Posterior decompression and fusion versus laminoplasty for cervical ossification of posterior longitudinal ligament: a systematic review and meta-analysis

Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up

Ossification of the posterior longitudinal ligament (OPLL) is a common cause of degenerative cervical myelopathy (DCM) in Asian populations. Characterization of OPLL progression following laminoplasty remains limited in the literature. 29 patients with OPLL received cervical laminoplasty and a minimum of 2-years follow-up. Clinical and radiological surveillance occurred at 3-months, 6-months, 12-months post-op and then at yearly intervals. Transverse (anteroposterior) diameter and sagittal length of OPLL in relation to their cervical vertebral level of localisation was assessed upon immediate post-op radiographs compared to those obtained at subsequent follow-up. OPLL progression was defined as an increase in transverse dimensions and/or length by ≥ 2 mm. The average period of clinical follow-up was 6.7 ± 3.3 years. Upon latest follow-up, 79% of patients demonstrated at least 2 mm of transverse or longitudinal progression of OPLL. This corresponded to 2-years and 5-year progression rates of 54% and 71% respectively. OPLL located over C5 demonstrated the greatest transverse progression rate at (0.24 ± 0.34 mm / year). The mean overall longitudinal progression rate was 1.61 ± 2.06 mm / year. No patients experienced neurological decline resulting from OPLL progression requiring revision decompression during the period of post-operative observation. Characterizing transverse and longitudinal progression by cervical level via radiographs has implications in surgical planning for OPLL and should be consolidated upon post-operative CT/MRI scans as well as larger sample sizes.

Sorafenib inhibits ossification of the posterior longitudinal ligament by blocking LOXL2-mediated vascularization

Ossification of the Posterior Longitudinal Ligament (OPLL) is a degenerative hyperostosis disease characterized by the transformation of the soft and elastic vertebral ligament into bone, resulting in limited spinal mobility and nerve compression. Employing both bulk and single-cell RNA sequencing, we elucidate the molecular characteristics, cellular components, and their evolution during the OPLL process at a single-cell resolution, and validate these findings in clinical samples. This study also uncovers the capability of ligament stem cells to exhibit endothelial cell-like phenotypes in vitro and in vivo. Notably, our study identifies LOXL2 as a key regulator in this process. Through gain-and loss-of-function studies, we elucidate the role of LOXL2 in the endothelial-like differentiation of ligament cells. It acts via the HIF1A pathway, promoting the secretion of downstream VEGFA and PDGF-BB. This function is not related to the enzymatic activity of LOXL2. Furthermore, we identify sorafenib, a broad-spectrum tyrosine kinase inhibitor, as an effective suppressor of LOXL2-mediated vascular morphogenesis. By disrupting the coupling between vascularization and osteogenesis, sorafenib demonstrates significant inhibition of OPLL progression in both BMP-induced and enpp1 deficiency-induced animal models while having no discernible effect on normal bone mass. These findings underscore the potential of sorafenib as a therapeutic intervention for OPLL.

Cervical laminoplasty versus laminectomy and fusion: An umbrella review of postoperative outcomes

While multiple studies exist comparing cervical laminoplasty (CLP) and posterior cervical laminectomy with fusion (PCF), no clear consensus exists on which intervention is better. An umbrella review helps provide an overall assessment by analyzing a given condition's multiple interventions and outcomes. It integrates all available information on a topic and allows a consensus to be reached on the intervention of choice. A literature search was conducted using specific search criteria in PubMed, Scopus, and Web of Science databases. Titles and abstracts were screened based on inclusion criteria. A full-text review of articles that passed the initial inclusion criteria was performed. Nine meta-analyses were deemed eligible for the umbrella review. Data was extracted on reported variables from these meta-analyses. Subsequent quality assessment using AMSTAR2 and data analysis using the R package metaumbrella were used to determine the significance of postoperative outcomes. When the meta-analyses were pooled, statistically significant differences between CLP and PCF were found for postoperative overall complications rate and postoperative JOA score. PCF was associated with a lower overall complication rate and a higher postoperative JOA score, both supported by a weak level of evidence (class IV). Data regarding all other outcomes were non-significant. Our umbrella review investigates CLP and PCF by providing a comprehensive overview of existing evidence and evaluating inconsistencies within the literature. This umbrella review revealed that PCF had better outcomes for overall complications rate and postoperative JOA than CLP, but they were classified as being of weak significance.

