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Kato S, Fujiwara S, Ohtomo N, Yamato Y, Sasaki K, Yu J, Doi T, Taniguchi Y, Matsubayashi Y, Ushikubo T, Ogata T, Tanaka S, Oshima Y. Motion Capture-based 3-dimensional Measurement of Range of Motion in Patients Undergoing Cervical Laminoplasty. Clin Spine Surg 2024:01933606-990000000-00321. [PMID: 38820120 DOI: 10.1097/bsd.0000000000001641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/29/2024] [Indexed: 06/02/2024]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE To measure 3-dimensional cervical range of motion (ROM) by noninvasive optical tracking-based motion-capture technology in patients undergoing laminoplasty, and to elucidate the postoperative effects of laminoplasty on cervical mobility. SUMMARY OF BACKGROUND DATA Cervical laminoplasty is a motion-sparing decompression surgery for degenerative cervical myelopathy. Unlike cervical laminectomy and fusion, the true postoperative impact of laminoplasty on neck motion has not been well studied. METHODS Participants comprised 25 patients undergoing double-door cervical laminoplasty for degenerative cervical myelopathy in a single center. Maximum flexion/extension, left/right rotation, and left/right side bending were recorded using the motion-capture device preoperatively and 3 months postoperatively. ROMs in 3 orthogonal axes were calculated. Preoperative differences in C2-7 Cobb angles on lateral flexion/extension x-rays were also measured as the radiologic ROM to assess reliability. Preoperative and 1-year postoperative Japanese Orthopaedic Association score, Neck Disability Index [NDI], and Euro-QOL were recorded, and correlations with ROMs were assessed. RESULTS Preoperative mean (±SD) ROMs for flexion/extension, rotation, and side bending were 90±17, 107±16, and 53±17 degrees, respectively. Although radiologic sagittal ROM measurement showed a smaller range than motion capture, averaging 36±13 degrees, a moderate to strong correlation between radiologic and motion capture values was observed (R=0.57, P=0.003). Preoperative NDI showed a negative correlation with coronal ROM (rho=-0.547, P=0.02). Postoperative ROM showed a significant reduction in rotation (95±16 degrees, P=0.002) but not in flexion/extension or side bending. CONCLUSIONS Three-dimensional motion-capture analysis allowed reliable measurement of cervical ROM. Rotational ROM was significantly reduced after laminoplasty, showing that cervical kinematics are still significantly altered.
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Affiliation(s)
- So Kato
- Department of Orthopaedic Surgery
| | - Sayaka Fujiwara
- Department of Rehabilitation Medicine, The University of Tokyo
| | | | | | | | - Jim Yu
- Department of Orthopaedic Surgery
| | - Toru Doi
- Department of Orthopaedic Surgery
| | | | | | | | - Toru Ogata
- Department of Rehabilitation Medicine, The University of Tokyo
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Jang HJ, Moon BJ, Kim KH, Park JY, Chin DK, Kim KS, Cho YE. Factors Associated With Repeat Surgery in Cervical Ossification of the Posterior Longitudinal Ligaments: Minimum 8-year Follow-up Study. Clin Spine Surg 2024; 37:131-137. [PMID: 38637933 DOI: 10.1097/bsd.0000000000001614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/04/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Single-center retrospective study. OBJECTIVE The objective of this study is to identify the factors leading to repeat surgery in patients with cervical ossification of the longitudinal ligament (OPLL) during a minimal 8-year follow-up after the initial surgery. SUMMARY OF BACKGROUND DATA The long-term effects of cervical OPLL are well known, but it's not always clear how many patients need to have surgery again because their neurological symptoms get worse. METHODS This study is included 117 patients who underwent surgery for cervical OPLL and had a follow-up of at least 8 years. OPLL type, surgical extent, surgical method, and sagittal radiological parameters were measured, and OPLL characteristics were analyzed. RESULTS The average age of patients at the time of surgery was 53.2 years, with a male-to-female ratio of 78:39. The median follow-up duration was 122 months (96-170 mo). Out of the total, 20 cases (17.1%) necessitated repeat surgery, among which 8 cases required surgery at the same site as the initial operation. The highest rate of repeat surgery was observed in patients who underwent total laminectomy without fusion (TL), where 6 out of 21 patients (29%) needed a second surgery, and 5 of these (23%) involved the same surgical site. Patients who underwent repeat surgery at the same site exhibited a greater range of motion (ROM) one year postsurgery (16.4 ± 8.5° vs. 23.1 ± 12.7°, P =0.041). In addition, the ROM at 1 year was higher in patients who underwent TL compared with those who had laminoplasty. Furthermore, the recurrence rate for hill-shape OPLL was higher at 30.8% compared to 10% for plateau-shape OPLL ( P = 0.05). CONCLUSION Larger cervical ROM 1 year after surgery is related to repeat surgery at the same level as previous surgery, especially in laminectomy without fusion surgery.
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Affiliation(s)
- Hyun Jun Jang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Bong Ju Moon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Kyung Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Jeong Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Dong Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Keun Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Yong Eun Cho
- Department of Neurosurgery, Leon Wiltse Memorial Hospital, Suwon, Korea
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Sun X, Li F, Zhao B, Zhang B, Sun K, Sun J, Xu X, Wang Y, Shi J. A Clinical Classification of Cervical Ossification of the Posterior Longitudinal Ligament to Guide Surgical Strategy. Spine (Phila Pa 1976) 2024; 49:239-246. [PMID: 37982704 DOI: 10.1097/brs.0000000000004878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
STUDY DESIGN A clinical classification of cervical ossification of the posterior longitudinal ligament (COPLL) was developed based on imaging findings. OBJECTIVE This study aimed to establish a clinical classification for COPLL and provide corresponding surgery strategies for each subtype. SUMMARY OF BACKGROUND DATA A practical and reliable classification is needed to guide the treatment of COPLL. MATERIALS AND METHODS This study retrospectively reviewed plain radiographs, computed tomography scans, and magnetic resonance images of patients diagnosed with COPLL between 2018 and 2022 at Shanghai Changzheng Hospital. The types of COPLL were classified according to the location, morphology, and canal-occupying ratio (OR) of the ossification mass. Interobserver and intraobserver reliability were evaluated using Cohen's kappa. RESULTS A total of 1000 cases were included, which were classified into five types: focal type (F type), short-sequential type (S type), long-sequential type (L type), high type (H type), and mixed type (M type). In addition, each type could be classified into subtype 1 or subtype 2 according to the canal-OR. Then each type could be further classified into other subtypes according to location and morphology. The interobserver reliabilities in the first and second rounds were 0.853 and 0.887, respectively. The intraobserver reliability was 0.888. CONCLUSION The authors classified COPLL into a system comprised of five types and several subtypes according to canal-OR, location, and morphology. Surgical strategies for each subtype are also suggested. This provides a theoretical guide for the description and surgical management of COPLL.
