenobu ◽  
Takahiro Ochi
Keyword(s):  
Recovery Rate ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Neurological Deterioration ◽  
Long Term Results ◽  
Content Type ◽  
Cervical Laminectomy ◽  
Fine Print

Object. This retrospective study was performed to assess the long-term results of cervical laminectomy in treating ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. Methods. The authors reviewed medical records in 44 of 52 patients who underwent cervical laminectomy between 1970 and 1985 (mean follow up 14.1 years). The neurological recovery rate after laminectomy was 44.2% after 1 year and 42.9% after 5 years. The surgical outcome was maintained after 5 years but worsened between 5 and 10 years postsurgery: the recovery rate at the last follow-up review was 32.8%. Using multivariate stepwise analysis, the preoperative factors that affected clinical results were found to be the age at operation, the severity of preexisting myelopathy, and a history of trauma. Late neurological deterioration was observed in 10 (23%) of 44 patients. The earliest deterioration occurred at 1 year and the latest was at 17 years postsurgery (mean 9.5 years). The most frequent cause of deterioration was trauma due to a fall (six patients), followed by ossification of the ligamentum flavum (three patients). Postoperative spread of the OPLL was noted in 70% of the patients, but it was clearly the cause of neurological deterioration in only one of them. After laminectomy, postoperative progression of kyphotic deformity was observed in 47% of patients, but these changes did not cause neurological deterioration. Conclusions. The authors recommend early surgical decompression for OPLL because the outcome is better for younger patients and for those with a higher score as measured by the Japanese Orthopedic Association's system.

Postchemonucleolysis discectomy versus repeat discectomy: a prospective 1- to 13-year comparison

1996 ◽  
Vol 85 (2) ◽  
pp. 231-238 ◽  
Author(s):  
Manucher J. Javid
Keyword(s):  
Success Rate ◽  
Lumbar Disc ◽  
Clinical Results ◽  
Long Term Results ◽  
Content Type ◽  
Employment Rates ◽  
Second Procedure ◽  
Fine Print

✓ This long-term prospective study evaluates the clinical results of subsequent laminectomy in 103 consecutive patients who initially underwent chemonucleolysis (CNL) or laminectomy for lumbar disc herniation. Between 1981 and 1994, 53 patients who had received CNL initially and then underwent laminectomy and 50 patients treated initially with laminectomy underwent a repeat laminectomy. Clinical assessment at 6 weeks showed a success rate of 80.8% for post-CNL laminectomy and 78% for repeat laminectomy. At 6 months, the success rate for patients treated with CNL was 86% versus 78.7% for laminectomy. At 12 months, the overall success rate for the CNL group was 80.4% versus 83.3% for the laminectomy group, but in patients who had not obtained relief from the first procedure the success rate for the second procedure was higher for the post-CNL patients. A questionnaire was sent to all patients for 1- to 13-year follow-up review. The average follow-up period was 6.6 years for post-CNL laminectomy and 5.2 years for repeat laminectomy. The long-term success rate (81.8%) was higher in the post-CNL group compared to 64.4% in the repeat laminectomy group. Seven patients in the post-CNL group and nine in the repeat laminectomy group had undergone a third operation. When these originally successfully treated patients were reassigned after unsuccessful outcomes, the success rate for the CNL groups was 72.7%, versus 51.1% in the laminectomy group (p = 0.049). Employment rates were 80% for patients with CNL (21.8% changed jobs) and 76.3% for patients undergoing laminectomy (48.3% changed jobs) (p = 0.036). In conclusion, patients who underwent laminectomies after receiving CNL had significantly better long-term results than those who had repeat laminectomies.

Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up

2002 ◽  
Vol 96 (2) ◽  
pp. 180-189 ◽  
Author(s):  
Motoki Iwasaki ◽  
Yoshiharu Kawaguchi ◽  
Tomoatsu Kimura ◽  
Kazuo Yonenobu
Keyword(s):  
Cervical Spine ◽  
Recovery Rate ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deterioration ◽  
Cervical Laminoplasty ◽  
Content Type ◽  
Younger Age ◽  
Fine Print

Object. The authors report the long-term (more than 10-year) results of cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine as well as the factors affecting long-term postoperative course. Methods. The authors reviewed data obtained in 92 patients who underwent cervical laminoplasty between 1982 and 1990. Three patients were lost to follow up, 25 patients died within 10 years of surgery, and 64 patients were followed for more than 10 years. Results were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate was calculated using the Hirabayashi method. The mean neurological recovery rate during the first 10 years after surgery was 64%, which declined to 60% at the last follow-up examination (mean follow up 12.2 years). Late neurological deterioration occurred in eight patients (14%) from 5 to 15 years after surgery. The most frequent causes of late deterioration were degenerative lumbar disease (three patients), thoracic myelopathy secondary to ossification of the ligamentum flavum (two patients), or postoperative progression of OPLL at the operated level (two patients). Postoperative progression of the ossified lesion was noted in 70% of the patients, but only two patients (3%) were found to have related neurological deterioration. Additional cervical surgery was required in one patient (2%) because of neurological deterioration secondary to progression of the ossified ligament. The authors performed a multivariate stepwise analysis, and found that factors related to better clinical results were younger age at operation and less severe preexisting myelopathy. Younger age at operation, as well as mixed and continuous types of OPLL, was highly predictive of progression of OPLL. Postoperative progression of kyphotic deformity was observed in 8% of the patients, although it did not cause neurological deterioration. Conclusions. When the incidence of surgery-related complications and the strong possibility of postoperative growth of OPLL are taken into consideration, the authors recommend expansive and extensive laminoplasty for OPLL.

