Intraoperative evaluation using mobile computed tomography in anterior cervical decompression with floating method for massive ossification of the posterior longitudinal ligament

Abstract

BackgroundAn anterior decompression and fusion (ADF) with the floating method is an effective procedure for treating ossification of the posterior longitudinal ligament (OPLL), allowing a direct decompressive effect on the spinal cord. However, the procedure is skill-intensive, particularly in cases of OPLL with a high canal-occupying ratio. In such cases, there are potential risks for insufficient decompression due to the incomplete floating of the OPLL. Here, we introduce an anterior decompression procedure for massive OPLL, using an intraoperative computed tomography (CT) with a mobile scanner gantry for the intraoperative evaluation of the decompression. We further evaluated the outcomes of ADF using mobile CT in comparison with a historical control of ADF without intraoperative CT evaluation.MethodsFifty OPLL patients who underwent ADF with the floating method were evaluated in this study: 25 patients with intraoperative CT (CT group) and 25 patients without CT (non-CT group). In the CT group, intraoperative CT scanning was performed before freeing the ossification from the surrounding bone tissues. The reconstructed images were reviewed to evaluate the extent of bone decompression and thinning of the OPLL. After review of the images, further thinning of the OPLL or removal of surrounding bone was performed as deemed necessary, to complete the floating of the OPLL.ResultsPatients’ background was similar between the CT and non-CT group. Operating time tended to be shorter for the CT group. On the postoperative CT, incomplete OPLL floating due to “impingement” between the OPLL and the medial aspect of the pedicle or uncovertebral joint was observed for four patients (16.0%) in the non-CT group, whereas insufficient decompression was not observed in the CT group.ConclusionsIntraoperative CT imaging was effective to avoid insufficient decompression following ADF with the floating method for massive OPLL. We also consider that the intraoperative three-dimensional imaging is helpful for providing informative feedback to surgeons to improve performance in skill-intensive surgeries such as ADF with the floating method.

Platelet-rich plasma in osteoarthritis treatment: review of current evidence

“…Here we comment on available evidence compiled from five recent meta-analyses and systematic reviews. 34–38 These included randomized or quasi-randomized clinical trials that evaluated intra-articular (IA) injection(s) of PRP-derived products (commercial or custom protocols) with other IA interventions [hyaluronic acid (HA), corticosteroids (CSs), saline or other] for osteoarthritis (OA) treatment. A total of 19 individual trials were identified in the five reviews but only 9 were level of evidence I RCTs.…”

“…Laudy and colleagues, Anitua and colleagues and Shen and colleagues used some version of the Cochrane collaboration risk of bias tool. 34–36 Meheux and colleagues used the modified Coleman methodology score and Chang and coworkers used the Jadad scale for RCTs and the Newcastle–Ottawa Scale for quasi-experimental studies. 37,38…”

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

“…However, the anteriorly migration of the OPLL in floating method is not controlled by surgeon and much owing to the pressure of the CSF, which requires as long as 8 weeks for the ossification to complete the migration [25]. Thus, the impingement between OPLL and the surrounding bone cannot be foreseen during the procedure and often results in incomplete floating of the OPLL [26]. Intraoperative CT scan was used to ensure that the VOC was isolated prior to the hoist.…”

“…Intraoperative CT scan was used to ensure that the VOC was isolated prior to the hoist. Intraoperative CT scan was also used in the floating method to avoid insufficient decompression [26]. However, the intraoperative CT scan is not the only way to know if the VOC is fully isolated, surgeon could also use a nerve hook to detect the border of the VOC.…”

The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An Updated Systematic Review and Meta-Analysis

“…1,32 Both studies were included and analyzed because they are not redundant papers. Two studies compared anterior surgery with laminectomy with fusion, 33,34 and the other 19 compared with laminoplasty.…”