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Affiliation(s)
- Xiaofei Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Fudong Li
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Baolian Zhao
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Bin Zhang
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, Naval Medical Center, Navy Medical University, Shanghai, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Ximing Xu
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
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D'Aliberti G, Villa F, Giorgi P, Crisà FM, Gribaudi G, Mastino L, Auricchio AM, Cenzato M, Talamonti G. Giant calcified thoracic disk herniations: ossification of PLL or autonomous entity? J Neurosurg Sci 2024; 68:70-79. [PMID: 32734747 DOI: 10.23736/s0390-5616.20.04938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Giant calcified thoracic disk herniation (GCTD) is an uncommon event, which requires surgical treatment in less than 1% of patients. GCDTs are a specific subgroup of herniated thoracic disks occupying more than 40% of the spinal canal showing calcifications associated with a certain degree of ossification. In this paper, we are reporting our whole experience in the surgical management of GCTDs through anterior approaches. We believe that they present characteristics that associate them to the circumscribed type of ossified posterior longitudinal ligament (OPLL) with a possible common pathophysiology consisting in the dural violation. METHODS Twenty-three consecutive patients with GCDTs were managed through anterior approaches during the period 1996-2019 at the Niguarda Hospital, Milan, Italy. Clinical data, radiological features, surgical reports, histological findings, and outcomes were reviewed. RESULTS There was no mortality, whereas permanent morbidity consisted of 1 case of worsened paraparesis due to accidental spinal cord contusion. One patient required reoperation to repair a postoperative cerebrospinal fluid (CSF) leakage. All patients underwent postoperative MRI which showed excellent decompression of cord and dural sac in all cases. Histological study of en-bloc removed GCTD showed typical calcification patterns of the PLL. CONCLUSIONS GCDTs may be assimilated to the so-called "circumscribed type" of OPLL. The GCDTs may show the same radiological CT and MRI pattern of OPLL. The anterior accesses now represent the standard of care for GCTDs. The use of operative microscope and intraoperative monitoring is mandatory. The risk of CSF leakage can be markedly reduced by meticulous reconstruction of the dura and the placement of spinal drainage. Adequate exposition may sometimes require one or two levels of corpectomy with consequent vertebral body reconstruction and fixation of anterior column of the spine.
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Affiliation(s)
| | - Fabio Villa
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - Pietro Giorgi
- Department of Orthopedics and Traumatology, ASST Niguarda Hospital, Milan, Italy
| | - Francesco M Crisà
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy -
- University of Milan, Milan, Italy
| | - Giulia Gribaudi
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
- University of Milan, Milan, Italy
| | - Lara Mastino
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
- Sapienza University, Rome, Italy
| | - Anna M Auricchio
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Marco Cenzato
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
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Hesni S, Baxter D, Saifuddin A. The imaging of cervical spondylotic myeloradiculopathy. Skeletal Radiol 2023; 52:2341-2365. [PMID: 37071191 DOI: 10.1007/s00256-023-04329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
This review provides a detailed description of the imaging features of cervical spondylotic myelopathy and radiculopathy, with a focus on MRI. Where relevant, we will outline grading systems of vertebral central canal and foraminal stenosis. Whilst post-operative appearances of the cervical spine are outside the scope of this paper, we will touch on imaging features recognised as predictors of clinical outcome and neurological recovery. This paper will serve as a reference for both radiologists and clinicians involved in the care of patients with cervical spondylotic myeloradiculopathy.
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Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK.
| | - David Baxter
- Department of Surgery, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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Kimchi G, Maimon T, Geva LL, Knoller N, Peled A, Yaniv G, Orlev A, Klug M, Harel R. Prevalence and Characteristics of Cervical Ossified Posterior Longitudinal Ligament in the Jewish Population. World Neurosurg 2023; 179:e256-e261. [PMID: 37619842 DOI: 10.1016/j.wneu.2023.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Numerous studies have demonstrated an association between ethnic identity and the prevalence rate of cervical ossified posterior longitudinal ligament (C-OPLL). To date, its prevalence rate in the Jewish population has not been determined. The aim of this historical prospective study is to evaluate the prevalence and characteristics of C-OPLL in the Jewish population. METHODS We performed a retrospective evaluation of imaging studies of all adult patients who underwent both cervical computed tomography and magnetic resonance imaging for all clinical indications within a span of 36 months between January 2017 and July 2020 at a single tertiary referral hospital located in central Israel. Identified C-OPLL carriers were interviewed by telephone. All the patients provided informed consent and then were questioned for current symptoms and demographics, including religion, Jewish ethnic identity, birthplace, parental birthplace and ethnic identity, and family history of spinal disorders. RESULTS Overall, 440 participants were radiographically evaluated. The prevalence of C-OPLL in the Jewish population was 7.5% (33 of 440). The mean age of the C-OPLL carriers was 65.8 years. All the C-OPLL carriers were symptomatic at analysis. The carriers had an increased proportion with a Sephardic Jewish ethnic identity (65.4%), with a significantly high rate of homogeneous parental Jewish identity (92.4%), suggesting a prominent genetic contribution to the development of this condition. CONCLUSIONS The prevalence of C-OPLL in the Jewish population in central Israel was 7.5%. This rate is significantly higher than that in other previously studied populations. To the best of our knowledge, this is the first study to identify the Jewish population as experiencing an increased prevalence of C-OPLL.