The Scope of Physiotherapy Rehabilitation in Compressive Myelopathy Managed by Spinal Fusion: A Case Report

Cervical myelopathy is a sequence of alterations that cause etiological ailments such as spondylosis, ossification of the posterior longitudinal ligament, and compression of nerve roots at various levels. The reduced diameter of the vertebral canal is because of degenerative changes in the structure of the disc, along with the formation of osteophytic spurs that compress the surrounding structures, such as nerve roots, at one or more levels. Radiography, CT, MRI, and dynamic study help identify cervical spondylotic myelopathy. Surgical methods such as anterior, posterior, or combined approaches are used to stabilize and potentially improve the subject's neurologic status. The spine's alignment, the number of mobility segments implicated, the morphology, and the location of the spondylotic compression guide surgical decision-making. Cervical spondylotic myelopathy is a condition of the cervical spine that causes narrowing of the spinal canal with symptoms such as neck pain, numbness in the hands, gait problems, and sphincter dysfunction. We present the case of a 52-year-old male diagnosed with compressive myelopathy from C3 to C7 with a history of falling from the bed. On MRI, there were degenerative changes, spondylosis, and compressive myelopathy, and a disc bulge at multiple levels was seen. The patient underwent a spinal fusion at C3 to C7 level followed by structured physical therapy rehabilitation to gain a good recovery and functional independence to improve quality of life.

Preoperative and Postoperative Factors Affecting Patient Satisfaction with Double-Door Laminoplasty for Cervical Spondylotic Myelopathy

Introduction

Few articles have investigated patient satisfaction with laminoplasty in patients with cervical spondylotic myelopathy (CSM) alone, excluding other diseases, such as ossification of the posterior longitudinal ligament. In this study, we aimed to investigate patient satisfaction after double-door laminoplasty for CSM and determine the preoperative and postoperative factors that affect patient satisfaction.

Methods

We retrospectively reviewed cases of laminoplasty for CSM. We measured sagittal imaging parameters (cervical lordosis [CL], C2-C7 cervical sagittal vertical axis [cSVA], and T1 slope [T1S]), Japanese Orthopaedic Association (JOA) score, and patient-reported outcomes (PROs) such as the neck disability index (NDI) and visual analog scale (VAS) preoperatively, 3 months postoperatively, and 1 year postoperatively. In addition, a multiple regression analysis was performed to investigate factors affecting patient satisfaction.

Results

Ninety patients were included in the analysis. After surgery, CL decreased significantly (p<0.01), whereas cSVA increased significantly (p<0.01). No significant differences were observed in the preoperative and postoperative T1S values (p=0.61). The JOA, NDI, and VAS scores significantly improved postoperatively (p<0.01). The median patient satisfaction was 85 (range, 12-100) at 1 year postoperatively and 80 (range, 25-100) at 3 months postoperatively. In the multiple regression analysis, lower-extremity sensory disorder in the JOA score at 1 year postoperatively (p<0.01) and VAS scores for neck pain preoperatively and 1 year postoperatively (p=0.01 and p<0.01, respectively) were determined as factors affecting patient satisfaction.

Conclusions

Cervical laminoplasty is a useful and satisfactory surgical procedure to restore patient function. However, patients with severe preoperative and postoperative neck pain and those with severe postoperative sensory disorders of the lower extremities may be less satisfied with the procedure. It is important to keep these things in mind when treating patients.

Posterior hybrid surgery for atlantoaxial dislocation coexisting with multilevel cervical spondylotic myelopathy

Background

To introduce a hybrid surgery of posterior craniovertebral fusion plus subaxial laminoplasty for atlantoaxial dislocation (AAD) coexisting with multilevel cervical spondylotic myelopathy (CSM).

