Postoperative K-line conversion from negative to positive is independently associated with a better surgical outcome after posterior decompression with instrumented fusion for K-line negative cervical ossification of the posterior ligament

Koda, Masao; Furuya, Takeo; Saito, Junya; Ijima, Yasushi; Kitamura, Mitsuhiro; Ohtori, Seiji; Orita, Sumihisa; Inage, Kazuhide; Abe, Tetsuya; Noguchi, Hiroshi; Funayama, Toru; Kumagai, Hiroshi; Miura, Kousei; Nagashima, Katsuya; Yamazaki, Masashi

doi:10.1007/s00586-018-5505-4

Cited by 14 publications

(17 citation statements)

References 20 publications

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“…Koda et al reported that K-line conversion from negative to positive is associated with better neurological outcomes. 31 Likewise, the results of the present study showed that conversion of mK-line status is associated with a recovery rate ≥50%. Second, since VBSO is a fusion procedure, ROM is eliminated at the pathologic segments.…”

Section: Discussionsupporting

confidence: 71%

Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament

Lee

Park

Hong

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: Vertebral body sliding osteotomy (VBSO) has previously been reported as a technique to decompress ossification of the posterior longitudinal ligament (OPLL) by translating the vertebral body anteriorly. This study aimed to evaluate the radiological and clinical efficacies of VBSO and clarify the surgical indications of VBSO for treating myelopathy caused by OPLL. Methods: Ninety-seven patients with symptomatic OPLL-induced cervical myelopathy treated with VBSO or laminoplasty who were followed up for more than 2 years were retrospectively reviewed. Cervical alignment, range of motion, fusion, modified K-line (mK-line) status, and minimum interval between ossified mass and mK-line (INT(min)), and the Japanese Orthopaedic Association (JOA) score were assessed. Patients in the VBSO group were compared with those who underwent laminoplasty. Results: Cervical lordosis and INT(min) significantly increased in the VBSO group. All patients in the VBSO group assessed as mK-line (-) preoperatively were assessed as mK-line (+) postoperatively. However, in the LMP group, the mK-line status changed from (+) preoperatively to (−) postoperatively in 3 patients. Final JOA score (p = 0.02) and JOA score improvement (p = 0.01) were significantly higher in the VBSO group. JOA recovery ratio (p = 0.03) and proportion of patients with a recovery rate ≥50% were significantly higher in the VBSO group (p < 0.01). Conclusions: VBSO is an effective surgical option for OPLL-induced myelopathy, demonstrating favorable neurological recovery and lordosis restoration with low complication rates. It is best indicated for kyphotic alignment, OPLL with a high space-occupying ratio, and OPLL involving ≤3 segments.

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Section: Discussionsupporting

confidence: 71%

Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament

Lee

Park

Hong

et al. 2020

Global Spine Journal

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“…As K‐line (−) was converted to K‐line (+) using PDF with VP, sufficient ventral and posterior decompression were met, which led to better outcomes than conventional PDF in the K‐line (−) case. To the best of our knowledge, the recovery rate for K‐line (−) patients approximately ranges from 54% to 73% after ADF and 38.2% to 43.6% after PDF 8,9,24,25,30,31 . Our study showed an average recovery rate of 70.59% in the JOA score of all cases, 72.08% in kyphotic cases, and 70.51% in thick OPLL (MOR>50%), which is acceptable as K‐line (−) indicates poor clinical prognosis (Fig.…”

Section: Discussionmentioning

confidence: 56%

“…6,7 Postoperative K-line conversion from negative to positive is associated with a better surgical outcome. 8 OPLL is primarily found in the cervical spine and is a common pathogeny of cervical myelopathy. 9,10 Most patients with C-OPLL do not exhibit any neurological symptoms in the early stages.…”

Section: Introductionmentioning

confidence: 99%

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Posterior Decompression and Fusion with Vertical Pressure Procedure in the Treatment of Multilevel Cervical OPLL with Kyphotic Deformity

