Neurological Complications of Cervical Laminoplasty for Patients With Ossification of the Posterior Longitudinal Ligament—A multi-Institutional Retrospective Study

Seichi, Atsushi; Hoshino, Yuichi; Kimura, Atsushi; Nakahara, Shiro; Watanabe, Masahiko; Kato, Tsuyoshi; Ono, Atsushi; Kotani, Yoshihisa; Mitsukawa, Mamoru; Ijiri, Kosei; Kawahara, Norio; Inami, Satoshi; Chikuda, Hirotaka; Takeshita, Katsushi; Nakagawa, Yukihiro; Taguchi, Toshihiko; Yamazaki, Masashi; Endo, Kenji; Sakaura, Hironobu; Uchida, Kenzo; Kawaguchi, Yoshiharu; Neo, Masashi; Takahashi, Masahito; Harimaya, Katsumi; Hosoe, Hideo; Imagama, Shiro; Taniguchi, Shinichiro; Ito, Takui; Kaito, Takashi; Chiba, Kazuhiro; Matsumoto, Morio; Toyama, Yoshiaki

doi:10.1097/brs.0b013e3181fda7fa

Cited by 58 publications

(55 citation statements)

References 18 publications

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“…27 In contrast, in a study by Seichi et al that reported outcomes of 581 patients with OPLL who underwent laminoplasty, postoperative upper-and lower-extremity motor deterioration were reported in only 4% and 3.1% of patients, respectively. 50 In the current study, we found no statistically significant difference in the incidence of total complications in the decompression and fusion and the decompression-only populations. There was, however, a statistically significant difference in the incidence of specific complications in each population.…”

Section: Complications and Revision Surgeries In Patients Who Underwecontrasting

confidence: 56%

“…5,8,10,14,25,27,35,44,46,48,50,52 Some of the most commonly reported complications after cervical decompression and fusion surgery include CSF leaks and pseudarthrosis, whereas posterior decompression is more commonly associated with neurological deterioration, persistent neuropathic pain in the extremities, and progression of kyphotic change. 6,14 Previous studies have demonstrated an increased incidence of complications after decompression and fusion compared with decompression only.…”

Section: Complications and Revision Surgeries In Patients Who Underwementioning

confidence: 99%

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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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Section: Complications and Revision Surgeries In Patients Who Underwecontrasting

confidence: 56%

Section: Complications and Revision Surgeries In Patients Who Underwementioning

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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“…While surgical decompression is the mainstay treatment for OPLL, there are currently few prognostic factors that are useful in predicting complications and postoperative outcomes [10,11]. Reported surgical complications of cervical decompression for OPLL include durotomy causing cerebrospinal fluid leak [12], spinal epidural hematoma formation [13], spinal cord herniation [14], rare bilateral phrenic nerve palsy [15] and vertebral artery injury [16].…”

Section: Discussionmentioning

confidence: 99%

“…Incidence ranges from 2.6% to 18.4% and onset typically is delayed, ranging from 4 hours to 7 days [5,[16][17][18][19]. Unilateral or bilateral palsies are possible [5].…”

Section: Discussionmentioning

confidence: 99%

Delayed C5 Palsy after Laminectomy and Fusion for Ossification of the Posterior Longitudinal Ligament

Lau¹,

Park²

2011

J Spine

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Ossification of the posterior longitudinal ligament (OPLL) can cause myelopathy. Laminectomy with fusion is one surgical option for the treatment of symptomatic OPLL. In this report, we present 2 illustrative cases of unilateral C5 palsy occurring in a delayed manner after posterior decompression for OPLL. Both patients were successfully treated with conservative management. incidence, potential etiology, management and outcomes for this potentially debilitating complication are reviewed.