Long-term follow-up review of suspension laminotomy for cervical compression myelopathy

1996 ◽  
Vol 85 (5) ◽  
pp. 817-823 ◽  
Author(s):  
Hidenori Inoue ◽  
Kazuo Ohmori ◽  
Yoshihiro Ishida ◽  
Kazuhiro Suzuki ◽  
Tetsuro Takatsu
Keyword(s):  
Posterior Longitudinal Ligament ◽  
Neurological Status ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Long Term Follow Up ◽  
Fine Print

This study compared the long-term outcome of cervical spondylotic myelopathy (CSM) with that of the ossification of the posterior longitudinal ligament of the cervical spine (OPLL) after suspension laminotomy, which was developed in the authors' clinic. Seventy-six patients who received follow-up care for more than 5 years were available for analysis. The duration of the follow-up period averaged 97.8 months (range 61–160 months). Radiological and neurological analyses were performed in these 76 patients (50 with CSM and 26 with OPLL). There were no differences in sex, age, follow-up period, and preoperative neurological status between the two groups. In the quantitative study of the dural configuration, 43 patients (86%) with CSM and 17 patients (65.4%) with OPLL attained complete decompression 1 month after surgery. At long-term follow-up review, complete decompression was maintained in 42 patients (84%) with CSM but in only seven patients (26.9%) with OPLL. The neurological evaluation improved markedly at early follow up in both groups but declined insignificantly at the last follow-up review, particularly in the OPLL group. Of 12 patients (24%) with CSM and 10 patients (38.5%) with OPLL whose neurological recovery grades later deteriorated, four (8%) with CSM and nine (34.6%) with OPLL demonstrated reconstriction causing spinal cord compression at long-term follow-up review. For the remaining eight patients (16%) with CSM, who were older than 70 years on average at last follow-up review, no radiological explanation was found. These long-term results indicate that OPLL does not resolve as well as CSM after suspension laminotomy; they both may have late deterioration due to reconstriction that occurs occasionally in CSM and frequently in OPLL.

Dynamic cranioplasty for brachycephaly in Apert syndrome: long-term follow-up study

2001 ◽  
Vol 94 (5) ◽  
pp. 757-764 ◽  
Author(s):  
José Guimarães-Ferreira ◽  
Fredrik Gewalli ◽  
Pelle Sahlin ◽  
Hans Friede ◽  
Py Owman-Moll ◽  
...  
Keyword(s):  
Cell Mass ◽  
Apert Syndrome ◽  
Long Term Results ◽  
Safe Procedure ◽  
Content Type ◽  
Skull Shape ◽  
The Mean ◽  
Fine Print

Object. Brachycephaly is a characteristic feature of Apert syndrome. Traditional techniques of cranioplasty often fail to produce an acceptable morphological outcome in patients with this condition. In 1996 a new surgical procedure called “dynamic cranioplasty for brachycephaly” (DCB) was reported. The purpose of the present study was to analyze perioperative data and morphological long-term results in patients with the cranial vault deformity of Apert syndrome who were treated with DCB. Methods. Twelve patients have undergone surgery performed using this technique since its introduction in 1991 (mean duration of follow-up review 60.2 months). Eleven patients had bicoronal synostosis and one had a combined bicoronal—bilambdoid synostosis. Perioperative data and long-term evolution of skull shape visualized on serial cephalometric radiographs were analyzed and compared with normative data. Changes in mean skull proportions were evaluated using a two-tailed paired-samples t-test, with differences being considered significant for probability values less than 0.01. The mean operative blood transfusion was 136% of estimated red cell mass (ERCM) and the mean postoperative transfusion was 48% of ERCM. The mean operative time was 218 minutes. The duration of stay in the intensive care unit averaged 1.7 days and the mean hospital stay was 11.8 days. There were no incidences of mortality and few complications. An improvement in skull shape was achieved in all cases, with a change in the mean cephalic index from a preoperative value of 90 to a postoperative value of 78 (p = 0.000254). Conclusions. Dynamic cranioplasty for brachycephaly is a safe procedure, yielding high-quality morphological results in the treatment of brachycephaly in patients with Apert syndrome.

Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration

1990 ◽  
Vol 72 (3) ◽  
pp. 370-377 ◽  
Author(s):  
Francois Aldrich
Keyword(s):  
Anterior Approach ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Skin Incision ◽  
Posterolateral Approach ◽  
Cervical Disc ◽  
Attractive Alternative ◽  
Disc Space ◽  
Content Type ◽  
Fine Print

✓ The controversy over whether to use a posterior or anterior approach for surgical treatment of soft cervical discs is still largely unsettled. However, although the posterior approach may be underutilized, it has distinct advantages when there are specific indications. Out of a large pool of cases, 53 patients presented with acute monoradiculopathy caused by soft cervical disc herniation. In 36 of these, the disc was sequestered (nonconfined) and was posterolateral to the disc space as seen on computerized tomography-myelography. Distinct motor weakness was a common clinical finding in all 36 cases. These patients were treated by using a 2- to 3-cm skin incision for the posterolateral microsurgical approach. The extent of the lateral facetectomy depended upon the relationship between the nerve root and the disc. All fragments were lateral to the dural sac and were sequestered through the anulus fibrosus and the posterior longitudinal ligament. Sequestrations were removed under direct microscopic vision, but the disc space was not entered. Pain relief and motor-power improvement in the affected radicular distribution were immediate in all patients. Sensory deficit and residual motor loss improved dramatically with normalization at approximately 6 months. No complications occurred and the mean hospital stay was 2 days. The follow-up period varied from 4 to 42 months with a mean of 26 months. Thus far, there have been no recurrences or other associated complications. By using strict selection criteria and a microsurgical posterolateral approach with removal of the sequestered disc fragment, excellent results with normalization of the monoradiculopathy can be obtained. The ease of this technique, low risk, minimal complications, and excellent results make it an attractive alternative to the anterior approach. The clinical presentations, specific indications, surgical technique, and clinical results are discussed; and a prototype of a small cervical self-retaining retractor is described.

Radiculopathy of C-5 after anterior decompression for cervical myelopathy

2005 ◽  
Vol 3 (3) ◽  
pp. 210-217 ◽  
Author(s):  
Minoru Ikenaga ◽  
Jitsuhiko Shikata ◽  
Chiaki Tanaka
Keyword(s):  
Cervical Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Manual Muscle Testing ◽  
Radiographic Evaluation ◽  
Anterior Decompression ◽  
Content Type ◽  
Muscle Testing ◽  
Anterior Corpectomy ◽  
Fine Print

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.

Long-term results of gamma knife surgery for growth hormone—producing pituitary adenoma: is the disease difficult to cure?

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 119-123 ◽  
Author(s):  
Tatsuya Kobayashi ◽  
Yoshimasa Mori ◽  
Yukio Uchiyama ◽  
Yoshihisa Kida ◽  
Shigeru Fujitani
Keyword(s):  
Growth Hormone ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Content Type ◽  
The Mean ◽  
Dose Radiation ◽  
Fine Print

Object. The authors conducted a study to determine the long-term results of gamma knife surgery for residual or recurrent growth hormine (GH)—producing pituitary adenomas and to compare the results with those after treatment of other pituitary adenomas. Methods. The series consisted of 67 patients. The mean tumor diameter was 19.2 mm and volume was 5.4 cm3. The mean maximum dose was 35.3 Gy and the mean margin dose was 18.9 Gy. The mean follow-up duration was 63.3 months (range 13–142 months). The tumor resolution rate was 2%, the response rate 68.3%, and the control rate 100%. Growth hormone normalization (GH < 1.0 ng/ml) was found in 4.8%, nearly normal (< 2.0 ng/ml) in 11.9%, significantly decreased (< 5.0 ng/ml) in 23.8%, decreased in 21.4%, unchanged in 21.4%, and increased in 16.7%. Serum insulin-like growth factor (IGF)—1 was significantly decreased (IGF-1 < 400 ng/ml) in 40.7%, decreased in 29.6%, unchanged in 18.5%, and increased in 11.1%, which was almost parallel to the GH changes. Conclusions. Gamma knife surgery was effective and safe for the control of tumors; however, normalization of GH and IGF-1 secretion was difficult to achieve in cases with large tumors and low-dose radiation. Gamma knife radiosurgery is thus indicated for small tumors after surgery or medication therapy when a relatively high-dose radiation is required.

Microsurgical infrapedicular paramedian approach for retrovertebral lumbar disc herniations

2005 ◽  
Vol 2 (1) ◽  
pp. 88-91 ◽  
Author(s):  
Nedal Hejazi
Keyword(s):  
Facet Joint ◽  
Lumbar Disc ◽  
Clinical Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Clinical Benefits ◽  
Disc Herniations ◽  
Fine Print

✓ The author performed a microsurgical infrapedicular paramedian approach in 35 patients (23 men and 12 women) to remove herniated lumbar retrovertebral discs that did not have an apparent origin at either the superior or inferior disc level. The goal of this surgery was to minimize the bone resection, preserve the facet joint, and avoid the risk of secondary vertebral instability. The Macnab outcome classification was used to assess all patients who attended follow-up examination for at least 15 months. The clinical results were excellent or good in 34 (97%) of 35 cases. This minimally invasive lumbar spine technique resulted in minimal morbidity, excellent clinical benefits, and a long-term outcome without evidence of secondary segmental instability.

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