Bridging the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a retrospective case series

Abstract

Background The purpose of this study was to investigate the surgical efficacy of crossing the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL). Methods From October 2009 to October 2017, 46 consecutive patients with multilevel cervical OPLL underwent posterior cervical laminectomy and crossing the cervicothoracic junction fusion were obtained in the study. Their medical records were retrospectively collected. Cervical lordosis and cervical sagittal balance were used to assess radiographic outcomes. Japanese Orthopedic Association (JOA), axial symptom, C5 root palsy, blood loss, and operation time were used to assess clinical outcomes. The mean follow-up period was 20.7 ± 8.3 months. Results The operation time was 205.2 ± 39.8 min and the intraoperative blood loss was 352.2 ± 143.7 ml. Analysis of the final follow-up data showed significant differences in JOA score (P < 0.01), C2-C7 lordosis angle (P < 0.01), and C2-C7 SVA (P < 0.01). CT confirmed that grafted bone was completely fused in all patients and progression of OPLL was observed in two patients (4.3%) at final follow-up. No adjacent segment disease (ASD) or instrument failure occurred in any patients. Conclusions Cervical laminectomy and crossing the cervicothoracic junction fusion are effective and safe methods to treat multilevel cervical OPLL. Randomized controlled studies compared constructs ending at cervical vertebrae or thoracic vertebrae are needed to confirm these results.

Factors Associated With Repeat Surgery in Cervical Ossification of the Posterior Longitudinal Ligaments

“…OPLL was defined, as in other studies, as heterotopic ossification of more than 2 mm on the posterior side of the vertebral body 14,15 . Surgery was performed in patients where spinal cord compression caused by OPLL was confirmed on preoperative MRI and was associated with significant neurologic deficits.…”

“…OPLL was defined, as in other studies, as heterotopic ossification of more than 2 mm on the posterior side of the vertebral body. 14,15 Surgery was performed in patients where spinal cord compression caused by OPLL was confirmed on preoperative MRI and was associated with significant neurologic deficits. Surgical segments included levels with cord compression, and the surgical approach was typically decided based on the extent of OPLL and patient symptoms.…”

Is It Necessary to Cross the Cervicothoracic Junction in Posterior Cervical Decompression and Fusion for Multilevel Degenerative Cervical Spine Disease? A Systematic Review and Meta-Analysis

“…The systematic search yielded 1528 articles, of which 553 were duplicates, and 942 were excluded by screening the title and abstract. After a full-text review, 18 studies were considered improper: six for including patients with diagnosis of trauma, infection, or tumour [13,14,[24][25][26][27]; five for non-comparative study (cervical group vs. thoracic group) [9,[28][29][30][31]; three for the absence of necessary outcomes [12,32,33]; three for partly duplicated cohorts [11,34,35]; and one for non-English study [36]. Finally, 15 studies were included in this systematic review and meta-analysis (Figure 1) [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

“…These unphysiological biomechanics increase the intradiscal pressures and motion of C7-T1, which would accelerate the degeneration of this level and induce adjacent segment disease (ASD) or other mechanical complications. Therefore, some studies have recommended prophylactic extension of the fusion construct into the upper thoracic spine, crossing the CTJ, to reduce the rate of complications and need for reoperations [9][10][11]. In contrast, some investigators reported that this procedure would further increase surgical invasiveness and disrupt the posterior stabilising structures, which have no benefits in solid fusion [12][13][14].…”