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Lee DH, Lee HR, Riew KD. An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review. Asian Spine J 2024; 18:274-286. [PMID: 38146052 PMCID: PMC11065509 DOI: 10.31616/asj.2023.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hyung Rae Lee
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu,
Korea
| | - Kiehyun Daniel Riew
- Department of Orthopaedic Surgery, New York-Presbyterian Och Spine Hospital, Columbia University, New York, NY,
USA
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Liu J, Wang J, Ding Z, Hai Y, Zhang Y, Kang N, Wang Q. Effect of K‑line on posterior cervical surgery versus anterior cervical surgery in patients with multi-level ossification of posterior longitudinal ligament. Eur Spine J 2023; 32:2396-2401. [PMID: 37150768 DOI: 10.1007/s00586-023-07736-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/03/2022] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To evaluate the influence of K-line on the outcome of open-door laminoplasty versus anterior cervical corpectomy decompression and fusion (ACCF) for patients with more than two levels of ossification of the posterior longitudinal ligament (OPLL). METHODS 60 patients undergoing open-door laminoplasty and 62 patients undergoing ACCF from January 2013 to January 2020 with more than 2 years of follow-up were included. Eighty-four cases with the ossification mass not beyond the K-line were grouped as K-line (+), while thirty-eight cases were grouped as K-line (-). The operation time, intraoperative blood loss, hospital stay, preoperative, postoperative, and last follow-up JOA scores, and postoperative complications were investigated. RESULTS The improvement rate of JOA scores after posterior approaches in cases of group K-line (+) and K-line (-) was 72.4% and 53.1%, respectively, which showed a significant difference (P < 0.01). In group K-line (+), the improvement of JOA scores for open-door laminoplasty was 73.4% and 71.8% for ACCF, which showed no significant difference (P > 0.05). In group K-line (-), the improvement of JOA scores for ACCF was 52.1% and 42.9% for open-door laminoplasty, which showed a significant difference (P < 0.05). The incidence of C5 palsy was significantly lower in cases with ACCF than in cases with open-door laminoplasty (P < 0.05). CONCLUSION For patients with more than two levels of OPLL, preoperative K-line (+) predicates a better outcome than K-line (-). For cases with K-line (-), ACCF provides better neurologic function recovery. For patients with K-line (+), open-door laminoplasty provides the same neurologic function recovery of ACCF.
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Affiliation(s)
- Jingwei Liu
- Department of Orthopedic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Dongdan DaHuaLu 1#, Dong-Cheng District, Beijing, 100730, China
| | - Jianqiang Wang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Zihao Ding
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Yiqi Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Nan Kang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Qiang Wang
- Department of Orthopedic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Dongdan DaHuaLu 1#, Dong-Cheng District, Beijing, 100730, China.
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Ikeda T, Miyamoto H, Akagi M. Usefulness of K-line in predicting prognosis of laminoplasty for cervical spondylotic myelopathy. BMC Musculoskelet Disord 2023; 24:118. [PMID: 36774455 DOI: 10.1186/s12891-023-06214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/31/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND K-line is widely recognized as a useful index for evaluating cervical alignment and the size of the cervical ossification at the posterior longitudinal ligament (OPLL). The purpose of this study was to investigate whether the K-line could be a useful clinical tool for predicting the prognosis of laminoplasty (LP) for cervical spondylotic myelopathy (CSM). METHODS Adult CSM patients scheduled for cervical LP were recruited for this study. C2-7 angle, local kyphosis angle, and K-line was evaluated by T2-weighted sagittal magnetic resonance imaging (MRI). Clinical findings were evaluated by the JOA score and the recovery rate. Clinical and radiological findings were evaluated preoperation and final follow-up. Patients were grouped into K-line ( +) and K-line (-). Patients with Kline (-) were further divided into two sub-groups: disc type (anterior cord compression due to disc protrusion with kyphosis) and osseous type (due to osseous structure such as osteophyte). RESULTS Sixty-eight patients were included in the analysis. The recovery rate of K-line (-) group (n = 11,19.4%) was significantly worse than that of K-line ( +) group (n = 57, 50.6%, p<0.05). Among 11 K-line (-) patients, 7 were disc type and 4 were osseous type. Over the period of follow-up, the disc type K-line (-) patients changed to K-line ( +) and showed significantly better recovery rate (27.6%) compared to the osseous type K-line (-) group (5.0%, p < 0.05). CONCLUSION The present of this study indicate that K-line may have a predictive value for clinical outcome in patients undergoing LP for CSM. K-line (-) of osseous type was worse than k-line (-) of disc type.
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Tang Z, Chen T, Tan J, Zhang H. Impact of the K-line in patients with ossification of the posterior longitudinal ligament: Analysis of sagittal cervical curvature changes and surgical outcomes. Front Surg 2023; 10:1095391. [PMID: 36874452 PMCID: PMC9975339 DOI: 10.3389/fsurg.2023.1095391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
Objective This study aimed to investigate the relationship of the K-line with sagittal cervical curvature changes and surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods We retrospectively reviewed 84 patients with OPLL who underwent posterior cervical single-door laminoplasty. The patients were divided into a K-line-positive (+) group and a K-line-negative (-) group. Perioperative data, radiographic parameters, and clinical outcomes were compared between the two groups. Results Of 84 total patients, 50 patients were in the K (+) group and 29 patients were in the K (-) group. Neurological function improved in both groups after laminoplasty. The C2-7 Cobb angle, T1 slope, and C2-7 sagittal vertical axis were significantly changed in the K(-) group compared with those in the K (+) group before the operation and at the 3-month and final follow-ups. Conclusion Neurological function was recovered in both groups, and the clinical effect on the K (+) group was better than that on the K (-) group. The cervical curvature in patients with OPLL tends to be anteverted and kyphotic after laminoplasty and is an important factor in reducing the clinical effect.
