Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine

Chen, Yu; Chen, Deyu; Wang, Xinwei; Lu, Xuhai; Guo, Yongfei; He, Zhimin; Tian, Haijun

doi:10.1007/s00264-008-0542-y

Cited by 61 publications

(61 citation statements)

References 22 publications

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“…Due to altered mechanical function of the disc, degenerative changes also begin to occur posteriorly in the facet joints [5][6][7][8][9]. The spondylotic changes in anterior structures, such as bulging, ossified, or herniated discs, as well as anterior osteophytic spurs are generally responsible for cord compression in CSM.…”

Section: Introductionmentioning

confidence: 99%

Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels

Morishita

Naito

Wang

2010

International Orthopaedics (SICOT)

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The lower cervical segments are commonly the level responsible for cervical spondylotic myelopathy; however, we rarely encounter stenosis at the upper cervical segment in a clinical setting. We assumed that there might be some differences between the pathogenetic mechanisms underlying the development of cervical canal stenosis at different segments. We performed positional MRI in the weight-bearing position for 295 consecutive symptomatic patients. All subjects were classified into four groups (A: normal; B: C3-4 stenosis; C: C5-6 stenosis; D: two-level cervical segments stenosis, stenosis at C3-4 and C5-6). Age, sagittal cervical canal diameter, cervical intervertebral disc degeneration, cervical cord compression, and cervical mobilities were evaluated for each group. Group B showed a narrow cervical spinal canal structure at the C3 to C4 pedicle levels, while groups C and D showed narrow structures at the C4 to C6 pedicle levels in the cervical spine. Additionally, the sagittal cervical canal diameters at all pedicle levels, except C7, in group D were significantly smaller than those observed in group C. We demonstrated the differences in the pathogenetic processes for the development of cervical spinal canal stenosis between C3-4, C5-6, and two-level cervical segments stenosis. Our results suggest that the developmental morphological structure of the cervical spinal canal plays an important role in the development of cervical canal stenosis at different segments. Moreover, individuals with sagittal cervical canal diameters of less than 13 mm may be exposed to an increased risk for future development of cervical spinal canal stenosis at the upper cervical segments following stenosis at the lower cervical segments.

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Section: Introductionmentioning

confidence: 99%

Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels

Morishita

Naito

Wang

2010

International Orthopaedics (SICOT)

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“…6,7,31 The total sample size for patients who received ADF or PDF or who received decompression only was 1222 and 745, respectively. Postoperative outcomes for patients who underwent decompression and fusion were identified in 12 studies [4][5][6]14,16,20,25,31,32,36,46,56 and in 7 studies for patients who underwent posterior decompression only. 2,6,10,14,20,25,32 Two of the studies in the fusion category contained both ADF and PDF patient groups.…”

Section: Study Characteristicsmentioning

confidence: 99%

Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis

Mehdi

Alentado

Lee

et al. 2016

FOC

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OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL. METHODS A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I2 values. Forest plots were constructed for each analysis group. RESULTS Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior decompression alone in patients with OPLL. These results indicate that surgical decompression and fusion lead to a faster recovery, improved postoperative neurological functioning, and a lower incidence of OPLL progression compared with posterior decompression only. Furthermore, decompression and fusion did not lead to a greater incidence of complications compared with posterior decompression only.

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“…Repair techniques employed include gelatin sponges, patch grafts, fibrin glue, and CSF diversion. Despite these techniques, the incidence of fistula and pseudomeningocele formation remains high (4.6e22.7%) [2,17]. In all reported cases, these fistulas ultimately required some form of temporary or permanent CSF diversion.…”

Section: Discussionmentioning

confidence: 94%

Management and outcome of cerebrospinal fluid leakage during anterior cervical fusion for an ossified posterior longitudinal ligament

Yeh

Chen

et al. 2013

Tzu Chi Medical Journal

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a b s t r a c tThe rate of dural tears during anterior cervical diskectomy or corpectomy with fusion is higher in those patients with ossified posterior longitudinal ligaments (OPLL) than with those with other causes of cervical spinal stenosis. Various techniques have been described to deal with dural tears with cerebrospinal fluid (CSF) leakage in OPLL. Dural repair accompanied by a shunting technique with a lumbar subarachnoid drain is most commonly used. However, overdrainage of CSF fluid can cause further complications. Monitoring to keep the lumbar drain from overdrainage has not been described well in previous reports. In our series, 50 patients diagnosed with OPLL underwent anterior cervical surgery between July 2005 and June 2012. Dural tears with CSF leakage occurred in three patients. The dural defects were all about 1 mm in length. The dural defect was covered with a blood clot and gelfoam sponge. A closed suction drain (Hemovac) was placed as usual. After completion of the cervical surgery, a lumbar subarachnoid drain was inserted. The purpose of the lumbar drain was to shunt CSF pressure and avoid CSF leakage at the tear site. The lumbar drain rate was set at <20 mL/hour to prevent further complications. The effects of the lumbar drain were monitored and the drain rate was decreased gradually by observing the amount of cervical closed drainage, which should be minimal. The lumbar drains were used for 7 days in these three cases. There were no infections, severe headaches, or any other CSF leakage-related complications. None of the patients required reoperation for CSF leakage. Using a blood clot and gelfoam sponge to cover a dural tear site and placing a distant lumbar drain to shunt CSF pressure is an effective and successful method to treat CSF leakage in cervical operations.

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Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine

Cited by 61 publications

References 22 publications

Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels

Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels

Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis

Management and outcome of cerebrospinal fluid leakage during anterior cervical fusion for an ossified posterior longitudinal ligament

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