Mei

et al. 2022

Orthopaedic Surgery

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Objective To report the outcomes and feasibility of a new technique to change K‐line (−) to K‐line (+) via only a posterior approach to treat multilevel non‐continuous cervical ossification of the posterior longitudinal ligament (C‐OPLL) with kyphotic deformity. Methods In this study, 17 consecutive cases of patients who underwent vertical pressure procedure (VP) combined with posterior cervical single‐open‐door laminoplasty and instrumented fusion from January 1, 2017 to December 31, 2019 were enrolled. The following radiographic parameters: C2‐C7 Cobb angle, local Cobb angle, extent of OPLL, and the distance from OPLL to the K‐line(DK) were measured and analyzed. Clinically, the JOA score, VAS‐N and VAS‐A, NDI, and complications were collected from medical records to evaluate the clinical outcomes. Results All 17 cases shifted from K‐line (−) to K‐line (+).Comparing the preoperative images to the final follow‐up images, the mean C2‐7 Cobb angle changed from −6.94° ± 8.30° to 8.18° ± 4.43°, and the local Cobb angle altered from −9.12° ± 8.68° to 6.65° ± 6.11°. The mean DK increased from −2.64 ± 1.52 mm to 3.09 ± 2.19 mm. One patient showed C5 palsy and recovered within 3 months. The mean JOA score increased from 8.88 ± 2.11 to 14.71 ± 1.36. The average NDI decreased from 20.65 ± 7.80 to 8.94 ± 4.93. The mean VAS‐N and VAS‐A decreased from 3.44 ± 1.80 and 4.69 ± 1.97 to 1.25 ± 0.86 and 1.38 ± 1.16. All patients were followed up for at least 1 year. Conclusion A new technique added to posterior decompression and fusion (PDF), the vertical pressure procedure effectively corrects K‐line (−) to K‐line (+) and avoids the shortcomings of conventional anterior decompression and fusion (ADF) as well as PDF to provide a relatively safe and adequate decompression, cervical realignment. It pronounced satisfactory clinical outcome for extensive non‐continuous OPLL with kyphotic deformity even though OPLL remains ventral to the spinal cord.

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“…Recent studies have reported poor postoperative neurologic improvements after laminoplasty in patients with Kline (−) OPLL [25]. The mean recovery rate of the K-line (−) OPLL patient group was significantly lower than that of the K-line (+) group.…”

Section: Discussionmentioning

confidence: 88%

The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients

Zhang

Dong

et al. 2020

The Spine Journal

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BACKGROUND CONTEXT: Laminoplasty is a common surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although laminoplasty is preferred over traditional laminectomy, the factors affecting the complications and outcomes are unclear. Recently, sagittal balance indexes have been revealed to be predictors of clinical outcomes in patients with cervical degenerative diseases, but their relationships with laminoplasty-treated OPLL outcomes remains unknown. PURPOSE: The purpose of this study is to evaluate the relationship of preoperative cervical sagittal balance indexes and clinical outcome in laminoplasty treated OPLL patients. STUDY DESIGN: This is a retrospective case study. PATIENT POPULATION: Between January 2015 and January 2017, 181 consecutively included patients who underwent cervical laminoplasty for OPLL were enrolled (male:female ratio=126:75; mean age=60.2 years). Cervical spine lateral radiographs in neutral, flexion, and extension positions were taken before and 2 years after the surgery. OUTCOME MEASURES: The C2−C7 Cobb angle, T1 slope, C1−C7 sagittal vertical axis (SVA), C2−C7 SVA, CGH (center of gravity of the head)-C7 SVA, cervical JOA (Japanese Orthopedic Association) score, and neck VAS (visual analogue scale) score were measured preoperatively and postoperatively at the 2-year follow-up. METHODS: The patients were divided into two groups according to changes in the lordotic angle or the recovery rate of the JOA score. The relationships between the postoperative lordosis loss or the clinical outcome and the preoperative variables, including the patient's age, JOA score, C2-C7 Cobb angle, T1 slope, C1-C7 SVA, C2-C7 SVA, and CGH-C7 SVA, were investigated. RESULTS: The patients were divided into two groups according to the postoperative change in the C2-C7 Cobb angle. There were no differences in the age, preoperative C2-C7 Cobb angle, C1-C7 SVA, or C2-C7 SVA; there was only a difference in the preoperative CGH-C7 SVA and T1 slope level (p=.038, p=.042). The postoperative JOA and JOA recovery rate were related to the postoperative lordosis loss in cervical alignment (p=.048, p=.031). We again divided the patients into two groups according to the JOA recovery rate and found that only the preoperative CGH-C7 SVA and FSA device/drug status: Not applicable.

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Postoperative K-line conversion from negative to positive is independently associated with a better surgical outcome after posterior decompression with instrumented fusion for K-line negative cervical ossification of the posterior ligament

Abstract: Postoperative K-line conversion from (-) to (+) is a factor independently associated with a better surgical outcome. These slides can be retrieved under Electronic Supplementary material.

Cited by 14 publications

References 20 publications

Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament

Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament

Posterior Decompression and Fusion with Vertical Pressure Procedure in the Treatment of Multilevel Cervical OPLL with Kyphotic Deformity

The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients

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