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Affiliation(s)
- Zhongxin Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tailong Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Tan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huafeng Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Li C, Mei Y, Li L, Li Z, Huang S. Posterior Decompression and Fusion with Vertical Pressure Procedure in the Treatment of Multilevel Cervical OPLL with Kyphotic Deformity. Orthop Surg 2022; 14:2361-2368. [PMID: 35979948 PMCID: PMC9483083 DOI: 10.1111/os.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To report the outcomes and feasibility of a new technique to change K‐line (−) to K‐line (+) via only a posterior approach to treat multilevel non‐continuous cervical ossification of the posterior longitudinal ligament (C‐OPLL) with kyphotic deformity. Methods In this study, 17 consecutive cases of patients who underwent vertical pressure procedure (VP) combined with posterior cervical single‐open‐door laminoplasty and instrumented fusion from January 1, 2017 to December 31, 2019 were enrolled. The following radiographic parameters: C2‐C7 Cobb angle, local Cobb angle, extent of OPLL, and the distance from OPLL to the K‐line(DK) were measured and analyzed. Clinically, the JOA score, VAS‐N and VAS‐A, NDI, and complications were collected from medical records to evaluate the clinical outcomes. Results All 17 cases shifted from K‐line (−) to K‐line (+).Comparing the preoperative images to the final follow‐up images, the mean C2‐7 Cobb angle changed from −6.94° ± 8.30° to 8.18° ± 4.43°, and the local Cobb angle altered from −9.12° ± 8.68° to 6.65° ± 6.11°. The mean DK increased from −2.64 ± 1.52 mm to 3.09 ± 2.19 mm. One patient showed C5 palsy and recovered within 3 months. The mean JOA score increased from 8.88 ± 2.11 to 14.71 ± 1.36. The average NDI decreased from 20.65 ± 7.80 to 8.94 ± 4.93. The mean VAS‐N and VAS‐A decreased from 3.44 ± 1.80 and 4.69 ± 1.97 to 1.25 ± 0.86 and 1.38 ± 1.16. All patients were followed up for at least 1 year. Conclusion A new technique added to posterior decompression and fusion (PDF), the vertical pressure procedure effectively corrects K‐line (−) to K‐line (+) and avoids the shortcomings of conventional anterior decompression and fusion (ADF) as well as PDF to provide a relatively safe and adequate decompression, cervical realignment. It pronounced satisfactory clinical outcome for extensive non‐continuous OPLL with kyphotic deformity even though OPLL remains ventral to the spinal cord.
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Affiliation(s)
- Cheng Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Yunli Mei
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Lei Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Zeqing Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Shuai Huang
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
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Li C, Zha G, Yang Z, Pang Y, Qiu S, Fan W, Liu Y, Jiang W. K-line in patients with cervical ossification of the posterior longitudinal ligament: relationship with change in sagittal cervical curvature and laminoplasty outcomes. Arch Orthop Trauma Surg 2022; 142:1743-1751. [PMID: 33555403 DOI: 10.1007/s00402-020-03741-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To analyze how K-line is related to change in sagittal cervical curvature and laminoplasty outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL). MATERIALS AND METHODS The study retrospectively analyzed 81 patients with OPLL who had undergone posterior cervical single-door laminoplasty and arch plate fixation between June 2011 and June 2017. Fifty-five were K-line positive (K[+]) and 26 were K-line negative (K[-]). Clinical and radiological results were compared between the groups. Patients were followed up for at least 2 years. RESULTS Before the operation, Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), and short-form-36 (SF-36) quality of life score did not differ significantly between the groups. Neurological function was improved in both groups after the procedure. At last follow-up, JOA score, VAS score, NDI, SF-36 score, and JOA score improvement rate differed significantly between the groups. Before the operation, at the 3-month and final follow-ups, C2-7 Cobb angle, T1 slope, and C2-7 SVA differed significantly between the groups. The changes were more marked in the K(-) group than in the K(+) group. The incidence of cervical kyphosis differed significantly between the groups (P < 0.05), as well as between patients with lordosis < 7° and those with lordosis ≥ 7°. CONCLUSIONS K-line negativity and lordosis < 7° may predict kyphosis after laminoplasty in patients with OPLL. The cervical curvature in patients with OPLL tends towards kyphosis and anteversion after laminoplasty, which contributes to the reduced clinical effect of the procedure.
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Affiliation(s)
- Cheng Li
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China
| | - Guochun Zha
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Zhi Yang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Yong Pang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Shang Qiu
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Wei Fan
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China
| | - Yijie Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China
| | - Weimin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China.
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Lee DH, Park S, Hong CG, Kim S, Cho JH, Hwang CJ, Yang JJ, Lee CS. Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament. Global Spine J 2022; 12:1074-1083. [PMID: 33222538 PMCID: PMC9210231 DOI: 10.1177/2192568220975387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Vertebral body sliding osteotomy (VBSO) has previously been reported as a technique to decompress ossification of the posterior longitudinal ligament (OPLL) by translating the vertebral body anteriorly. This study aimed to evaluate the radiological and clinical efficacies of VBSO and clarify the surgical indications of VBSO for treating myelopathy caused by OPLL. METHODS Ninety-seven patients with symptomatic OPLL-induced cervical myelopathy treated with VBSO or laminoplasty who were followed up for more than 2 years were retrospectively reviewed. Cervical alignment, range of motion, fusion, modified K-line (mK-line) status, and minimum interval between ossified mass and mK-line (INT(min)), and the Japanese Orthopaedic Association (JOA) score were assessed. Patients in the VBSO group were compared with those who underwent laminoplasty. RESULTS Cervical lordosis and INT(min) significantly increased in the VBSO group. All patients in the VBSO group assessed as mK-line (-) preoperatively were assessed as mK-line (+) postoperatively. However, in the LMP group, the mK-line status changed from (+) preoperatively to (-) postoperatively in 3 patients. Final JOA score (p = 0.02) and JOA score improvement (p = 0.01) were significantly higher in the VBSO group. JOA recovery ratio (p = 0.03) and proportion of patients with a recovery rate ≥50% were significantly higher in the VBSO group (p < 0.01). CONCLUSIONS VBSO is an effective surgical option for OPLL-induced myelopathy, demonstrating favorable neurological recovery and lordosis restoration with low complication rates. It is best indicated for kyphotic alignment, OPLL with a high space-occupying ratio, and OPLL involving ≤3 segments.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea,Sehan Park, MD, Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 14 Siksadong, Ilsandonggu, Goyangsi, Gyeonggido 411-773, Korea.