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“…The most accurate numbers may be in the range of 2.3%-4%, determined in 2 multi-institutional studies that used nationwide samples of > 1800 and 500 patients, respectively. 77 Excluding those reviews, we found that 16% of the studies that were published in the last 10 years reported a C-5 palsy rate of > 10% (totaling 534 patients), 41% reported a rate of 5%-10% (totaling 1006 patients), 23% reported a rate of 1%-5% (totaling 857 patients), and 12.5% reported a rate of 0% (totaling 168 patients).…”

Section: Neck Painmentioning

confidence: 91%

Cervical laminoplasty developments and trends, 2003–2013: a systematic review

Duetzmann¹,

Cole²,

Ratliff³

2015

SPI

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OBJECT Despite extensive clinical experience with laminoplasty, the efficacy of the procedure and its advantages over laminectomy remain unclear. Specific clinical elements, such as incidence or progression of kyphosis, incidence of axial neck pain, postoperative cervical range of motion, and incidence of postoperative C-5 palsies, are of concern. The authors sought to comprehensively review the laminoplasty literature over the past 10 years while focusing on these clinical elements. METHODS The authors conducted a literature search of articles in the Medline database published between 2003 and 2013, in which the terms “laminoplasty,” “laminectomy,” and “posterior cervical spine procedures” were used as key words. Included was every single case series in which patient outcomes after a laminoplasty procedure were reported. Excluded were studies that did not report on at least one of the above-mentioned items. RESULTS A total of 103 studies, the results of which contained at least 1 of the prespecified outcome variables, were identified. These studies reported 130 patient groups comprising 8949 patients. There were 3 prospective randomized studies, 1 prospective nonrandomized alternating study, 15 prospective nonrandomized data collections, and 84 retrospective reviews. The review revealed a trend for the use of miniplates or hydroxyapatite spacers on the open side in Hirabayashi-type laminoplasty or on the open side in a Kurokawa-type laminoplasty. Japanese Orthopaedic Association (JOA) scoring was reported most commonly; in the 4949 patients for whom a JOA score was reported, there was improvement from a mean (± SD) score of 9.91 (± 1.65) to a score of 13.68 (± 1.05) after a mean follow-up of 44.18 months (± 35.1 months). The mean preoperative and postoperative C2–7 angles (available for 2470 patients) remained stable from 14.17° (± 0.19°) to 13.98° (± 0.19°) of lordosis (average follow-up 39 months). The authors found significantly decreased kyphosis when muscle/posterior element–sparing techniques were used (p = 0.02). The use of hardware in the form of hydroxyapatite spacers or miniplates did not influence the progression of deformity (p = 0.889). An overall mean (calculated from 2390 patients) of 47.3% loss of range of motion was reported. For the studies that used a visual analog scale score (totaling 986 patients), the mean (cohort size–adjusted) postoperative pain level at a mean follow-up of 29 months was 2.78. For the studies that used percentages of patients who complained of postoperative axial neck pain (totaling 1249 patients), the mean patient number–adjusted percentage was 30% at a mean follow-up of 51 months. The authors found that 16% of the studies that were published in the last 10 years reported a C-5 palsy rate of more than 10% (534 patients), 41% of the studies reported a rate of 5%–10% (n = 1006), 23% of the studies reported a rate of 1%–5% (n = 857), and 12.5% reported a rate of 0% (n = 168). CONCLUSIONS Laminoplasty remains a valid option for decompression of the spinal cord. An understanding of the importance of the muscle-ligament complex, plus the introduction of hardware, has led to progress in this type of surgery. Reporting of outcome metrics remains variable, which makes comparisons among the techniques difficult.

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Neurological Complications of Cervical Laminoplasty for Patients With Ossification of the Posterior Longitudinal Ligament—A multi-Institutional Retrospective Study

Abstract: Although most neurological deterioration can be expected to recover to some extent, the frequency of short-term neurological complications was higher than the authors expected.

Cited by 58 publications

References 18 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

Delayed C5 Palsy after Laminectomy and Fusion for Ossification of the Posterior Longitudinal Ligament

Cervical laminoplasty developments and trends, 2003–2013: a systematic review

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