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Affiliation(s)
- Gil Kimchi
- Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Tomer Maimon
- Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Liat Lerner Geva
- Women and Children's Health Research Unit, Gertner Institute of Epidemiology, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Nachshon Knoller
- Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Anton Peled
- Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gal Yaniv
- Department of Radiology, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Alon Orlev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel; Department of Neurosurgery, Rabin Medical Center, Petah Tikva, Israel
| | - Maximiliano Klug
- Department of Radiology, Sheba Medical Center, Ramat-Gan, Israel
| | - Ran Harel
- Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Nagoshi N, Yoshii T, Egawa S, Sakai K, Kusano K, Tsutsui S, Hirai T, Matsukura Y, Wada K, Katsumi K, Koda M, Kimura A, Furuya T, Sato Y, Maki S, Nishida N, Nagamoto Y, Oshima Y, Ando K, Nakashima H, Takahata M, Mori K, Nakajima H, Murata K, Miyagi M, Kaito T, Yamada K, Banno T, Kato S, Ohba T, Moridaira H, Fujibayashi S, Katoh H, Kanno H, Watanabe K, Taneichi H, Imagama S, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Yamazaki M. Comparison of Surgical Outcomes of Anterior and Posterior Fusion Surgeries for K-line (-) Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study. Spine (Phila Pa 1976) 2023; 48:937-943. [PMID: 36940262 DOI: 10.1097/brs.0000000000004634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/09/2023] [Indexed: 03/22/2023]
Abstract
STUDY DESIGN A prospective multicenter study. OBJECTIVE The objective of this study is to compare the surgical outcomes of anterior and posterior fusion surgeries in patients with K-line (-) cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Although laminoplasty is effective for patients with K-line (+) OPLL, fusion surgery is recommended for those with K-line (-) OPLL. However, whether the anterior or posterior approach is preferable for this pathology has not been effectively determined. MATERIALS AND METHODS A total of 478 patients with myelopathy due to cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for two years. Of the 478 patients, 45 and 46 with K-line (-) underwent anterior and posterior fusion surgeries, respectively. After adjusting for confounders in baseline characteristics using a propensity score-matched analysis, 54 patients in both the anterior and posterior groups (27 patients each) were evaluated. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. RESULTS Both approaches showed comparable neurological and functional recovery. The cervical range of motion was significantly restricted in the posterior group because of the large number of fused vertebrae compared with the anterior group. The incidence of surgical complications was comparable between the cohorts, but the posterior group demonstrated a higher frequency of segmental motor paralysis, whereas the anterior group more frequently reported postoperative dysphagia. CONCLUSIONS Clinical improvement was comparable between anterior and posterior fusion surgeries for patients with K-line (-) OPLL. The ideal surgical approach should be informed based on the balance between the surgeon's technical preference and the risk of complications.
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Affiliation(s)
- Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Toshitaka Yoshii
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoru Egawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchishi, Saitama, Japan
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyadaku, Japan
| | - Shunji Tsutsui
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takashi Hirai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yu Matsukura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Niigata, Japan
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Maki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Norihiro Nishida
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi, Japan
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroaki Nakashima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiko Takahata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta, Otsu, Shiga, Japan
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Yoshida-gun, Fukui, Japan
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masayuki Miyagi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Kitasato University, School of Medicine, Sagamiharashi, Kanagawa, Japan
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Tomohiro Banno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Moridaira
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan; and Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Hiroshi Taneichi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Shiro Imagama
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Masashi Yamazaki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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8
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Onuma H, Sakai K, Arai Y, Torigoe I, Tomori M, Sakaki K, Hirai T, Egawa S, Kobayashi Y, Okawa A, Yoshii T. Augmented Reality Support for Anterior Decompression and Fusion Using Floating Method for Cervical Ossification of the Posterior Longitudinal Ligament. J Clin Med 2023; 12:jcm12082898. [PMID: 37109235 PMCID: PMC10143834 DOI: 10.3390/jcm12082898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Anterior decompression and fusion (ADF) using the floating method for cervical ossification of the posterior longitudinal ligament (OPLL) is an ideal surgical technique, but it has a specific risk of insufficient decompression caused by the impingement of residual ossification. Augmented reality (AR) support is a novel technology that enables the superimposition of images onto the view of a surgical field. AR technology was applied to ADF for cervical OPLL to facilitate intraoperative anatomical orientation and OPLL identification. In total, 14 patients with cervical OPLL underwent ADF with microscopic AR support. The outline of the OPLL and the bilateral vertebral arteries was marked after intraoperative CT, and the reconstructed 3D image data were transferred and linked to the microscope. The AR microscopic view enabled us to visualize the ossification outline, which could not be seen directly in the surgical field, and allowed sufficient decompression of the ossification. Neurological disturbances were improved in all patients. No cases of serious complications, such as major intraoperative bleeding or reoperation due to the postoperative impingement of the floating OPLL, were registered. To our knowledge, this is the first report of the introduction of microscopic AR into ADF using the floating method for cervical OPLL with favorable clinical results.
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Affiliation(s)
- Hiroaki Onuma
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Kyohei Sakaki
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Yutaka Kobayashi
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
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9
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Cao B, Chen J, Yuan B, Sun Y, Zhou S, Zhao Y, Xu Z, Tang Y, Chen X. 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. Bone Joint J 2023; 105-B:412-421. [PMID: 36924177 DOI: 10.1302/0301-620x.105b4.bjj-2022-0804.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
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.
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Affiliation(s)
- Bing Cao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jingxuan Chen
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bo Yuan
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yanqing Sun
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shengyuan Zhou
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yin Zhao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zheng Xu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yifan Tang
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
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10
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White cord syndrome secondary to decompressive laminectomy associated with cervical arthrodesis in a patient with diffuse idiopathic skeletal hyperostosis and posterior longitudinal ligament ossification. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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11
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Xue F, Deng H, Chen Z, Yang H, Li Y, Yuan S, Zheng N, Chen M. Effects of cervical rotatory manipulation on the cervical spinal cord complex with ossification of the posterior longitudinal ligament in the vertebral canal: A finite element study. Front Bioeng Biotechnol 2023; 11:1095587. [PMID: 36714008 PMCID: PMC9880201 DOI: 10.3389/fbioe.2023.1095587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
Background: There are few studies focusing on biomechanism of spinal cord injury according to the ossification of the posterior longitudinal ligament (OPLL) during cervical rotatory manipulation (CRM). This study aimed to explore the biomechanical effects of CRM on the spinal cord, dura matter and nerve roots with OPLL in the cervical vertebral canal. Methods: Three validated FE models of the craniocervical spine and spinal cord complex were constructed by adding mild, moderate, and severe OPLL to the healthy FE model, respectively. We simulated the static compression of the spinal cord by OPLL and the dynamic compression during CRM in the flexion position. The stress distribution of the spinal cord complex was investigated. Results: The cervical spinal cord experienced higher von Mises stress under static compression by the severe OPLL. A higher von Mises stress was observed on the spinal cord in the moderate and severe OPLL models during CRM. The dura matter and nerve roots had a higher von Mises stress in all three models during CRM. Conclusion: The results show a high risk in performing CRM in the flexion position on patients with OPLL, in that different occupying ratios in the vertebral canal due to OPLL could significantly increase the stress on the spinal cord complex.