| | - Chul Gie Hong
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Korea
| | - Shinseok Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Inoue T, Maki S, Yoshii T, Furuya T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Fujii K, Kimura A, 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, Ohtori S, Yamazaki M, Okawa A. Is anterior decompression and fusion more beneficial than laminoplasty for K-line (+) cervical ossification of the posterior longitudinal ligament? An analysis using propensity score matching. J Neurosurg Spine 2022; 37:13-20. [PMID: 35171838 DOI: 10.3171/2021.11.spine211205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is unclear whether anterior cervical decompression and fusion (ADF) or laminoplasty (LMP) results in better outcomes for patients with K-line-positive (+) cervical ossification of the posterior longitudinal ligament (OPLL). The purpose of the study is to compare surgical outcomes and complications of ADF versus LMP in patients with K-line (+) OPLL. METHODS The study included 478 patients enrolled in the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament and who underwent surgical treatment for cervical OPLL. The patients who underwent anterior-posterior combined surgery or posterior decompression with instrumented fusion were excluded. The patients with a follow-up period of fewer than 2 years were also excluded, leaving 198 patients with K-line (+) OPLL. Propensity score matching was performed on 198 patients with K-line (+) OPLL who underwent ADF (44 patients) or LMP (154 patients), resulting in 39 pairs of patients based on the following predictors for surgical outcomes: age, preoperative Japanese Orthopaedic Association (JOA) score, C2-7 angle, and the occupying ratio of OPLL. Clinical outcomes were assessed 1 and 2 years after surgery using the recovery rate of the JOA score. Complications and reoperation rates were also investigated. RESULTS The mean recovery rate of the JOA score 1 year after surgery was 55.3% for patients who underwent ADF and 42.3% (p = 0.06) for patients who underwent LMP. Two years after surgery, the recovery rate was 53.4% for those who underwent ADF and 38.7% for LMP (p = 0.07). Although both surgical procedures yielded good results, the mean recovery rate of JOA scores tended to be higher in the ADF group. The incidence of surgical complications, however, was higher following ADF (33%) than LMP (15%; p = 0.06). The reoperation rate was also higher in the ADF group (15%) than in the LMP group (0%; p = 0.01). CONCLUSIONS Clinical outcomes were good for both ADF and LMP, indicating that ADF and LMP are appropriate procedures for patients with K-line (+) OPLL. Clinical outcomes of ADF 1 and 2 years after surgery tended to be better than LMP, but the analysis did not detect any significant difference in clinical outcomes between the groups. Conversely, patients who underwent ADF had a higher incidence of surgery-related complications. When considering indications for ADF or LMP, benefits and risks of the surgical procedures should be carefully weighed.
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Affiliation(s)
- Takaki Inoue
- 1Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Satoshi Maki
- 1Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Toshitaka Yoshii
- 2Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Takeo Furuya
- 1Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Satoru Egawa
- 2Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Kenichiro Sakai
- 3Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama
| | - Kazuo Kusano
- 4Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyoda-yu, Tokyo
| | - Yukihiro Nakagawa
- 5Department of Orthopedic Surgery, Wakayama Medical University Kihoku Hospital, Ito-gun, Wakayama
| | - Takashi Hirai
- 2Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Kanichiro Wada
- 6Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori
| | - Keiichi Katsumi
- 7Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata
| | - Kengo Fujii
- 8Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Atsushi Kimura
- 9Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi
| | - Narihito Nagoshi
- 10Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - Tsukasa Kanchiku
- 11Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi
| | - Yukitaka Nagamoto
- 12Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakai, Osaka
| | - Yasushi Oshima
- 13Department of Orthopedic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo
| | - Kei Ando
- 14Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi
| | - Masahiko Takahata
- 15Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido
| | - Kanji Mori
- 16Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga
| | - Hideaki Nakajima
- 17Department of Orthopedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Fukui
| | - Kazuma Murata
- 18Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo
| | - Shunji Matsunaga
- 19Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshima
| | - Takashi Kaito
- 20Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka
| | - Kei Yamada
- 21Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka
| | - Sho Kobayashi
- 22Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Satoshi Kato
- 23Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa
| | - Tetsuro Ohba
- 24Department of Orthopedic Surgery, University of Yamanashi, Chuo, Yamanashi
| | - Satoshi Inami
- 25Department of Orthopedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi
| | - Shunsuke Fujibayashi
- 26Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto
| | - Hiroyuki Katoh
- 27Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa
| | - Haruo Kanno
- 28Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi; and
| | - Shiro Imagama
- 14Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi
| | - Masao Koda
- 8Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Yoshiharu Kawaguchi
- 29Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Japan
| | - Katsushi Takeshita
- 9Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi
| | - Morio Matsumoto
- 10Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - Seiji Ohtori
- 1Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Masashi Yamazaki
- 8Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Atsushi Okawa
- 2Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
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10
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TÜRKOĞLU ME, GÜLMEZ A, ELBİR Ç, ŞAHİN ÖS, HANALİOĞLU Ş, DİNÇ S, TÖNGE Ç, KALAN M. Surgical outcome of laminoplasty for cervical spondylotic myelopathy: a single-institution experience. Turk J Med Sci 2021; 51:2887-2896. [PMID: 33890448 PMCID: PMC10734866 DOI: 10.3906/sag-2102-308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 12/13/2021] [Accepted: 04/21/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Cervical spondylotic myelopathy (CSM) develops as a result of compression of the spinal cord in the cervical region. Early diagnosis and surgical treatment can limit the progression of symptoms. Various surgical approaches and strategies have been described in the literature. This study aims to evaluate the clinical and radiological results of open-door laminoplasty for the treatment of CSM. Materials and methods In this study, we retrospectively analyzed the patients who underwent expansive open-door laminoplasty secured with titanium miniplates. Thirty-four patients with CSM who were followed up postoperatively for more than 12 months were included in the study. The modified Japanese Orthopaedic Association (mJOA) score was used to assess the degree of myelopathy. We evaluated cervical sagittal alignment with C2–C7 Cobb angle, the ambulatory status with the Nurick grade, and measured postoperative neck pain with the visual analogue scale (VAS). Results Themeanm JOA score was 11 (range 6–15) preoperatively, and 13.5 (range 9–16) postoperatively with an average 55% recovery rate (range 0–75) (p < 0.001). Themean–Nurick grade was 2 (range 1–3) preoperatively and 1 (range 0–3) postoperatively (p < 0.001). The median cervical lordotic angle increased from 7.5 ° preoperatively to 12.5 ° postoperatively (p = 0.044). K-line (+) patients› mean mJOA scores significantly increased from 10.8 ± 1.7 to 13.3 ± 1.7 postoperatively (p < 0.001). The mean preoperative VAS reduced from 2.66 ± 1.4 to 1.59 ± 1.4 postoperatively (p < 0.001). Conclusion Open-door laminoplasty technique is an effective surgical procedure that can be used safely to treat cervical spondylotic myelopathy. Our findings suggest that it can limit the progression of symptoms and alter the poor prognosis in CSM.
