nach oben

European Spine Journal

Erschienen in:

03.12.2019 | Original Article

Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy

verfasst von: Kaiqiang Sun, Shunmin Wang, Le Huan, Jingchuan Sun, Ximing Xu, Xiaofei Sun, Jiangang Shi, Yongfei Guo

Erschienen in: European Spine Journal | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Objective

To investigate the changes of spinal cord angle between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy in treating severe ossification of the posterior longitudinal ligament (OPLL).

Patients and methods

Seventy-one patients with cervical OPLL were enrolled. Patients in this study were divided into group A and group P. Japanese Orthopaedic Association (JOA) score was utilized to evaluate the neurological function. Radiological assessments included the spinal cord angle, Cobb angle, and area of the spinal cord. Surgery-related complications were also recorded.

Results

At the final follow-up, patients in group A had better recovery of local and whole cord angle, and the area of the cord than those in group P (all p < 0.05). A strong correlation between the change of local cord angle and the recovery of the spinal cord area was observed (r = − 0.867, p < 0.05). In addition, patients in group P had worse Cobb angle (9.15° ± 1.10°) than in group A (18.58° ± 0.73°) (p < 0.05). The final mean JOA score and its improvement rate were better in the group A than in group P (p < 0.05). During the follow-up, 15.15% patients in group P experienced surgery-related complications and 7.89% in group A.

Conclusion

This present study revealed that ACAF can achieve better recovery of the expansion of the spinal cord, spinal cord alignment, and Cobb angle, with better postoperative JOA score and less complications, compared with posterior laminectomy in treating severe cervical OPLL.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Nur mit Berechtigung zugänglich

Fujimori T, Le H, Hu SS, Chin C, Pekmezci M, Schairer W, Tay BK, Hamasaki T, Yoshikawa H, Iwasaki M (2015) Ossification of the posterior longitudinal ligament of the cervical spine in 3161 patients: a ct-based study. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000000791 CrossRef

Hou Y, Liang L, Shi GD, Xu P, Xu GH, Shi JG, Yuan W (2017) Comparing effects of cervical anterior approach and laminoplasty in surgical management of cervical ossification of posterior longitudinal ligament by a prospective nonrandomized controlled study. Orthop Traumatol Surg Res 103:733–740. https://doi.org/10.1016/j.otsr.2017.05.011 CrossRefPubMed

Pham MH, Attenello FJ, Lucas J, He S, Stapleton CJ, Hsieh PC (2011) Conservative management of ossification of the posterior longitudinal ligament. A review. Neurosurg Focus 30(3):E2. https://doi.org/10.3171/2011.1.FOCUS10273 CrossRefPubMed

Yoshii T, Sakai K, Hirai T, Yamada T, Inose H, Kato T, Enomoto M, Tomizawa S, Kawabata S, Arai Y, Okawa A (2016) Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a ≥ 50% canal occupying ratio: a multicenter retrospective study. Spine J 16(11):1351–1357. https://doi.org/10.1016/j.spinee.2016.07.532 CrossRefPubMed

Smith ZA, Buchanan CC, Raphael D, Khoo LT (2011) Ossification of the posterior longitudinal ligament: pathogenesis, management, and current surgical approaches. A review. Neurosurg Focus 30:E10. https://doi.org/10.3171/2011.1.FOCUS10256 CrossRefPubMed

Abiola R, Rubery P, Mesfin A (2016) Ossification of the posterior longitudinal ligament: etiology, diagnosis, and outcomes of nonoperative and operative management. Glob Spine J 6:195–204. https://doi.org/10.1055/s-0035-1556580 CrossRef

Lee CH, Jahng TA, Hyun SJ, Kim KJ, Kim HJ (2016) Expansive laminoplasty versus laminectomy alone versus laminectomy and fusion for cervical ossification of the posterior longitudinal ligament: is there a difference in the clinical outcome and sagittal alignment? Clin Spine Surg 29:E9–E15. https://doi.org/10.1097/BSD.0000000000000058 CrossRefPubMed

Ahsan MK, Awwal MA, Khan SI, Zaman N, Haque MH, Zahangiri Z (2017) Open-door laminoplasty for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament (OPLL) using titanium reconstruction miniplate and screws. Mymensingh Med J 26:558–568PubMed

Ma L, Liu FY, Huo LS, Zhao ZQ, Sun X, Li F, Ding WY (2018) Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis. Medicine (Baltimore) 97:e11542. https://doi.org/10.1097/MD.0000000000011542 CrossRef

10.