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Affiliation(s)
- Fan Xue
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Hao Deng
- Department of Orthopaedics, Jiashan Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, China
| | - Zujiang Chen
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Han Yang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China,*Correspondence: Yikai Li, ; Shiguo Yuan,
| | - Shiguo Yuan
- Department of Orthopaedics, Hainan Traditional Chinese Medicine Hospital, Haikou, Hainan, China,*Correspondence: Yikai Li, ; Shiguo Yuan,
| | - Nansheng Zheng
- Department of Orthopaedics, Hainan Traditional Chinese Medicine Hospital, Haikou, Hainan, China
| | - Meixiong Chen
- Department of Orthopaedics, Hainan Traditional Chinese Medicine Hospital, Haikou, Hainan, China
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12
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Tung NTC, He Z, Makino H, Yasuda T, Seki S, Suzuki K, Watanabe K, Futakawa H, Kamei K, Kawaguchi Y. Association of Inflammation, Ectopic Bone Formation, and Sacroiliac Joint Variation in Ossification of the Posterior Longitudinal Ligament. J Clin Med 2023; 12:jcm12010349. [PMID: 36615149 PMCID: PMC9821616 DOI: 10.3390/jcm12010349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/22/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is considered a multifactorial condition characterized by ectopic new bone formation in the spinal ligament. Recently, its connections with inflammation as well as sacroiliac (SI) joint ankylosis have been discussed. Nevertheless, whether inflammation, spinal ligament ossification, and SI joint changes are linked in OPLL has never been investigated. In this study, whole-spinal computed tomography and serum high-sensitive C-reactive protein (hs-CRP) levels were obtained in 162 patients with cervical OPLL. Ossification lesions were categorized as plateau and hill shapes. Accordingly, patients were divided into plateau-shaped (51 males and 33 females; mean age: 67.7 years) and hill-shaped (50 males and 28 females; mean age: 67.2 years) groups. SI joint changes were classified into four types and three subtypes, as previously described. Interactions among ossification shapes, hs-CRP levels, and morphological changes in the SI joint were investigated. The plateau shape was more common in the vertebral segments (59.5%), compared to the hill shape, which was predominant in the intervertebral regions (65.4%). Serum hs-CRP levels in the plateau-shaped group (0.11 ± 0.10 mg/dL) were significantly higher than those in the hill-shaped group (0.07 ± 0.08 mg/dL). SI joint intra-articular fusion was the main finding in the plateau-shaped group and showed significantly higher hs-CRP levels compared to the anterior para-articular bridging, which more frequently occurred in the hill-shaped group. Our findings suggested a possible inflammation mechanism that might contribute to the new bone formation in OPLL, particularly the plateau shape.
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Affiliation(s)
- Nguyen Tran Canh Tung
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
- Department of Trauma and Orthopaedic Surgery, Vietnam Military Medical University, Hanoi 100000, Vietnam
| | - Zhongyuan He
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Taketoshi Yasuda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Kenta Watanabe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hayato Futakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
- Correspondence: ; Tel.: +81-76-434-7353; Fax: +81-76-434-5035
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13
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Prospective Investigation of Surgical Outcomes after Anterior Decompression with Fusion and Laminoplasty for the Cervical Ossification of the Posterior Longitudinal Ligament: A Propensity Score Matching Analysis. J Clin Med 2022; 11:jcm11237012. [PMID: 36498586 PMCID: PMC9736093 DOI: 10.3390/jcm11237012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
The ideal surgical strategy for cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial due to the lack of high-quality evidence. Herein, we prospectively investigated the surgical outcomes of anterior cervical decompression with fusion (ADF) and laminoplasty (LAMP) with cervical OPLL. Three hundred patients were included in this study (ADF: n = 89; LAMP: n = 211 patients), and propensity score matching yielded 67 pairs of patients with ADF and LAMP, in which clinical outcomes were compared. Crude analysis revealed that the ADF group showed greater neurological recovery in cervical Japanese Orthopedic Association scores at two years, compared with that in the LAMP group (53.1% vs. 44.3%, p = 0.037). The ratio of minimum clinically important difference (MCID) success was significantly greater in the ADF group (59.6% vs. 43.6%, p = 0.016). Multivariate analysis showed that the factors affecting MCID success were age, body mass index, duration of symptoms, and choice of ADF. In the 1:1 matched analysis, neurological improvement was more favorable in the ADF group (57.2%) compared to the LAMP group (46.8%) at two years (p = 0.049). However, perioperative complications, such as dysphagia and graft-related complications, were more common in the ADF group.
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14
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Li N, Ma S, Duan F, Wei Y, He D, Nagoshi N, Watanabe K, Nakamura M, Matsumoto M, Jeon H, Lee JJ, Kim KN, Ha Y, Kwan K, Cheung AKP, Clark A. Are clinical outcomes affected by laminoplasty method and K-line in patients with cervical ossification of posterior longitudinal ligament? A multicenter study. J Orthop Surg Res 2022; 17:513. [PMID: 36434732 PMCID: PMC9700906 DOI: 10.1186/s13018-022-03407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Open-door laminoplasty (ODL) and French-door laminoplasty (FDL) are the main laminoplasty techniques used to treat cervical ossification of the posterior longitudinal ligament (C-OPLL). However, few studies have compared the outcomes of ODL and modified FDL (mFDL) for C-OPLL. We explored the differences in outcomes between ODL and mFDL for C-OPLL and analyzed the technical efficacy of each procedure in patients with K-line (+) or (-) C-OPLL. METHODS From January 2010 to December 2015, 202 patients with K-line (+) or (-) C-OPLL were retrospectively recruited from 4 institutions. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, JOA score recovery rate, operative time, blood loss, and complications. Univariate analysis and binary logistic regression models were adjusted for confounding factors. RESULTS Two hundred patients (mFDL, n = 69; ODL, n = 131) with a median follow-up of 42 months (range 36-54 months) were included. The postoperative JOA score significantly improved in both groups (P < 0.05). After adjusting for confounding factors, there was a statistically significant difference in blood loss (≥ 300 mL) between the two groups (P = 0.005), but there was no significant difference in the postoperative JOA score (≥ 14) (P = 0.062), JOA score recovery rate (≥ 0.82) (P = 0.187), or operative time (≥ 90 min) (P = 0.925). C5 palsy tended to occur more often in the mFDL group, although the difference was not significant (P > 0.05). The stratified analysis of the K-line status showed more blood loss in K-line (+) patients who underwent mFDL, but there was no significant difference in the postoperative JOA score, JOA score recovery rate, or operative time between the ODL and mFDL groups. Additionally, there was no significant difference in blood loss, postoperative JOA score, JOA score recovery rate, or operative time among all patients with K-line (+) or (-) C-OPLL in both groups. CONCLUSIONS Both ODL and mFDL are effective for patients with C-OPLL. However, more blood loss tends to occur during mFDL. This study showed no significant difference in the operative time or incidence of complications between the two techniques. The efficacy of ODL and mFDL was not affected by the K-line status (+ or -) in patients with C-OPLL.