Methods

A retrospective study was performed by reviewing data from 23 patients with the coexistence of AAD and CSM who underwent the hybrid technique (n = 23). Clinical outcomes, including visual analogue scale (VAS), Japanese Orthopaedic Association (JOA), and neck disability index (NDI) score, and radiological cervical alignment parameters including C0-2 and C2-7 Cobb angle and range of motion (ROM) were analyzed. The operation time, blood loss, surgical levels, and complications were recorded.

Results

The included patients were followed up with an average of 20.91 months (range, 12-36 months). Clinical outcomes including JOA, NDI, and VAS scores were significantly improved at different postoperative follow-up points. C0-2 Cobb angle, C2-7 Cobb angle, and ROM showed a stable tendency after 1-year follow-up. No major perioperative complications occurred.

Conclusion

This study underlined the importance of pathologic condition of AAD coexisting with CSM and presented a novel hybrid approach of posterior craniovertebral fusion plus subaxial laminoplasty. This hybrid surgery was effective in achieving the desired clinical outcomes and better maintaining cervical alignment, proving its value and safety as an alternative technique.

Comparison of the outcome after anterior cervical ossified posterior longitudinal ligament en bloc resection versus posterior total laminectomy and fusion in patients with ossification of the cervical posterior longitudinal ligament: a prospective randomized controlled trial

The optimal procedure for the treatment of ossification of the posterior longitudinal ligament (OPLL) remains controversial. The aim of this study was to compare the outcome of anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) with posterior laminectomy and fusion with bone graft and internal fixation (PTLF) for the surgical management of patients with this condition. Between July 2017 and July 2019, 40 patients with cervical OPLL were equally randomized to undergo surgery with an ACOE or a PTLF. The clinical and radiological results were compared between the two groups. The Japanese Orthopaedic Association (JOA) score and recovery rate in the ACOE group were significantly higher than those in the PTLF group during two years postoperatively, provided that the canal occupying ratio (COR) was > 50%, or the K-line was negative. There was no significant difference in JOA scores and rate of recovery between the two groups in those in whom the COR was < 50%, or the K-line was positive. There was no significant difference in the Cobb angle between C2 and C7, sagittal vertical axis, cervical range of motion (ROM), and complications between the two groups. Compared with PTLF, ACOE is a preferred surgical approach for the surgical management of patients with cervical OPLL in that it offers a better therapeutic outcome when the COR is > 50%, or the K-line is negative, and it also preserves better cervical curvature and sagittal balance. The prognosis of ACOE is similar to that of PTLE when the COR is < 50%, or the K-line is positive.

Instrumented fusion versus instrumented non-fusion following expansive open-door laminoplasty for multilevel cervical ossification of the posterior longitudinal ligament

PURPOSE

To compare the outcomes of expansive open-door laminoplasty with instrumented fusion (ELIF) and expansive open-door laminoplasty with instrumented non-fusion (ELINF) for multilevel cervical ossification of the posterior longitudinal ligament (OPLL).

METHODS

Patients who underwent ELIF or ELINF due to multilevel cervical OPLL from June 2013 to June 2019 were identified. Clinical and radiological outcomes were compared between the two groups.

RESULTS

A total of 78 patients were enrolled in this study with a minimum follow-up of 24 months, including 42 patients in the ELIF group and 36 patients in the ELINF group. At the final follow-up, sagittal vertical axis (SVA) and C2-C7 Cobb angle in the ELIF group were significantly better than those in the ELINF group, and cervical range of movement (ROM) in the ELIF group decreased significantly than that in the ELINF group. The incidence of OPLL progression at the final follow-up was 4.76% (2/42) in the ELIF group and 27.78% (10/36) in the ELINF group. Postoperative Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) score improved significantly in each group, but JOA score and recovery rate (RR) in the ELIF group were significantly better than those in the ELINF group at the final follow-up. When K-line was positive, the difference in the final JOA score between the two groups was not significant, but the RR in the ELIF group was significantly better than that in the ELINF group. When K-line was negative, the final JOA score and RR in the ELIF group were significant higher than those in the ELINF group.