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Affiliation(s)
- M. Erhan TÜRKOĞLU
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
| | - Ahmet GÜLMEZ
- Neurosurgery Clinic, Yozgat City Hospital, Ministry of Health, Yozgat,
Turkey
| | - Çağirı ELBİR
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
| | - Ömer Selçuk ŞAHİN
- Department of Neurosurgery, Mengücek Gazi Education and Research Hospital, Erzincan Binali Yıldırım University, Erzincan,
Turkey
| | - Şahin HANALİOĞLU
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Samet DİNÇ
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
| | - Çağhan TÖNGE
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
| | - Mehmet KALAN
- Department of Neurosurgery, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Faculty of Gülhane Medicine, University of Health Sciences, Ankara,
Turkey
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11
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Li H, Song C, Wang Y, Qiu Z, Yan J, Liu X. Effectiveness of additional C2 decompression of the cervical spinal canal after cervical laminoplasty: a retrospective cohort study. Br J Neurosurg 2021:1-8. [PMID: 34319203 DOI: 10.1080/02688697.2021.1958152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/15/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to assess the effects of additional C2 decompression of the cervical spinal canal on the postoperative outcomes after cervical laminoplasty in patients with cervical stenosis caused by ossification of the posterior longitudinal ligament (OPLL). MATERIALS AND METHODS This retrospective cohort study included patients with cervical stenosis due to OPLL and treated between April 2014 and December 2015. The patients who underwent C2-7 (additional C2 decompression) and C3-7 posterior decompression were compared using the Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, axial symptom scores, and intervals between the posterior margin of the vertebral body and the K-line. RESULTS There were 36 and 24 patients in the additional C2 decompression and control groups, respectively. The JOA scores were higher in the additional C2 decompression group than the controls at 1 and 3 years (p < 0.05). Upper extremity motor function after the operation and at 1 and 3 years and lower extremity motor function after operation were improved in the additional C2 decompression group (all p < 0.05 vs. controls). VAS scores were lower in the additional C2 decompression group than controls at 1 year (p < 0.05). Axial symptom scores in the additional C2 decompression group were decreased postoperatively but increased at 1 and 3 years (p < 0.05 vs. controls). Finally, the posterior shift of the K-line in the additional C2 decompression group was significant (from 0.98 to 1.68 cm, p < 0.05). CONCLUSIONS Additional C2 decompression might improve the effectiveness of cervical laminoplasty in patients with cervical stenosis caused by OPLL.
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Affiliation(s)
- Huashuai Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Chengchao Song
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yufu Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Zhaowen Qiu
- Heilongjiang Tuomeng Technology Co. Ltd., Harbin, China
| | - Jinglong Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Xiaoqi Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
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12
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Sakai K, Yoshii T, Arai Y, Hirai T, Torigoe I, Inose H, Tomori M, Sakaki K, Yuasa M, Yamada T, Matsukura Y, Oyaizu T, Morishita S, Okawa A. K-Line Tilt is a Predictor of Postoperative Kyphotic Deformity After Laminoplasty for Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament. Global Spine J 2021; 13:1005-1010. [PMID: 33949218 DOI: 10.1177/21925682211012687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective single-center study. OBJECTIVES K-line is a decision-making tool to determine the appropriate surgical procedures for patients with cervical ossification of the posterior longitudinal ligament (C-OPLL). Laminoplasty (LAMP) is one of the standard surgical procedures indicated on the basis of K-line measurements (+: OPLL does not cross the K-line). We investigated the impact of K-line tilt, a radiographic parameter of cervical sagittal balance measured using the K-line, on surgical outcomes after LAMP. METHODS The study included 62 consecutive patients with K-line (+) C-OPLL who underwent LAMP. The following preoperative and postoperative radiographic measurements were evaluated: (1) the K-line, (2) K-line tilt (an angle between the K-line and vertical line), (3) center of gravity of the head -C7 sagittal vertical axis, (4) C2-C7 lordotic angle, (5) C7 slope, and (6) C2-C7 range of motion. Clinical results were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score). RESULTS All the patients had non-kyphotic cervical alignment (CL ≥ 0°) preoperatively; however, kyphotic deformity (CL < 0°) was observed in 6 patients (9.7%) postoperatively. The recovery rate of the C-JOA scores was poor in the kyphotic deformity (+) group (7.8%) than in the kyphotic deformity (-) group (47.5%). The K-line tilt was identified to be a preoperative risk factor in the multivariate analysis, and the cutoff K-line tilt for predicting the postoperative kyphotic deformity was 20°. CONCLUSIONS LAMP is not suitable for K-line (+) C-OPLL patients with K-line tilts >20°.
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Affiliation(s)
- Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Kyohei Sakaki
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuyoshi Yamada
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuya Oyaizu
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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13
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Staedt H, Heimes D, Lehmann KM, Ottl P, Bjelopavlovic M, Wagner W, Al-Nawas B, Kämmerer PW. Does the Modification of the Apical Geometry of a Dental Implant Affect Its Primary Stability? A Comparative Ex Vivo Study. Materials (Basel) 2021; 14:1728. [PMID: 33915933 DOI: 10.3390/ma14071728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 01/14/2023]
Abstract
(1) Background: Primary stability—one fundamental criterion for the success of dental implants—is influenced by implant geometry even if the effect of apical shape modifications on implant primary stability has not yet been examined. Therefore, the aim of the ex vivo study was to compare primary stability of implants differing in apically located screw threads (J-line) or a flat tip (K-line) only. (2) Methods: 28 implants of each group of the same diameter (4.3 mm) were randomly inserted into porcine bone blocks. The first group (9, 11 and 13 mm) was inserted into “hard”, the second (11 mm) into “soft” bone, here using a normal and an undersized drilling protocol. Insertion torque (Ncm), Periotest® value, resonance frequency (implant stability coefficient, ISQ) and push-out force (N) were measured. (3) Results: In “hard” bone, primary stability increased with increasing length in both groups but it was significantly higher in J-line (p < 0.03). An undersized preparation of the implant bed in “soft” bone resulted in a significant increase in primary stability in both groups. Here, J-line also showed a significantly increased primary stability when compared to equally prepared K-line (insertion torque: 37 Ncm vs. 26 Ncm; Periotest®: −6.5 vs. −4.3; push-out force: 365 N vs. 329 N; p < 0.05 each). (4) Conclusions: Primary stability is significantly higher with increasing implant length and apically located screw threads as well as with undersized drilling protocols. When preparing the implant site and subsequently selecting the implant system, modifying factors such as implant geometry (also at the tip) should be taken into account.