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Affiliation(s)
- Nan Li
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Sai Ma
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Fangfang Duan
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Yi Wei
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Da He
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Narihito Nagoshi
- grid.26091.3c0000 0004 1936 9959Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- grid.26091.3c0000 0004 1936 9959Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- grid.26091.3c0000 0004 1936 9959Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- grid.26091.3c0000 0004 1936 9959Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hyeongseok Jeon
- grid.15444.300000 0004 0470 5454Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J. J. Lee
- grid.15444.300000 0004 0470 5454Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Keung-Nyun Kim
- grid.15444.300000 0004 0470 5454Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ha
- grid.15444.300000 0004 0470 5454Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea ,grid.49100.3c0000 0001 0742 4007POSTECH Biotech Center, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk 37673 Republic of Korea
| | - Kenny Kwan
- grid.194645.b0000000121742757Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - A. K. P. Cheung
- grid.194645.b0000000121742757Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Aaron Clark
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, CA USA
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15
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Tetreault L, Kalsi-Ryan S, Benjamin Davies, Nanna-Lohkamp L, Garwood P, Martin AR, Wilson JR, Harrop JS, Guest JD, Kwon BK, Milligan J, Arizala AM, Kotter MR, Fehlings MG. Degenerative Cervical Myelopathy: A Practical Approach to Diagnosis. Global Spine J 2022; 12:1881-1893. [PMID: 35043715 PMCID: PMC9609530 DOI: 10.1177/21925682211072847] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVES The objective of this review is to provide a stepwise approach to the assessment of patients with potential symptoms of degenerative cervical myelopathy (DCM). METHODS N/A. RESULTS DCM is an overarching term used to describe progressive compression of the cervical spinal cord by age-related changes to the spinal axis. These alterations to normal anatomy narrow the spinal canal, reduce the space available for the spinal cord, and may ultimately compress the ascending and descending neural tracts. Patients with DCM present with a wide range of symptoms that can significantly impact quality of life, including bilateral hand numbness and paresthesia, gait impairment, motor weakness of the upper and lower extremities, and bladder and bowel dysfunction. Unfortunately, DCM is often misdiagnosed, resulting in delayed assessment and management by the appropriate specialist. The proper evaluation of a patient with suspected DCM includes obtaining a detailed patient history, conducting a comprehensive neurological examination, and ordering appropriate tests to rule in or out other diagnoses. CONCLUSION This review summarizes a stepwise approach to the diagnosis of patients with DCM.
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Affiliation(s)
- Lindsay Tetreault
- Division of Neurology, Graduate
Medical Education, New York University
Langone, New York, NY, USA
| | | | - Benjamin Davies
- Department of Academic
Neurosurgery, University of Cambridge, Cambridge, UK
| | - Laura Nanna-Lohkamp
- Division of Neurosurgery,
Department of Surgery, University of Toronto, Toronto, ON, Canada,Division of Neurosurgery, Spinal
Program, Toronto Western Hospital, University Health
Network, Toronto, ON, Canada
| | - Philip Garwood
- Internal Medicine Resident,
Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan R. Martin
- Spine Neurosurgery, University of California
Davis, Davis, CA, USA
| | - Jefferson R. Wilson
- Division of Neurosurgery,
Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - James S. Harrop
- Departments of Neurological and
Orthopedic Surgery, Thomas Jefferson
University, Philadelphia, PA, USA
| | - James D. Guest
- The Miami Project to Cure
Paralysis, University of Miami, Miami, FL, USA
| | - Brian K. Kwon
- Department, of Orthopaedics, University of British
Columbia, Vancouver, BC, Canada
| | - James Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Mark R. Kotter
- Department of Academic
Neurosurgery, University of Cambridge, Cambridge, UK
| | - Michael G. Fehlings
- Division of Neurosurgery,
Department of Surgery, University of Toronto, Toronto, ON, Canada,Division of Neurosurgery, Spinal
Program, Toronto Western Hospital, University Health
Network, Toronto, ON, Canada,Michael G. Fehlings, MD, PhD, FRCSC, FACS,
Division of Neurosurgery and Spinal Program, Department of Surgery, University
of Toronto, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst
Street, Suite 4WW-449, Toronto, ON M5T 2S8, Canada.
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16
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Ossification of the Posterior Longitudinal Ligament: Pathophysiology, Diagnosis, and Management. J Am Acad Orthop Surg 2022; 30:820-830. [PMID: 35587949 DOI: 10.5435/jaaos-d-22-00049] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/10/2022] [Indexed: 02/01/2023] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) occurs as heterotopic bone forms in the posterior longitudinal ligament, resulting in neural compression, myelopathy, and radiculopathy. OPLL is most commonly observed in East Asian populations, with prevalence rates of 1.9% to 4.3% reported in Japan. OPLL rates are lower in North American and European patients, with reported prevalence of 0.1% to 1.7%. Patients typically develop symptoms due to OPLL in their cervical spines. The etiology of OPLL is multifactorial, including genetic, metabolic, and anatomic factors. Asymptomatic or symptomatic patients with OPLL can be managed nonsurgically, whereas patients with neurologic symptoms may require surgical decompression from an anterior, posterior, or combined approach. Surgical treatment can provide notable improvement in neurologic function. Surgical decision making accounts for multiple factors, including patient comorbidities, neurologic status, disease morphology, radiographic findings, and procedure complication profiles. In this study, we review OPLL epidemiology and pathophysiology, clinical features, radiographic evaluation, management, and complications.
