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Open Access 01-06-2018 | Ideas and Technical Innovations

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

Authors: Jingchuan Sun, Jiangang Shi, Ximing Xu, Yong Yang, Yuan Wang, Qingjie Kong, Haisong Yang, Yongfei Guo, Dan Han, Jingjing Jiang, Guodong Shi, Wen Yuan, Lianshun Jia

Published in: European Spine Journal | Issue 6/2018

Abstract

Purpose

Although anterior and posterior decompression surgery are both reported to treat patients with myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). The surgical strategy of the disease is still controversial when the OPLL is multilevel and severe. This present study reports the preliminary clinical results of a novel technique named anterior controllable antidisplacement and fusion (ACAF) for the treatment of multilevel-severe OPLL with myelopathy.

Methods

A series of 15 patients with cervical myelopathy caused by compression of multilevel severe OPLL were enrolled. All the patients underwent ACAF after thorough surgical designing based on preoperative imaging. The patients were followed for a mean follow-up duration of 9 months in this study. The main surgical procedures include discectomy of the involved levels, thinning of the anterior part of the involved vertebrae, intervertebral cages, anterior plate and screws installation, bilateral osteotomies of the vertebrae, and antedisplacement of the vertebrae-OPLL complex (VOC). The Japanese Orthopaedic Association (JOA) scales, Visual Analog Scale (VAS) were studied. And the pre- and postoperative radiological parameters, and surgical complications were also investigated.

Results

Postoperative CT and MRI showed complete decompression of the cord by antidisplacement of the VOC. Restoration of neurological defects was confirmed at the last follow-up assessment. Bone fusion was confirmed by CT at 6 months follow-up. No specific complications were identified that were associated with this technique.

Conclusions

The present study demonstrates that excellent postoperative outcome can be achieved with the use of the ACAF. Though further study is required to confirm the conclusion, this novel technique has the potential to serve as an alternative surgical technique for the treatment of cervical OPLL.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Epstein N (2002) Diagnosis and surgical management of cervical ossification of the posterior longitudinal ligament.[J]. Spine J 2(6):436CrossRefPubMed

Liu S, Zhang D, Jia P et al (1995) Epidemiology research of ossification of posterior longitudinal ligament of cervical spine. J Jilin Univ 4:411–413

Nd EC, Heller JG, Murakami H (2002) Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine 27(11):1168CrossRef

Jain SK, Salunke PS, Vyas KH et al (2005) Multisegmental cervical ossification of the posterior longitudinal ligament: anterior vs posterior approach. Neurol India 53(3):283–285 (discussion 286) CrossRefPubMed

Cardoso MJ, Koski TR, Aruna G et al (2011) Approach-related complications after decompression for cervical ossification of the posterior longitudinal ligament. Neurosurg Focus 30(3):285–293CrossRef

Chen Y, Guo Y, Lu X et al (2011) Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine[J]. J Spinal Disord Tech 24(1):24CrossRefPubMed

Tomita K, Nomura S, Umeda S et al (1988) Cervical laminoplasty to enlarge the spinal canal in multilevel ossification of the posterior longitudinal ligament with myelopathy. Arch Orthop Trauma Surg 107(3):148–153CrossRefPubMed

Chen Y, Yang L, Liu Y et al (2014) Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament. PLoS One 9(7):e102008CrossRefPubMedPubMedCentral

Shinomiya K, Matsuoka T, Kurosa Y et al (2006) Anterior cervical decompression for cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). Springer, Tokyo, pp 209–218

10.

Pitzen T, Chrobok JJ, Ruffing S et al (2009) Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: 2-year results of a multi-centric, randomized, controlled study. Spine 34(7):641–646CrossRefPubMed

11.

Hirabayashi K, Watanabe K, Wakano K et al (2001) Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine 8(7):693CrossRef

12.

Iwasaki M, Kawaguchi Y, Kimura T et al (2002) Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg 96(2 Suppl):180PubMed

13.

Fujimori T, Iwasaki M, Okuda S et al (2014) Long-term results of cervical myelopathy due to ossification of the posterior longitudinal ligament with an occupying ratio of 60% or more. Spine 39(1):58CrossRefPubMed

14.

Petty P (1997) Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures. Neurosurgery 41(1):769–776CrossRef

15.

SPSS (Computer program) (2009) Version 18.0. SPSS Inc, Chicago

16.

Baba H, Furusawa N, Chen Q et al (1995) Cervical laminoplasty in patients with ossification of the posterior longitudinal ligaments. Paraplegia 33(1):25–29PubMed

17.

Lee DH, Joo YS, Hwang CJ et al (2016) A novel technique to correct kyphosis in cervical myelopathy due to continuous-type ossification of the posterior longitudinal ligament. J Neurosurg Spine 26(3):1

18.

Sakaura H, Hosono N, Mukai Y et al (2003) C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine 28(21):2447–2451CrossRefPubMed

19.

Lee SE, Chung CK, Jahng TA et al (2013) Long-term outcome of laminectomy for cervical ossification of the posterior longitudinal ligament. J Neurosurg Spine 18(5):465–471CrossRefPubMed

20.

Kato Y, Iwasaki M, Fuji T et al (1998) Long-term follow-up results of laminectomy for cervical myelopathy caused by ossification of the posterior longitudinal ligament. J Neurosurg 89(2):217–223CrossRefPubMed

21.

Onari K, Akiyama N, Kondo S et al (2001) Long-term follow-up results of anterior interbody fusion applied for cervical myelopathy due to ossification of the posterior longitudinal ligament. Spine 26(5):488CrossRefPubMed

22.

Chen Y, Liu X, Chen D et al (2012) Surgical strategy for ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics 35(8):e1231CrossRefPubMed

23.

Shin JH, Steinmetz MP, Benzel EC et al (2011) Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament: considerations for approach selection and review of surgical outcomes. Neurosurg Focus 30(3):E8CrossRefPubMed

24.

Yamaura I, Kurosa Y, Matuoka T et al (1999) Anterior floating method for cervical myelopathy caused by ossification of the posterior longitudinal ligament. Clin Orthop Relat Res 359(359):27CrossRef

25.

Matsuoka T, Yamaura I, Kurosa Y et al (2011) Long-term results of the anterior floating method for cervical myelopathy caused by ossification of the posterior longitudinal ligament. Spine 26(3):241–248CrossRef

26.

Yoshii T, Hirai T, Yamada T et al (2017) Intraoperative evaluation using mobile computed tomography in anterior cervical decompression with floating method for massive ossification of the posterior longitudinal ligament. J Orthop Surg Res 12(1):12CrossRefPubMedPubMedCentral

27.

Goel A, Nadkarni T, Shah A et al (2015) Is only stabilization the ideal treatment for ossified posterior longitudinal ligament? Report of early results with a preliminary experience in 14 patients. World Neurosurg 84(3):813–819CrossRefPubMed

28.

Cho JY, Chan CK, Lee SH et al (2012) Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine: the utilization of a volume-controlled pseudomeningocele. J Spinal Disord Tech 25(4):E93CrossRefPubMed

29.

Belanger TA, Roh JS, Hanks SE et al (2005) Ossification of the posterior longitudinal ligament Results of anterior cervical decompression and arthrodesis in 61 North American patients. J Bone Jt Surg 87(3):610 (American Volume) CrossRef

30.

Hannallah D, Lee J, Khan M et al (2008) Cerebrospinal fluid leaks following cervical spine surgery. J Bone Jt Surg Am 90(5):1101–1105CrossRef

31.

Lin D, Ding Z, Lian K et al (2012) Cervical ossification of the posterior longitudinal ligament: anterior versus posterior approach. Indian J Orthop 46(1):92CrossRefPubMedPubMedCentral

Title: 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
Authors: Jingchuan Sun
Jiangang Shi
Ximing Xu
Yong Yang
Yuan Wang
Qingjie Kong
Haisong Yang
Yongfei Guo
Dan Han
Jingjing Jiang
Guodong Shi
Wen Yuan
Lianshun Jia
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 6/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5437-4

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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

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

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Abstract

Purpose

Methods

Results

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