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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 7/2013

01-07-2013 | Surgical Technique

Surgical Technique: Hemilaminectomy and Unilateral Lateral Mass Fixation for Cervical Ossification of the Posterior Longitudinal Ligament

Authors: Kun Liu, MD, Jiangang Shi, MD, Lianshun Jia, MD, Wen Yuan, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 7/2013

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Abstract

Background

Surgical approaches for cervical ossification of the posterior longitudinal ligament (OPLL) include anterior, posterior, or combined decompression with or without fusion. The goal of surgery is to decompress the spinal cord while maintaining the stability and sagittal alignment of the cervical spine. C5 palsy has been reported as a postoperative complication of cervical laminectomy or laminoplasty characterized as motor weakness of the muscles supplied with C5 nerve roots. Several studies have shown this phenomenon was partially attributable to posterior shift of spinal cord.

Description of Technique

The rationale for choosing hemilaminectomy is to control postoperative posterior shift of the spinal cord and afford more stability by preserving ligamentous attachments and posterior bony elements as much as possible. After a fixation system of lateral mass screws and rods is installed unilaterally, laminae are removed from the underlying dura using a high-speed burr and Kerrison laminectomy rongeur on the other side. The spinous processes are preserved.

Patients and Methods

Patients with multilevel continuous/mixed cervical OPLL are good candidates for this technique. We retrospectively reviewed 146 patients who had multilevel continuous/mixed cervical OPLL and underwent surgery from January 2006 to January 2010. Neurologic condition was evaluated using the improvement ratio (IR) of the Japanese Orthopaedic Association (JOA) score for cervical myelopathy.

Results

The mean JOA score increased from 10 points before surgery to 14 points at last followup. The mean IR of neurologic function (JOA score) was 59%. C5 palsy was not observed in any patient after decompression, and cervical lordosis changed from 8.7° preoperatively to 9.1° at last followup.

Conclusions

For patients with multilevel continuous/mixed cervical OPLL without fixed kyphosis, multilevel hemilaminectomy with unilateral lateral mass fixation is an effective alternative technique.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Anderson PA, Henley MB, Grady MS, Montesano PX, Winn HR. Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine (Phila Pa 1976). 1991;16(3 suppl):S72–S79.
2.
Asazuma T, Nakamura M, Matsumoto M, Chibo K, Toyama Y. Postoperative changes of spinal curvature and range of motion in adult patients with cervical spinal cord tumors: analysis of 51 cases and review of the literature. J Spinal Disord Tech. 2004;17:178–182.PubMedCrossRef
3.
Benzel EC, Lancon J, Kesterson L, Hadden T. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord. 1991;4:286–295.PubMedCrossRef
4.
Cardoso MJ, Koski TR, Ganju A, Liu JC. Approach-related complications after decompression for cervical ossification of the posterior longitudinal ligament. Neurosurg Focus. 2011;30:E12.PubMedCrossRef
5.
Gao R, Yang L, Chen H, Liu Y, Liang L, Yuan W. Long term results of anterior corpectomy and fusion for cervical spondylotic myelopathy. PLoS One. 2012;7:e34811.PubMedCrossRef
6.
Geck MJ, Eismont FJ. Surgical options for the treatment of cervical spondylotic myelopathy. Orthop Clin North Am. 2002;33:329–348.PubMedCrossRef
7.
Hee HT, Majd ME, Holt RT, Whitecloud TS 3rd, Pienkowski D. Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord Tech. 2003;16:1–8; discussion 8–9.
8.
Jeanneret B, Magerl F, Ward EH, Ward JC. Posterior stabilization of the cervical spine with hook plates. Spine (Phila Pa 1976). 1991;16(3 suppl):S56–S63.
9.
Komotar RJ, Mocco J, Kaiser MG. Surgical management of cervical myelopathy: indications and techniques for laminectomy and fusion. Spine J. 2006;6(6 suppl):252S–267S.PubMedCrossRef
10.
Mehdorn HM, Fritsch MJ, Stiller RU. Treatment options and results in cervical myelopathy. Acta Neurochir Suppl. 2005;93:177–182.PubMedCrossRef
11.
Mizuno J, Nakagawa H. Ossified posterior longitudinal ligament: management strategies and outcomes. Spine J. 2006;6(6 suppl):282S–288S.PubMedCrossRef
12.
Nakashima H, Imagama S, Yukawa Y, Kanemura T, Kamiya M, Yanase M, Ito K, Machino M, Yoshida G, Ishikawa Y, Matsuyama Y, Hamajima N, Ishiguro N, Kato F. Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation. J Neurosurg Spine. 2012;17:103–110.PubMedCrossRef
13.
Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H. C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine (Phila Pa 1976). 2003;28:2447–2451.
14.
Saunders RL. On the pathogenesis of the radiculopathy complicating multilevel corpectomy. Neurosurgery. 1995;37:408–412; discussion 412–413.
15.
Sekhon LH. Posterior cervical lateral mass screw fixation: analysis of 1026 consecutive screws in 143 patients. J Spinal Disord Tech. 2005;18:297–303.PubMedCrossRef
16.
Steinmetz MP, Kager CD, Benzel EC. Ventral correction of postsurgical cervical kyphosis. J Neurosurg. 2003;98(1 suppl):1–7.PubMed
17.
Tsuzuki N, Abe R, Saiki K, Zhongshi L. Extradural tethering effect as one mechanism of radiculopathy complicating posterior decompression of the cervical spinal cord. Spine (Phila Pa 1976). 1996;21:203–211.
18.
Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K. Neurologic complications of surgery for cervical compression myelopathy. Spine (Phila Pa 1976). 1991;16:1277–1282.
Metadata
Title
Surgical Technique: Hemilaminectomy and Unilateral Lateral Mass Fixation for Cervical Ossification of the Posterior Longitudinal Ligament
Authors
Kun Liu, MD
Jiangang Shi, MD
Lianshun Jia, MD
Wen Yuan, MD
Publication date
01-07-2013
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 7/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-2889-7

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