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17
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Namgoong J, Lee YH, Ju AR, Chai J, Choi D, Choi HJ, Seo JY, Park KS, Lee YJ, Lee J, Ha IH. Long-Term Follow-Up of Patients with Neck Pain Associated with Ossification of the Posterior Longitudinal Ligament Treated with Integrative Complementary and Alternative Medicine: A Retrospective Analysis and Questionnaire Survey. J Pain Res 2022; 15:1527-1541. [PMID: 35637765 PMCID: PMC9148200 DOI: 10.2147/jpr.s356280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Integrative Korean medicine treatment (KMT) is a conservative treatment approach for the ossification of the posterior longitudinal ligament (OPLL) in Korea; nonetheless, relevant studies focusing on KMT for OPLL are lacking. A multicenter retrospective analysis of patient medical records and a questionnaire survey were conducted to investigate the effectiveness of integrative KMT in patients with OPLL treated for neck pain. Patients and Methods A total of 78 inpatients radiologically diagnosed with OPLL and treated for neck pain at four Korean medicine hospitals from April 1, 2016, to December 31, 2019, were enrolled. The primary index was an improvement in the numeric rating scale (NRS) score for neck pain, whereas the secondary outcome indices were improvements in the NRS score for arm pain, neck disability index (NDI) score, and EuroQol 5-dimension 5-level (EQ-5D-5L) score. Results At discharge, the NRS score for neck pain, NRS score for arm pain, and NDI score decreased by 2.47 (95% confidence interval [CI], −2.81 to −2.14), 1.32 (95% CI, −1.73 to −0.91), and 16.02 (95% CI, −18.89 to −13.15), respectively, as compared with the scores at admission (p < 0.001). The EQ-5D-5L score increased by 0.12 (95% CI, 0.09 to 0.16) as compared with the score at admission (p < 0.001). This trend was also evident during follow-up. With respect to Patient Global Impression of Change evaluation, 33 (61.1%) patients claimed to have very much improved, whereas 17 (31.5%) patients reported to have much improved. Conclusion Inpatients with OPLL who received integrative KMT showed improvements in neck pain, arm pain, the NDI, and quality of life, which were retained throughout the follow-up period.
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Affiliation(s)
- Jin Namgoong
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Yun-Ha Lee
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Ah Ra Ju
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Jiwon Chai
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - DongJoo Choi
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Hyo Jung Choi
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Ji-Yeon Seo
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Kyoung Sun Park
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea.,Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jinho Lee
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea.,Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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18
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Kim SH, Lee SH, Shin DA. Could Machine Learning Better Predict Postoperative C5 Palsy of Cervical Ossification of the Posterior Longitudinal Ligament? Clin Spine Surg 2022; 35:E419-E425. [PMID: 35020623 PMCID: PMC9162065 DOI: 10.1097/bsd.0000000000001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to investigate whether machine learning (ML) can perform better than a conventional logistic regression in predicting postoperative C5 palsy of cervical ossification of the posterior longitudinal ligament (OPLL) patients. SUMMARY OF BACKGROUND DATA C5 palsy is one of the most common postoperative complications after surgical treatment of OPLL, with an incidence rate of 1.4%-18.4%. ML has recently been used to predict the outcomes of neurosurgery. To our knowledge there has not been a study to predict postoperative C5 palsy of cervical OPLL patient with ML. METHODS Four sampling methods were used for data balancing. Six ML algorithms and conventional logistic regression were used for model development. A total of 35 ML prediction model and 5 conventional logistic prediction models were generated. The performances of each model were compared with the area under the curve (AUC). Patients who underwent surgery for cervical OPLL at our institute from January 1998 to January 2012 were reviewed. Twenty-five variables of each patient were used to make a prediction model. RESULTS In total, 901 patients were included [651 male and 250 female, median age: 55 (49-63), mean±SD: 55.9±9.802]. Twenty-six (2.8%) patients developed postoperative C5 palsy. Age (P=0.043), surgical method (P=0.0112), involvement of OPLL at C1-3 (P=0.0359), and postoperative shoulder pain (P≤0.001) were significantly associated with C5 palsy. Among all ML models, a model using an adaptive reinforcement learning algorithm and downsampling showed the largest AUC (0.88; 95% confidence interval: 0.79-0.96), better than that of logistic regression (0.69; 95% confidence interval: 0.43-0.94). CONCLUSIONS The ML algorithm seems to be superior to logistic regression for predicting postoperative C5 palsy of OPLL patient after surgery with respect to AUC. Age, surgical method, and involvement of OPLL at C1-C3 were significantly associated with C5 palsy. This study demonstrates that shoulder pain immediately after surgery is closely associated with postoperative C5 palsy of OPLL patient.
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Affiliation(s)
- Soo Heon Kim
- Department of Neurosurgery, Yonsei University College of Medicine
| | - Sun Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University College of Medicine
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19
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Chae HD, Hong SH, Yeoh HJ, Kang YR, Lee SM, Kim M, Koh SY, Lee Y, Park MS, Choi JY, Yoo HJ. Improved diagnostic performance of plain radiography for cervical ossification of the posterior longitudinal ligament using deep learning. PLoS One 2022; 17:e0267643. [PMID: 35476649 PMCID: PMC9045646 DOI: 10.1371/journal.pone.0267643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background A high false-negative rate has been reported for the diagnosis of ossification of the posterior longitudinal ligament (OPLL) using plain radiography. We investigated whether deep learning (DL) can improve the diagnostic performance of radiologists for cervical OPLL using plain radiographs. Materials and methods The training set consisted of 915 radiographs from 207 patients diagnosed with OPLL. For the test set, we used 200 lateral cervical radiographs from 100 patients with cervical OPLL and 100 patients without OPLL. An observer performance study was conducted over two reading sessions. In the first session, we compared the diagnostic performance of the DL-model and the six observers. The diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC) at the vertebra and patient level. The sensitivity and specificity of the DL model and average observers were calculated in per-patient analysis. Subgroup analysis was performed according to the morphologic classification of OPLL. In the second session, observers evaluated the radiographs by referring to the results of the DL-model. Results In the vertebra-level analysis, the DL-model showed an AUC of 0.854, which was higher than the average AUC of observers (0.826), but the difference was not significant (p = 0.292). In the patient-level analysis, the performance of the DL-model had an AUC of 0.851, and the average AUC of observers was 0.841 (p = 0.739). The patient-level sensitivity and specificity were 91% and 69% in the DL model, and 83% and 68% for the average observers, respectively. Both the DL-model and observers showed decreases in overall performance in the segmental and circumscribed types. With knowledge of the results of the DL-model, the average AUC of observers increased to 0.893 (p = 0.001) at the vertebra level and 0.911 (p < 0.001) at the patient level. In the subgroup analysis, the improvement was largest in segmental-type (AUC difference 0.087; p = 0.002). Conclusions The DL-based OPLL detection model can significantly improve the diagnostic performance of radiologists on cervical radiographs.