Liu H, Li Y, Chen Y, Wu W, Zou D (2013) Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament. Eur Spine J 22:1480–1488. https://doi.org/10.1007/s00586-013-2707-7 CrossRefPubMedPubMedCentral

11.

Rajshekhar V, Kumar GS (2005) Functional outcome after central corpectomy in poor-grade patients with cervical spondylotic myelopathy or ossified posterior longitudinal ligament. Neurosurgery 56:1279–1284 (discussion 1284-5) CrossRefPubMed

12.

Phan K, Scherman DB, Xu J, Leung V, Virk S, Mobbs RJ (2017) Laminectomy and fusion vs laminoplasty for multi-level cervical myelopathy: a systematic review and meta-analysis. Eur Spine J 26:94–103CrossRefPubMed

13.

Kennamer BT, Arginteanu MS, Moore FM, Steinberger AA, Yao KC, Gologorsky Y (2019) Complications of poor cervical alignment in patients undergoing posterior cervicothoracic laminectomy and fusion. World Neurosurg 122:e408–e414. https://doi.org/10.1016/j.wneu.2018.10.062 CrossRefPubMed

14.

Sun J, Shi J, Xu X, Yang Y, Wang Y, Kong Q, Yang H, Guo Y, Han D, Jiang J, Shi G, Yuan W, Jia L (2018) Anterior controllable antidisplacement and fusion surgery for the treatment of multilevel severe ossification of the posterior longitudinal ligament with myelopathy: preliminary clinical results of a novel technique. Eur Spine J 27:1469–1478. https://doi.org/10.1007/s00586-017-5437-4 CrossRefPubMed

15.

Sun K, Wang S, Sun J, Wang H, Huan L, Sun X, Lv H, Wang Z, Zou W, Shi J (2019) Surgical outcomes after anterior controllable antedisplacement and fusion (ACAF) compared to single open-door laminoplasty: preliminary analysis of postoperative changes of the spinal cord displacement. World Neurosurg 127:e288–e298. https://doi.org/10.1016/j.wneu.2019.03.108 CrossRefPubMed

16.

Liu X, Chen Y, Yang H, Li T, Xu B, Chen D (2017) Expansive open-door laminoplasty versus laminectomy and instrumented fusion for cases with cervical ossification of the posterior longitudinal ligament and straight lordosis. Eur Spine J 26:1173–1180. https://doi.org/10.1007/s00586-016-4912-7 CrossRefPubMed

17.

Lau D, Winkler EA, Than KD, Chou D, Mummaneni PV (2017) Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy: influence of cervical alignment on outcomes. J Neurosurg Spine 27:508–517. https://doi.org/10.3171/2017.4.SPINE16831 CrossRefPubMed

18.

Lee SE, Jahng TA, Kim HJ (2015) Correlation between cervical lordosis and adjacent segment pathology after anterior cervical spinal surgery. Eur Spine J 24:2899–2909. https://doi.org/10.1007/s00586-015-4132-6 CrossRefPubMed

19.

Yang H, Sun J, Shi J, Yang Y, Guo Y, Zheng B, Wang Y (2018) In situ decompression to spinal cord during anterior controllable antedisplacement fusion treating degenerative kyphosis with stenosis: surgical outcomes and analysis of C5 nerve palsy based on 49 patients. World Neurosurg 15:e501–e508. https://doi.org/10.1016/j.wneu.2018.04.078 CrossRef

20.

Grosso MJ, Hwang R, Mroz T, Benzel E, Steinmetz MP (2013) Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery. J Neurosurg Spine 18(6):537–544. https://doi.org/10.3171/2013.2.SPINE12525 CrossRefPubMed

21.

Yang H, Sun J, Shi J, Guo Y, Zheng B, Wang Y, Xu X, Shi G (2018) Anterior controllable antedisplacement fusion as a choice for 28 patients of cervical ossification of the posterior longitudinal ligament with dura ossification: the risk of cerebrospinal fluid leakage compared with anterior cervical corpectomy and fusion. Eur Spine J. https://doi.org/10.1007/s00586-018-5813-8 CrossRefPubMed

22.