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14
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Li Y, Li J, Wang F, Wang L, Shen Y. Influence of K-line on intraoperative and hidden blood loss in patients with ossification of the posterior longitudinal ligament when undergoing unilateral open-door laminoplasty. J Orthop Surg Res 2021; 16:34. [PMID: 33422106 PMCID: PMC7797147 DOI: 10.1186/s13018-020-02181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/25/2020] [Indexed: 11/24/2022] Open
Abstract
Background The K-line is a virtual straight line that connects the midpoints of the anteroposterior spinal canal diameter from C2 to C7 on a cervical lateral X-ray film. Patients with cervical ossification of the posterior longitudinal ligament (OPLL), in which the peak of the OPLL exceeds the K-line (K-line [-]), are less likely to experience sufficient decompression after laminoplasty compared with patients for whom the OPLL does not exceed the K-line (K-line [+]). This retrospective study investigated the influence of K-line position relative to the OPLL on intraoperative and hidden blood loss during unilateral open-door laminoplasty for OPLL. Methods Data were retrospectively analyzed of 108 patients with OPLL who underwent unilateral open-door laminoplasty between April 2015 and March 2018. Patient cases were categorized as K-line (+) or (-). The evaluated perioperative parameters were haematocrit, haemoglobin, intraoperative and hidden blood loss, surgical time, postoperative drainage, and complications. Radiological parameters included ossification occupancy ratio and C2-7 lordosis. Results The K-line (+) and K-line (-) groups were statistically comparable with regard to age, gender, body mass index, OPLL classification, medication history, C2-7 lordosis, postoperative haemoglobin and haematocrit, postoperative drainage, hidden blood loss, and complications. The occupying ratio of the K-line (-) group was significantly greater than that of the K-line (+) group (49.5 ± 15.3% cf. 42.3 ± 10.1%; P = 0.006), and the intraoperative blood loss was also significantly higher (286 ± 110.5 mL cf. 205.5 ± 98.3 L, P = 0.003). The hidden blood loss of the K-line (-) group was higher than that of the K-line (+), but not significantly (295.5 ± 112.6 mL cf. 265.6 ± 103.8 mL; P = 0.072). Conclusion Intraoperative and hidden blood loss associated with unilateral open-door laminoplasty can be predicted by the spatial relationship of the K-line and osteophyte. This relationship is a simple and practical index that may help surgeons determine the appropriate surgical strategy for patients with OPLL.
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Affiliation(s)
- Yipeng Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Jia Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Feng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Yong Shen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China. .,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
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15
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Saito J, Koda M, Furuya T, Maki S, Ijima Y, Kitamura M, Miyamoto T, Orita S, Inage K, Hasue F, Fujiyoshi T, Kamiya K, Ikeda Y, Nakajima F, Hashimoto M, Noguchi H, Takahashi H, Yamazaki M, Ohtori S. Segmental motion at the peak of the ossification foci is independent risk factor except for mal-alignment and thick ossification foci for poor outcome after laminoplasty for cervical ossification of the posterior longitudinal ligament: analyses in patients with positive K-line, lordotic alignment, and lower canal occupying ratio. J Orthop Surg Res 2020; 15:407. [PMID: 32928257 PMCID: PMC7489006 DOI: 10.1186/s13018-020-01903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To elucidate the independent preoperative factors that have a significant impact on poor surgical outcome after laminoplasty for K-line (+) ossification of the posterior longitudinal ligament (OPLL). Analyses in K-line (+) patient population can exclude the influence by mal-alignment and thick OPLL, both of which are well known two major factors that have significant impact on clinical outcome. METHODS The present study included 72 patients (50 male and 22 female) who underwent laminoplasty for K-line (+) cervical OPLL and were followed-up for at least 1 year. Recovery of Japanese Orthopedic Association score (JOA score) for cervical myelopathy was used as the measure of clinical outcome. For radiographic assessment, the type of OPLL, the maximum OPLL occupation ratio, the C2-C7 angle, and the segmental range of motion at the peak of OPLL (segmental ROM) were assessed. To elucidate the factors that are significantly associated with a poor clinical outcome after laminoplasty for K-line (+) OPLL, statistical analyses were conducted. RESULTS The mean preoperative JOA score was 8.9 points and improved to 12.8 points after surgery. The recovery of JOA score was 47 ± 35%. Stepwise logistic regression following univariate analyses revealed that preoperative segmental ROM at the peak of OPLL is an independent factor associated with a poor outcome (p = 0.04, odds ratio = 1.15). CONCLUSIONS Large preoperative segmental ROM at the peak of the OPLL is an independent factor that has significant impact on poor surgical outcome after laminoplasty for K-line (+) OPLL.
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Affiliation(s)
- Junya Saito
- Department of Orthopedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana Chuou-ku Chiba City, Chiba, 260-8670, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Takeo Furuya
- Department of Orthopedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana Chuou-ku Chiba City, Chiba, 260-8670, Japan
| | - Satoshi Maki
- Department of Orthopedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana Chuou-ku Chiba City, Chiba, 260-8670, Japan
| | - Yasushi Ijima
- Department of Orthopedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana Chuou-ku Chiba City, Chiba, 260-8670, Japan
| | - Mitsuhiro Kitamura
- Department of Orthopedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana Chuou-ku Chiba City, Chiba, 260-8670, Japan
| | - Takuya Miyamoto
- Department of Orthopedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana Chuou-ku Chiba City, Chiba, 260-8670, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana Chuou-ku Chiba City, Chiba, 260-8670, Japan
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana Chuou-ku Chiba City, Chiba, 260-8670, Japan
| | - Fumio Hasue
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, 1010, Sakurai, Kisarazu, Chiba, 292-8535, Japan
| | - Takayuki Fujiyoshi
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, 1010, Sakurai, Kisarazu, Chiba, 292-8535, Japan
| | - Koshiro Kamiya
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, 1010, Sakurai, Kisarazu, Chiba, 292-8535, Japan
| | - Yoshikazu Ikeda
- Department of Orthopedic Surgery, Chiba Rosai Hospital, 2-16, Tatsumidaihigashi, Ichihara, Chiba, 290-0003, Japan
| | - Fumitake Nakajima
- Department of Orthopedic Surgery, Chiba Rosai Hospital, 2-16, Tatsumidaihigashi, Ichihara, Chiba, 290-0003, Japan
| | - Mitsuhiro Hashimoto
- Department of Orthopedic Surgery, Chiba Rosai Hospital, 2-16, Tatsumidaihigashi, Ichihara, Chiba, 290-0003, Japan
| | - Hiroshi Noguchi
- Department of Orthopedic Surgery, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Toho University Chiba Medical Center, 564-1, Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana Chuou-ku Chiba City, Chiba, 260-8670, Japan
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Ishikawa Y, Miyakoshi N, Hongo M, Kasukawa Y, Kudo D, Sato C, Shimada Y. Thin Cervical Spinal Cord Between Ossifications of the Ligamentum Flavum and the Posterior Longitudinal Ligament: Case Report and Literature Review. World Neurosurg 2020; 145:83-88. [PMID: 32920158 DOI: 10.1016/j.wneu.2020.09.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cervical ossification of the ligamentum flavum (OLF) is a rare condition; however, the coexistence of OLF and ossification of the posterior longitudinal ligament (OPLL) is extremely uncommon. These can exist simultaneously and cause thinning of the cervical spinal cord. Sufficient decompression, dural ossification, semispinalis dissection, and postoperative kyphosis were evaluated. We report the successful treatment of coexisting cervical OLF and OPLL. CASE DESCRIPTION A 70-year-old man had been experiencing weakness in the left knee and clumsiness in the left hand for 6 months. Hemiparesis was considered; however, magnetic resonance imaging revealed a cervical spinal lesion. Hence a spine surgeon diagnosed the patient with severe stenosis with OLF at the C2-C3 levels and OPLL at the C2-C4 levels. The patient presented with spastic gait and left-hand motor weakness. Computed tomography scan revealed the disappearance of the black line, indicating dural ossification surrounding the OLF. OPLL was observed in 61.5% of the C2 spinal canal. The K-line was (-); however, the alternative K-line between the C1 and C7 level was (+). Posterior laminectomy at the C2-C3 levels and laminoplasty at the C4-C7 levels with muscle preservation resulted in sufficient decompression. The patient's symptoms improved, and cervical alignment was maintained 2 years after surgery. CONCLUSIONS An alternative K-line comprised successful treatment for coexisting cervical OLF and OPLL. Surgeons must evaluate the severity of adhesion, damage of the paraspinal muscles, and necessity of posterior corrective surgery along with the patient's comorbidities and possible postoperative complications.
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Affiliation(s)
- Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Chiaki Sato
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Li C, Zhou H, Yang S, Zhu X, Zha G, Yang Z, Yuan F, Jiang W. Effect of K-line on posterior cervical surgery in patients with posterior longitudinal ligament ossification. Eur Spine J 2020; 29:2368-2377. [PMID: 32564230 DOI: 10.1007/s00586-020-06507-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/14/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the effect of K-line on posterior single-door decompression with fusion fixation (PFF) and posterior single-door decompression with non-fusion fixation (PNF) for patients with ossification of posterior longitudinal ligament (OPLL). METHODS A total of 65 patients with OPLL were analyzed retrospectively. They consisted of 44 patients with positive K-line, designated as the K ( +) group, and 21 patients with negative K-line, designated as K (-). The patients were also divided into a PFF group (38 patients) and a PNF group (27 patients). The Japanese Orthopaedic Association (JOA) score, C2-C7 Cobb angle, improvement rate of JOA score, and complications were calculated and statistically analyzed between the groups. RESULTS In the K ( +) group, there were no significant differences in the incidence of C5 nerve root palsy and C2-C7 Cobb angle between the two groups of surgical patients, but there were significant differences in the improvement rate of JOA score and the incidence of axial pain. In the K (-) group, there were no significant differences in the incidence of axial pain, the incidence of C5 nerve root palsy, and preoperative C2-C7 Cobb angle between the two groups, but significant differences were observed in the improvement rate of JOA score and C2-C7 Cobb angle at the last follow-up. CONCLUSION In the K ( +) group, the improvement rate of JOA score was higher and the incidence of axial pain was lesser in the PNF group than in the PFF group. In the K (-) group, the improvement rate of JOA score was higher in the PFF group than in the PNF group, and there was significant loss of C2-C7 Cobb angle in the PNF group.
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Affiliation(s)
- Cheng Li
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China
| | - Hong Zhou
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China
| | - Sen Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China
| | - Xuanchen Zhu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China
| | - Guochun Zha
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Zhi Yang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Feng Yuan
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Weimin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, pinghai road, Suzhou, 215006, Jiangsu Province, China.
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Katsumi K, Hirano T, Watanabe K, Ohashi M, Mizouchi T, Wakasugi M, Makino T, Yamazaki A, Endo N. A novel concept of posterior decompression and instrumented fusion with selective lordotic correction for cervical ossification of the posterior longitudinal ligament. J Clin Neurosci 2019; 68:312-316. [PMID: 31337582 DOI: 10.1016/j.jocn.2019.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The recovery rate of Japanese Orthopedic Association (JOA) score with K-line (-) cervical ossification of the posterior longitudinal ligament (OPLL) for posterior decompression with in-situ fusion (PDF) tends to be lower than that of anterior decompression with fusion (ADF). However, ADF is a technically demanding operation and has ADF-specific complications. This prospective report introduced a novel concept of PDF with selective lordotic correction as well as prophylactic foraminal decompression. METHODS Six consecutive patients (four men and two women; mean age, 61.8 years) were included. PDF was performed, attempting to create cervical lordosis to acquire a posterior shift of the spinal cord, while preventing postoperative C5 palsy by prophylactic facetectomy and selective lordotic correction. RESULTS The mean recovery rate of JOA score at the final follow-up was 70.9 ± 20.3%. The mean C2-C7 angle preoperatively and at final follow-up was 5.5 ± 3.9° and 12.2 ± 4.8°, respectively. No symptomatic nerve root palsy, except one case with transient C7 root iatrogenic palsy, was found. CONCLUSIONS A novel concept of PDF with selective lordotic correction obtained recovery rates of JOA scores comparable to those of ADF. We believe that this method can improve PDF outcomes in patients with K-line (-) OPLL.