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Affiliation(s)
- Hee-Dong Chae
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- * E-mail:
| | - Hyun Jung Yeoh
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeo Ryang Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minyoung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seok Young Koh
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | - Ja-Young Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
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20
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AlShammari QT, AlHouty M, Malik BA, Salih M, AlRumyan SA, AlShammari MT, Alshareef R, Yousif E. Comparison between Magnetic Resonance Imaging and Ultrasound in Diagnosing Uterine Fibroids in Hail Area, Saudi Arabia. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2022. [DOI: 10.51847/5buvqymmxj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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21
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Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Fujii K, Kimura A, Furuya T, Nagoshi N, Kanchiku T, Nagamoto Y, Oshima Y, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Imagama S, Koda M, Kawaguchi Y, Takeshita K, Matsumoto M, Yamazaki M, Okawa A. Perioperative Complications in Posterior Surgeries for Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Nationwide Investigation. Clin Spine Surg 2021; 34:E594-E600. [PMID: 34347632 DOI: 10.1097/bsd.0000000000001243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a prospective multicenter study. OBJECTIVE The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures. MATERIALS AND METHODS We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications. RESULTS Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2-C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery. CONCLUSIONS In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2-C7 angle were the independent risk factors for motor palsy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchishi
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyadaku
| | - Yukihiro Nakagawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, Wakayama
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Niigata University Medicine and Dental General Hospital, Niigata
| | - Kengo Fujii
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedics, Jichi Medical University, Shimotsuke
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba
| | - Narihito Nagoshi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo
| | - Tsukasa Kanchiku
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Osaka
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Fukui
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo
| | - Shunji Matsunaga
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshimashi
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Fukuoka
| | - Sho Kobayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi
| | - Satoshi Inami
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Tochigi
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Miyagi
| | - Shiro Imagama
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedics, Jichi Medical University, Shimotsuke
| | - Morio Matsumoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo
| | - Masashi Yamazaki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Bunkyo-ku, Tokyo
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22
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Sun N, Liang Y, Hu B, Feng J, Lin G, Chen X, Rui G. circSKIL promotes the ossification of cervical posterior longitudinal ligament by activating the JNK/STAT3 pathway. Exp Ther Med 2021; 22:761. [PMID: 34035858 PMCID: PMC8135123 DOI: 10.3892/etm.2021.10193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic spinal condition that involves genetic factors as well as non-genetic factors, and its underlying molecular mechanism is largely unknown. Recently, circular RNAs (circRNAs) have been attracting the attention of researchers since they have important regulatory roles in many diseases, including bone metabolism disorders. The present study aimed to investigate the role of circRNA SKI-like proto-oncogene (circSKIL) in OPLL disease progression. First, primary posterior longitudinal ligament cells from patients with cervical spondylotic myelopathy (CSM) without OPLL (control group) and CSM patients with OPLL (OPLL group) were isolated, and the expression levels of circSKIL in ligament cells was found to be significantly increased in the OPLL group compared with control. This result was also confirmed in OPLL tissues. Next, circSKIL was overexpressed in control ligament cells, and the proliferation, mineralization, and osteogenic differentiation of ligament cells were found to be significantly enhanced; the phosphorylation levels of both JNK and STAT3 were upregulated. By contrast, the knockdown of circSKIL in OPLL ligament cells inhibited proliferation, mineralization, and osteogenic differentiation and inactivated the JNK/STAT3 pathway. Therefore, circSKIL may have a significant role in osteogenic differentiation and could serve as a potential target to prevent OPLL progression.
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Affiliation(s)
- Naikun Sun
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian 350122, P.R. China.,Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361005, P.R. China
| | - Yunbang Liang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361005, P.R. China
| | - Baoshan Hu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361005, P.R. China
| | - Jinyi Feng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361005, P.R. China
| | - Guangxun Lin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361005, P.R. China
| | - Xin Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361005, P.R. China
| | - Gang Rui
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian 350122, P.R. China.,Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361005, P.R. China
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23
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Wang C, Wang QZ, Gao JH, Zhang L, Zhang L, Chen BH. Clinical Comparison of Selective versus Nonselective Decompression for Symptomatic Tandem Stenosis of the Cervical and Thoracic Spine: A Retrospective Cohort Study. Orthop Surg 2021; 13:537-545. [PMID: 33619891 PMCID: PMC7957417 DOI: 10.1111/os.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of the present paper was to reveal the clinical differences between selective and nonselective decompression for symptomatic tandem stenosis of the cervical and thoracic spine (TSCTS). METHODS A total of 34 patients were eligible and included in the study. Among them, 8 patients underwent selective cervical decompression (CD), 15 patients underwent selective thoracic decompression (TD), and 11 patients underwent combined CD and TD (CTD) surgery. Age, sex, operative time, intraoperative blood loss, postoperative hospital stay, inpatient expenditure, preoperative upper Japanese Orthopaedic Association (JOA) rate, canal occupation rate, high-intensity T2-weighted image (T2WI) of the spinal cord, and preoperative and postoperative JOA scores were compared among the three groups. RESULTS The CD group had shorter operative time (138.8 ± 36.1 vs 229.7 ± 95.8 vs 328.6 ± 94.8, min, P < 0.001), less intraoperative blood loss (141.3 ± 116.7 vs 496.7 ± 361.8 vs 654.6 ± 320.5, mL, P = 0.004), and shorter postoperative hospital stay (4.6 ± 1.6 vs 9.0 ± 3.5 vs 10.3 ± 6.6, days, P = 0.008), as well as lower preoperative upper JOA rate (34.1 ± 5.6 vs 53.9 ± 8.4 vs 48.2 ± 15.2, %, P = 0.001) than the TD and CTD groups. The CTD group had higher inpatient expenditure than the CD and TD groups (87,850 ± 18,379 vs 55,100 ± 12,890 vs 55,772 ± 15,715, CNY, P < 0.001). The cervical canal occupation rates were similar among different groups (P > 0.05); however, the TD group showed a higher thoracic canal occupation rate than the CD group (58.3 ± 14.7 vs 43.3 ± 12.3, %, P = 0.035). All positive levels in high-intensity T2WI of the spinal cord were decompressed. The preoperative JOA scores as well as the postoperative JOA scores at 6 months and at last follow-up were comparable among the three groups (P > 0.05). Similarly, the JOA recovery rate showed no significant difference among the groups (P > 0.05). CONCLUSION Selective CD or TD alone demonstrated similar clinical effectiveness to nonselective and combined CTD for TSCTS. Individualized surgical decision should be made after meticulous assessments of clinical and radiological manifestations, general patient condition, and socioeconomic factors.