CONCLUSIONS

ELIF and ELINF were two effective surgical procedures for treating multilevel cervical OPLL. However, ELIF was superior to ELINF due to better postoperative JOA score and RR, significant improvement of C2-C7 Cobb angle and maintenance of SVA, and suppressant effect on OPLL progression, especially for patients with K-line ( - ) OPLL.

Risk Factors for Poor Prognosis of Spinal Cord Injury without Radiographic Abnormality Associated with Cervical Ossification of the Posterior Longitudinal Ligament

Purpose

To investigate the factors associated with the prognosis of spinal cord injury without radiographic abnormality (SCIWORA) accompanied by cervical ossification of the posterior longitudinal ligament (C-OPLL).

Methods

We retrospectively investigated 287 patients with SCIWORA associated with C-OPLL, who were admitted within 30 days after trauma to our facility between August 2014 and August 2018. All patients were divided into the good or poor prognosis group. Patient demographics were analyzed. Besides, occupying ratio on CT and spinal cord high signal changes in MRI T2WI were measured and recorded. Multivariate linear regression was applied to analyze the correlation of prognosis with spinal cord high signal changes in MRI T2WI, cause of injury, and occupying ratio.

Results

Occupying ratio of ossification mass was 43.5 ± 10.7% in the poor prognosis group and 27.3 ± 7.7% in the good prognosis group. The occurrence rate of high signal changes in MRI T2WI was 84.2% in the poor prognosis group and 41.3% in the good prognosis group. Poor prognosis was correlated with high occupying ratio and spinal cord high signal changes in MRI T2WI. In the patient with SCIWORA associated with C-OPLL, ROC curve of occupying ratio showed 30% as a predictor for the poor prognosis. Among the 92 patients with occupying ratio ≤ 30%, poor prognosis was observed in 5 cases (5.4%), whereas in the 72 cases with occupying ratio > 30%, poor prognosis was seen in 33 cases (45.8%). Postoperative AIS grade at final follow-up in occupying ratio > 30% group was significantly worse.

Conclusions

Patients suffering from SCIWORA with C-OPLL have poor prognosis when they have higher occupying ratio of ossification mass and spinal cord high signal changes in MRI T2WI. The cut-off value of occupying ratio for predicting the poor prognosis was 30% in patients with SCIWORA associated with C-OPLL.

Comparison of Interventions for Cervical Ossification of Posterior Longitudinal Ligament: A Systematic Review and Network Meta-Analysis

OBJECTIVE

To summarize the literature and systematically evaluate outcomes for ossification of posterior longitudinal ligament interventions including anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement and fusion (ACAF), laminoplasty (LP), and laminectomy with fusion (LF).

METHODS

We searched PubMed, Embase, Web of Science, and the Cochrane Library from January 1990 to March 2021. Patient demographic data, Japanese Orthopaedic Association score, cervical lordosis and overall complications were analyzed.

RESULTS

We evaluated 30 studies involving 2038 patients. Patients undergoing ACCF had improved Japanese Orthopaedic Association scores compared with patients undergoing LP (weighted mean difference [WMD] 1.17, 95% confidence interval [CI] 0.49-1.85) and LF (WMD 1.21, 95% CI 0.17-2.24). Patients with ACAF had better cervical lordosis compared with patients with ACCF (WMD 7.00, 95% CI 0.72-13.27), LP (WMD 10.27, 95% CI 4.64-15.90), and LF (WMD 8.98, 95% CI 2.48-15.47). Additionally, ACAF (odds ratio 0.24, 95% CI 0.07-0.84) and LP (odds ratio 0.50, 95% CI 0.28-0.90) had a lower incidence of complications compared with ACCF.

CONCLUSIONS

Japanese Orthopaedic Association score outcomes indicated that ACCF was superior to LP and LF. ACAF had the largest cervical lordosis among all procedures. ACCF showed a higher incidence of overall complications compared with ACAF and LP.