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Affiliation(s)
- Keiichi Katsumi
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, Niigata City, Niigata, Japan; Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata City, Niigata, Japan.
| | - Toru Hirano
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata City, Niigata, Japan; Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-uonuma City, Niigata, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata City, Niigata, Japan
| | - Masayuki Ohashi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata City, Niigata, Japan
| | - Tatsuki Mizouchi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata City, Niigata, Japan
| | - Masashi Wakasugi
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-uonuma City, Niigata, Japan
| | - Tatsuo Makino
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, Niigata City, Niigata, Japan
| | - Akiyoshi Yamazaki
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, Niigata City, Niigata, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata City, Niigata, Japan
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Katsumi K, Hirano T, Watanabe K, Ohashi M, Shoji H, Mizouchi T, Yamazaki A, Izumi T, Sawakami K, Denda H, Takahashi K, Endo N. Perioperative factors associated with favorable outcomes of posterior decompression and instrumented fusion for cervical ossification of the posterior longitudinal ligament: A retrospective multicenter study. J Clin Neurosci 2018; 57:74-8. [PMID: 30146402 DOI: 10.1016/j.jocn.2018.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Posterior decompression with instrumented fusion (PDF) is a suitable surgical treatment for K-line (-)-type cervical ossification of the posterior longitudinal ligament (OPLL). However, the adequate indications of PDF have not been clarified yet. The purpose of this study was to investigate the surgical results of PDF and perioperative factors that influence the surgical outcome, and to clarify the adequate indications of PDF. METHODS Twenty-seven patients (21 men and 6 women, mean age: 61.4 years) who were diagnosed with a K-line (-)-type OPLL that was treated with PDF were included in this study. We evaluated these patients clinically and radiologically to investigate the outcomes of PDF and perioperative factors that influence improvements in the Japanese Orthopedic Association (JOA) score. RESULTS The mean recovery rate of JOA score at the final follow-up examination was 53.3%. In the statistical analysis, the preoperative C2-C7 angle and the C2-C7 angle immediately postoperatively significantly predicted the surgical outcome. The C2-C7 angle immediately postoperatively was the only most important predictor. Using a receiver operating characteristic curve analysis, we found that the cutoff value of the C2-C7 angle immediately postoperatively for good outcomes (recovery rate of JOA score ≥50%) was -2.0°. CONCLUSIONS PDF for K-line (-)-type OPLL patients with preoperative lordotic alignment can be expected to have favorable outcomes, which is the adequate indication for PDF. Since the C2-C7 angle immediately postoperatively was the most important predictor, the physician should pay attention to maintain the cervical lordotic alignment to enhance the surgical outcomes in surgical planning.
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Wang YN, Xie MQ, Xuan AW, Guo MM, Li QS, Ma F, Wang Q. [Combining K-line to analyse the relationship between cervical range of motion of patients with ossification of cervical posterior longitudinal ligament and surgical prognosis]. Zhongguo Gu Shang 2018; 31:763-768. [PMID: 30185013 DOI: 10.3969/j.issn.1003-0034.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Combining K-line (the connecting line of the midpoint of C₂ and C₇ spinal canal on the cervical lateral X-ray film) to analyze the relationship between cervical range of motion of patients with ossification of posterior longitudinal ligament (OPLL) and surgical prognosis. METHODS A total 42 patients with ossification of cervical posterior longitudinal ligament underwent cervical posterior single open-door laminoplasty between April 2014 and March 2017 were retrospectively ananyzed. The patients were dividing into K-line (+) group and K-line (-) group according to the position realationship of OPLL and K-line. The lesion of ossification of the posterior longitudinal ligament was not over than the K-line known as K-line (+). Conversely, the lesion of ossification of the posterior longitudinal ligament crossing the K-line was called K-line (-). Preoperative and postoperative 3 months JOA scores were observed, and postoperative 3 months JOA improvement rate were computed to assess patient's neurological function recovery. Preoperation and postoperative 3 months, OPLL occupation ratio (OOR), cervical lordotic angles (CLA) and cervical lordotic value (CLV) were measured respectively. The realationship between postoperative neurologic functional recovery in patients of CLV>0 group and CLV<=0 group was evaluated in different K-line subgroups. RESULTS For the patients in K (+) group and K (-) group, preoperative CLA were (14.7±9.6)° and (-6.4±9.5)°(P<0.05) respectively, postoperative at 3 months CLA were (14.0±8.0)° and (-1.4±10.4)°(P<0.05) respectively; preoperative JOA scores were 10.9±3.2 and 11.2±2.5 (P>0.05) respectively, postoperative at 3 months JOA scores were 14.2±1.8 and 12.6±2.2 (P<0.05) respectively, and postoperative at 3 months JOA score improvement rate were (54.7±17.6)% and (25.5±15.7)%(P<0.05) respectively. In the K-line (+) group, there were 29 patients in CLV>0 group at 3 months after operation, with improvement rate of (52.3±17.2)%, and 4 patients in CLV<=0 group, with improvement rate of (72.2±7.8)%. The improvement rate of the patients in CLV<=0 group was significantly better than that of the patients in CLV>0 group (P<0.05). CONCLUSIONS No matter whether the ossification of cervical posterior longitudinal ligament was classified as K-line (+) or K-line (-), the cervical posterior single open-door laminoplasty can improve the neurological symptoms of patients, especially the patients in the K-line(+) group with better prognosis. The patinets in K-line(+) group, when postoperative at 3 months CLV>0, their improvement rate was lower than that of the patients with postoperative at 3 months CLV<=0.