Sun J, Sun K, Wang Y, Shi J, Yang H, Guo Y, Xu X, Kong Q, Chen K, Zheng B, Shi G, Wang Y (2018) Quantitative anterior enlargement of the spinal canal by anterior controllable antedisplacement and fusion for the treatment of cervical ossification of the posterior longitudinal ligament with myelopathy. World Neurosurg 120:e1098–e1106. https://doi.org/10.1016/j.wneu.2018.08.233 CrossRefPubMed

23.

Chen CJ, Lyu RK, Lee ST, Wong YC, Wang LJ (2001) Intramedullary high signal intensity on T2-weighted MR images in cervical spondylotic myelopathy: prediction of prognosis with type of intensity. Radiology 221:789–794CrossRefPubMed

24.

Vedantam A, Rajshekhar V (2014) Change in morphology of intramedullary T2-weighted increased signal intensity after anterior decompressive surgery for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 39:1458–1462. https://doi.org/10.1097/BRS.0000000000000440 CrossRef

25.

Lee N, do Yoon H, Kim KN, Shin HC, Shin DA, Ha Y (2018) Compression angle of ossification of the posterior longitudinal ligament and its clinical significance in cervical myelopathy. J Korean Neurosurg Soc 59:471–477. https://doi.org/10.3340/jkns.2016.59.5.471 CrossRef

26.

Sun K, Wang S, Sun J, Huan L, Xu X, Sun X, Zhang B, Wang Y, Shi J, Guo Y (2018) Analysis of the correlation between cerebrospinal fluid space and outcomes of anterior controllable antedisplacement and fusion for cervical myelopathy due to ossification of the posterior longitudinal ligament. World Neurosurg 122:e358–e366. https://doi.org/10.1016/j.wneu.2018.10.051 CrossRefPubMed

27.

28.

Fujimori T, Iwasaki M, Okuda S, Takenaka S, Kashii M, Kaito T, Yoshikawa H (2014) Long-term results of cervical myelopathy due to ossification of the posterior longitudinal ligament with an occupying ratio of 60% or more. Spine 39:58–67. https://doi.org/10.1097/BRS.0000000000000054 CrossRefPubMed

29.

Henderson FC, Geddes JF, Vaccaro AR, Woodard E, Berry KJ, Benzel EC (2005) Stretch-associated injury in cervical spondylotic myelopathy: new concept and review. Neurosurgery 56:1101–1113 (discussion 1101-1113) PubMed

30.

Kuwazawa Y, Pope MH, Bashir W, Takahashi K, Smith FW (2006) The length of the cervical cord: effects of postural changes in healthy volunteers using positional magnetic resonance imaging. Spine (Phila Pa 1976) 31:E579–E583CrossRef

31.

Sun JC, Zhang B, Shi J, Sun KQ, Huan L, Sun XF, Liu N, Zheng B, Wang HB (2018) Can K-line predict the clinical outcome of anterior controllable antedisplacement and fusion surgery for cervical myelopathy caused by multi-segmental ossification of the posterior longitudinal ligament? World Neurosurg 116:e118–e127. https://doi.org/10.1016/j.wneu.2018.04.128 CrossRefPubMed

32.

33.

Kim B, Yoon DH, Ha Y, Yi S, Shin DA, Lee CK, Lee N, Kim KN (2016) Relationship between T1 slope and loss of lordosis after laminoplasty in patients with cervical ossification of the posterior longitudinal ligament. Spine J 16:219–225. https://doi.org/10.1016/j.spinee.2015.10.042 CrossRefPubMed

34.

Yang H, Guo Y, Shi J, Sun J, Wang Y, Xu X, Zheng B, Shi G (2018) Surgical results and complications of anterior controllable antedisplacement fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament. J Clin Neurosci 56:21–27. https://doi.org/10.1016/j.jocn.2018.08.014 CrossRefPubMed

35.

Takase H, Murata H, Sato M, Tanaka T, Miyazaki R, Yoshizumi T, Tateishi K, Kawahara N, Yamamoto T (2018) Delayed C5 palsy after anterior cervical decompression surgery: preoperative foraminal stenosis and postoperative spinal cord shift increase the risk of palsy. World Neurosurg 120:e1107–e1119. https://doi.org/10.1016/j.wneu.2018.08.240 CrossRefPubMed

Titel: Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy
verfasst von: Kaiqiang Sun
Shunmin Wang
Le Huan
Jingchuan Sun
Ximing Xu
Xiaofei Sun
Jiangang Shi
Yongfei Guo
Publikationsdatum: 03.12.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 5/2020
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-06216-6

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy