Morphologic Limitations of Posterior Decompression by Midsagittal Splitting Method for Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament in the Cervical Spine

Yamazaki, A.; Homma, Takao; Uchiyama, Seiji; Katsumi, Yutaka; Okumura, Hiroshi

doi:10.1097/00007632-199901010-00008

Cited by 95 publications

(37 citation statements)

References 4 publications

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“…57 Furthermore, laminoplasty, specifically, has been correlated with progressive kyphosis and subsequent neurological deterioration at long-term follow-up, probably accounting for our findings of an increased recovery rate in the decompression and fusion population. 28,51 Although outcomes after laminoplasty for a large OPLL mass are poor, 32 previous studies have shown that higher preoperative lordosis is associated with better outcomes after laminoplasty in patients with a large OPLL mass.…”

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confidence: 62%

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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confidence: 62%

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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“…2,3 Previous studies evaluated these 2 factors independently, and, to the best of our knowledge, no report has analyzed them in 1 parameter. In the present study, we proposed a new index that can evaluate the cervical alignment and the OPLL size in 1 parameter.…”

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confidence: 99%

A New Concept for Making Decisions Regarding the Surgical Approach for Cervical Ossification of the Posterior Longitudinal Ligament

Fujiyoshi

Yamazaki²,

Kawabe³

et al. 2008

Spine

310

250

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“…Studies have also found an association between depth of cervical lordosis and chronic headache 54, 55 . Several researchers have reported that neurologic improvement is associated with posterior shift of the spinal cord and for this to happen, lordotic alignment of the cervical spine is essential to allow the spinal cord to shift dorsally 46, 56, 57 .…”

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confidence: 99%

Anterior Cervical Spondylosis Surgical Interventions are Associated with Improved Lordosis and Neurological Outcomes at Latest Follow up: A Meta-analysis

Zhang

Luo

et al. 2017

Sci Rep

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Aim of this study was to evaluate the effect of cervical spondylosis surgery on cervical lordosis and to identify factors affecting the change by latest follow-up. Literature search was carried out in electronic databases and study selection followed a priori eligibility criteria. Random effects meta-analyses were performed to estimate effect size/s of change in lordosis after surgery (at latest follow-up) and metaregression analyses were performed to identify factors affecting this change. Nineteen studies (1845 patients; age 55.18 [95% CI: 54.78, 55.57] years; 60.99 [60.63, 61.36] % males; follow-up 25.59 [25.20, 25.99] months) were included. Whereas, corpectomy (4.06 [2.65, 5.46] degree; p < 0.00001) and discectomy (4.59 [2.07, 7.11] degree; p < 0.00001) were associated with increase, laminectomy (−1.87 [−8.40, 4.66] degree; p = 0.57) and laminoplasty (0.25 [−1.07, 1.56] degree; p = 0.711) were not associated with significant change in lordosis at latest follow-up. Change in Japanese Orthopedic Association (JOA)/modified JOA (mJOA) score at latest follow-up was also significantly (p = 0.0005) higher in anterior than in posterior surgery group. Change in lordosis at latest follow-up had significant positive relationship with follow-up duration but had significant inverse associations with age, male gender, and preoperative JOA/mJOA score, independently. In posterior surgery subjects, after adjusting for age and gender, preoperative JOA/mJOA score was significantly inversely related to change in lordosis.

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Morphologic Limitations of Posterior Decompression by Midsagittal Splitting Method for Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament in the Cervical Spine

Abstract: Patients who exhibit significant risk factors for continued contact of the spinal cord should be morphologically considered for anterior decompression.

Cited by 95 publications

References 4 publications

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

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

A New Concept for Making Decisions Regarding the Surgical Approach for Cervical Ossification of the Posterior Longitudinal Ligament

Anterior Cervical Spondylosis Surgical Interventions are Associated with Improved Lordosis and Neurological Outcomes at Latest Follow up: A Meta-analysis

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