Can K-Line Predict the Clinical Outcome of Anterior Controllable Antedisplacement and Fusion Surgery for Cervical Myelopathy Caused by Multisegmental Ossification of the Posterior Longitudinal Ligament?

Jing, Sun; Zhang, Bin; Shi, Jiangang; Sun, Kai Qiang; Huan, Le; Sun, Xiao Fei; Liu, Ning; Zheng, Bing; Wang, Hai Bo

doi:10.1016/j.wneu.2018.04.128

Cited by 17 publications

(13 citation statements)

References 19 publications

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“…However, for OPLL > 6 mm, the K-line (−) had a better outcome than the K-line (+) group [52]. A survey study amongst spine surgeons in the Asia-Pacific region concludes that anterior decompression was recommended for one-or two-level disease, LP was preferred for twoto four-level disease and LP was preferred for multi-level OPLL [26].…”

Section: Clinical Outcomementioning

confidence: 99%

Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches

Kwok

2020

BMC Musculoskelet Disord

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Background The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. Main body of the abstract A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives. Conclusion From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.

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Section: Clinical Outcomementioning

confidence: 99%

Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches

Kwok

2020

BMC Musculoskelet Disord

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“…This may be explained by the thicker ossification in extension K-line (−) subgroup, which made it necessary to resect more of the anterior vertebral bodies of the vertebrae to provide more hoisting space. However, if too much bone is removed, even the shortest cervical screws can penetrate the remaining vertebrae, causing damage to the spinal cord (26). Consequently, the postoperative OR for these patients was higher.…”

Section: Discussionmentioning

confidence: 99%

The effect of K-line classification in different cervical dynamic position on surgical outcomes in patients with ossification of the posterior longitudinal ligament after anterior controllable antedisplacement and fusion

Han

Sun²,

Chen

et al. 2022

Front. Surg.

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PurposeTo investigate whether the K-line classification in different cervical dynamic position of patients with Ossification of the Posterior Longitudinal Ligament (OPLL) affects clinical outcome after Anterior Controllable Antedisplacement and Fusion (ACAF) surgery.MethodsA total of 93 patients who suffered from cervical spondylosis caused by OPLL underwent ACAF surgery between June 2015 and December 2017 in a single institution. Neutral, neck-flexed and neck-extended cervical radiographs were obtained from every patient. Subsequently they were classified into K-line (+) and K-line (−) with reference to the K-line classification criteria. Clinical outcomes were assessed by the JOA score, improvement rate (IR) and visual analogue scale (VAS). Radiological assessment included Cobb angle and occupation ratio (OR) of OPLL. Correlations between the long-term surgical outcomes and classification of K-line in different dynamic position were analyzed by one-way analysis of variance.ResultsSignificant improvements were shown in all postoperative clinical and radiographic assessments (P < 0.05). There were no differences in IR, Cobb angle and VAS among flexion K-line (−), flexion K-line (+), extension K-line (−) and extension K-line (+) at the 2-year follow-up (P > 0.05). However, the OR of extension K-line (−) (16.13% ± 11.58%) was higher than that of extension K-line (+) (9.00% ± 10.27%) and flexion K-line (+) subgroup (9.47% ± 9.97%) (P < 0.05).ConclusionThe ACAF procedure has shown satisfactory surgical outcomes in various K-line classifications in different dynamic position.

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“…Consensus has not been reached about the optimal surgical strategy of cervical OPLL 6, 7, 8. Compared with a posterior decompression strategy, techniques with the anterior approach were reported to be more efficient in neural function recovery when dealing with K-line (−) patients 9, 10. However, the incidence rate of complications including CSF leakage, hardware failure, neural injury, or insufficient decompression was reported to be higher than that of posterior decompression surgery 11, 12…”

Section: Discussionmentioning

confidence: 99%

How to Avoid Postoperative Remaining Ossification Mass in Anterior Controllable Antedisplacement and Fusion Surgery

Sun

Wang

et al. 2019

World Neurosurgery: X

Self Cite

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Objectives To retrospectively review the cases with ossification of the posterior longitudinal ligament (OPLL) treated with anterior controllable antedisplacement and fusion (ACAF). Patients with postoperative remaining ossification mass (PROM) are analyzed to figure out the causes and preventions of this problem. Methods A total of 115 patients were included. PROM was identified as remaining OPLL existed in the spinal canal other than included in the vertebral-OPLL complex on postoperative computed tomography. The Japanese Orthopaedic Association scoring system was used to evaluate the neurologic status. Surgery-related complications such as cerebrospinal fluid (CSF) leakage and spinal cord or nerve injury were all recorded. The patients with the PROM group and those without the PROM group were compared. Results There were 14 patients with wide-base OPLL (12.2%) and 10 patients (8.7%) with PROM among the 115 patients with OPLL. The 10 patients with PROM were all with wide-base OPLL. The average improvement rate of Japanese Orthopaedic Association score in patients without PROM was significantly larger than that in patients with PROM (69.5 ± 22.6% vs. 36.7 ± 22.0, P < 0.01). Incidence rate of postoperative CSF leakage and neural deterioration were significantly higher in patients with PROM than that in patients without PROM (CSF leakage, 40.0% vs. 5.9%; neural deterioration, 50.0% vs. 3.0%). No other complications were observed. Conclusions The occurrence of PROM might cause complications and poor neural function recovery in patients treated with ACAF. Surgical techniques should be noted to avoid PROM in ACAF surgery.

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Can K-Line Predict the Clinical Outcome of Anterior Controllable Antedisplacement and Fusion Surgery for Cervical Myelopathy Caused by Multisegmental Ossification of the Posterior Longitudinal Ligament?

Cited by 17 publications

References 19 publications

Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches

Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches

The effect of K-line classification in different cervical dynamic position on surgical outcomes in patients with ossification of the posterior longitudinal ligament after anterior controllable antedisplacement and fusion

How to Avoid Postoperative Remaining Ossification Mass in Anterior Controllable Antedisplacement and Fusion Surgery

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