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Affiliation(s)
- Chao Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qi-Zun Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing-Hao Gao
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Liang Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lu Zhang
- Medical Research Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bo-Hua Chen
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Kwok SSS, Cheung JPY. Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches. BMC Musculoskelet Disord 2020; 21:823. [PMID: 33292175 PMCID: PMC7724709 DOI: 10.1186/s12891-020-03830-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. Main body of the abstract A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives. Conclusion From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.
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Affiliation(s)
- Suzanna Sum Sum Kwok
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
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25
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Mid-term Surgical Outcome of Posterior Decompression With Instrumented Fusion in Patients With K-line (-) Type Cervical Ossification of the Posterior Longitudinal Ligament With a 5-Year Minimum Follow-up. Clin Spine Surg 2020; 33:333-338. [PMID: 33003047 DOI: 10.1097/bsd.0000000000001072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVE The objective of this study was to assess mid-term surgical outcomes after posterior decompression with instrumented fusion (PDF) in patients with K-line (-) type cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA The poor surgical outcome for K-line (-) type cervical OPLL can result from posterior decompression alone. MATERIALS AND METHODS We reviewed cases of K-line (-) type cervical OPLL in 24 patients who underwent PDF in our institute from 2002 to 2014. As a control, we used K-line (-) type cervical OPLL in 9 patients who underwent laminoplasty before 2002 (LMP group). The neurological status and radiographic findings were evaluated retrospectively. RESULTS The preoperative Japanese Orthopedic Association score was 7.9±2.4 points in the PDF group and 7.4±2.3 points in the LMP group (P=0.584). The postoperative Japanese Orthopedic Association score was 11.7±2.6 points in the PDF group and 9.2±2.0 points in the LMP group at a 5-year follow-up (P=0.008). The recovery rate on average was 39.0% in the PDF group and 14.9% in the LMP group at a 5-year follow-up (P=0.037). The range of motion postoperatively at the maximal spinal cord compression level decreased significantly in the PDF group. The C2-C7 angle was 2.7 degrees of kyphosis in the PDF group, whereas 5.5 degrees of kyphosis was found in the LMP group at a 5-year follow-up (P=0.303). The center of gravity of the head-C7 sagittal vertical axis was 40 mm in the PDF group and 43 mm in the LMP group (P=0.936). CONCLUSIONS The relatively good surgical outcome could be obtained by PDF for patients with K-line (-)-type cervical OPLL. The addition of posterior instrumented fusion eliminated the dynamic factor at the level of maximal spinal cord compression. LEVEL OF EVIDENCE Level IV.
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Lee JK, Ham CH, Kwon WK, Moon HJ, Kim JH, Park YK. A New Classification for Cervical Ossification of the Posterior Longitudinal Ligament Based on the Coexistence of Segmental Disc Degeneration. J Korean Neurosurg Soc 2020; 64:69-77. [PMID: 33105534 PMCID: PMC7819796 DOI: 10.3340/jkns.2020.0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/09/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features associated with the shape of the ossification, including the concept of spondylosis seems necessary because of the similarity in age distribution.
Methods Patients diagnosed with OPLL who presented with increase signal intensity (ISI) on magnetic resonance imaging were surgically treated in our department. The patients were divided into two groups (pure versus degenerative) according to the presence of disc degeneration.
Results Of 141 patients enrolled in this study, more than half (61%) were classified into the degenerative group. The pure group showed a profound male predominance, early presentation of myelopathy, and a different predilection for ISI compared to the degenerative group. The mean canal compromise ratio (CC) of the ISI was 47% in the degenerative group versus 61% in the pure group (p<0.0000). On the contrary, the global and segment motions were significantly larger in the degenerative group (p<0.0000 and p=0.003, respectively). The canal diameters and global angles did not differ between groups.
Conclusion Classifying cervical OPLL based on the presence of combined disc degeneration is beneficial for understanding the disorder’s behavior. CC appears to be the main factor in the development of myelopathy in the pure group, whereas additional dynamic factors appear to affect its development in the degenerative group.
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Affiliation(s)
- Jun Ki Lee
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Hong Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
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Head J, Rymarczuk G, Stricsek G, Velagapudi L, Maulucci C, Hoelscher C, Harrop J. Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications. Neurospine 2019; 16:517-529. [PMID: 31607083 PMCID: PMC6790740 DOI: 10.14245/ns.1938222.111] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/05/2019] [Indexed: 01/30/2023] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.
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Affiliation(s)
- Jeffery Head
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - George Rymarczuk
- Division of Neurosurgery, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Geoffrey Stricsek
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lohit Velagapudi
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Christian Hoelscher
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
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Shimokawa N, Sato H, Matsumoto H, Takami T. Review of Radiological Parameters, Imaging Characteristics, and Their Effect on Optimal Treatment Approaches and Surgical Outcomes for Cervical Ossification of the Posterior Longitudinal Ligament. Neurospine 2019; 16:506-516. [PMID: 31607082 PMCID: PMC6790724 DOI: 10.14245/ns.1938268.134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Determining the optimal surgical method for cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. The surgical indication should be made based on not only radiological findings, but also the patient’s age, preoperative neurological findings, social background, activities of daily life, and the presence or absence of comorbid diseases. Anterior resection for OPLL with or without wide corpectomy and fusion, posterior decompression with or without relatively long fusion, or anterior and posterior combined surgery may be considered. When evaluating the clinical condition of patients with cervical OPLL before surgery, various radiological parameters should be carefully considered, including the number of spinal segments involved, the cervical alignment or tilt angle, the relationship between OPLL and the C2–7 line (termed the “K-line”), the occupying ratio of OPLL, and the involvement of dural ossification. The objective of this article is to review the radiological parameters in current use for deciding upon the optimal surgical strategy and for predicting surgical outcomes, focusing on cervical OPLL.
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Affiliation(s)
| | - Hidetoshi Sato
- Department of Neurosurgery, Tsukazaki Hospital, Hyogo, Japan
| | | | - Toshihiro Takami
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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