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Affiliation(s)
- Ya-Nan Wang
- Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China
| | - Meng-Qi Xie
- Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China
| | - An-Wu Xuan
- Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China
| | - Ming-Ming Guo
- Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China
| | - Qing-Song Li
- Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China
| | - Fei Ma
- Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China
| | - Qi Wang
- Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China;
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Ijima Y, Furuya T, Ota M, Maki S, Saito J, Kitamura M, Miyamoto T, Ohtori S, Orita S, Inage K, Suzuki T, Yamazaki M, Koda M. The K-line in the cervical ossification of the posterior longitudinal ligament is different on plain radiographs and CT images. J Spine Surg 2018; 4:403-407. [PMID: 30069535 PMCID: PMC6046332 DOI: 10.21037/jss.2018.05.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/25/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The K-line, which is a virtual line between the midpoints of the antero-posterior canal diameter at C2 and C7, can be useful for determination of surgical procedures for cervical ossification of the posterior longitudinal ligament (OPLL). Although K-line is originally measured with plain radiogram, computed tomography multiplanar reconstruction (CT-MPR) is applied for K-line measurement by several surgeons. The purpose of the present study was to analyze whether there is a difference in K-lines obtained from radiographs of standing patients and those obtained from CT-MPR images of supine patients. METHODS The present study included 65 patients with cervical OPLL underwent surgical treatment. We investigated the K-line (+ or -) before surgery, measured from lateral cervical spine radiographs taken in standing patients in a neutral position (X-P-based K-line) and CT-MPR mid-sagittal images obtained in supine patients (CT-based K-line). The X-P-based and CT-based K-lines were compared and differences between them were assessed. RESULTS The-X-P-based K-line was found to be (+) in 35 patients and (-) in 30 patients. Four of 35 patients with an X-P-based K-line (11%) showed a change from K-line (+) to (-) in CT-based K-line measurements. One of 30 patients with an X-P-based K-line (3%) showed a change from (-) to (+) in CT-based measurements. CONCLUSIONS The K-line should be measured with plain radiogram of standing patients because X-P-based K-line and CT-based K-line can be different.
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Affiliation(s)
- Yasushi Ijima
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mitsutoshi Ota
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Junya Saito
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mitsuhiro Kitamura
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takuya Miyamoto
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takane Suzuki
- Department of Environmental Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
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Li S, Zhang P, Gao X, Miao D, Gao Y, Shen Y. Potential risk factors for poor outcome after anterior surgery for patients with cervical ossification of the posterior longitudinal ligament. Ther Clin Risk Manag 2018; 14:341-347. [PMID: 29503553 PMCID: PMC5824755 DOI: 10.2147/tcrm.s152416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Our purpose here was to identify risk factors of poor outcome after anterior operation in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods This study retrospectively reviewed 98 patients who underwent anterior surgery for improving neurological symptoms. The Japanese Orthopedic Association (JOA) recovery rate <50% was defined as poor surgical outcome. We investigated the relationship between various predictors and outcome by logistic regression analysis and receiver operating characteristic curves. To explore the cause of cerebrospinal fluid (CSF) leakage, we used the Mann–Whitney U-test, χ2 test, or independent t-test. Results Multivariate logistic regression analysis showed that age (odds ratio [OR] =1.1, 95% confidence interval [CI] =1.03–1.18, P=0.005), occupying ratio of OPLL (OR =1.08, 95% CI =1.03–1.12, P=0.001), and residual ratio of OPLL (OR =1.07, 95% CI =1.02–1.13, P=0.008) were independently associated with poor outcome. The cutoffs of the above risk factors were set at 63.5 years, 39.65%, and 25.165%, respectively. Predictors for CSF leakage were occupying ratio of OPLL, the K-line, and shape of the ossified lesion (P<0.001, P=0.019, and P=0.003). Conclusion These findings suggest that advanced age, high occupying ratio of OPLL, and high residual ratio of OPLL were risk factors for postoperative poor outcome in patients with OPLL. In addition, the high occupying ratio of OPLL, the K-line (−), and hill-shape ossification were potential causes of CSF leakage.
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Affiliation(s)
- Shaoqing Li
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Peng Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Xianda Gao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Dechao Miao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yanlong Gao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yong Shen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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Saito J, Maki S, Kamiya K, Furuya T, Inada T, Ota M, Iijima Y, Takahashi K, Yamazaki M, Aramomi M, Mannoji C, Koda M. Outcome of posterior decompression with instrumented fusion surgery for K-line (-) cervical ossification of the longitudinal ligament. J Clin Neurosci 2017; 32:57-60. [PMID: 27591553 DOI: 10.1016/j.jocn.2015.12.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/29/2015] [Indexed: 10/21/2022]
Abstract
We investigated the outcome of posterior decompression and instrumented fusion (PDF) surgery for patients with K-line (-) ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, who may have a poor surgical prognosis. We retrospectively analyzed the outcome of a series of 27 patients who underwent PDF without correction of cervical alignment for K-line (-) OPLL and were followed-up for at least 1 year after surgery. We had performed double-door laminoplasty followed by posterior instrumented fusion without excessive correction of cervical spine alignment. The preoperative Japanese Orthopedic Association (JOA) score for cervical myelopathy was 8.0 points and postoperative JOA score was 11.9 points on average. The mean JOA score recovery rate was 43.6%. The average C2-C7 angle was 2.2° preoperatively and 3.1° postoperatively. The average maximum occupation ratio of OPLL was 56.7%. In conclusion, PDF without correcting cervical alignment for patients with K-line (-) OPLL showed moderate neurological recovery, which was acceptable considering K-line (-) predicts poor surgical outcomes. Thus, PDF is a surgical option for such patients with OPLL.
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Affiliation(s)
- Junya Saito
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba 260-8670, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba 260-8670, Japan.
| | - Koshiro Kamiya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba 260-8670, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba 260-8670, Japan
| | - Taigo Inada
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba 260-8670, Japan
| | - Mitsutoshi Ota
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba 260-8670, Japan
| | - Yasushi Iijima
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba 260-8670, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba 260-8670, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaragi, Japan
| | - Masaaki Aramomi
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Chikato Mannoji
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba 260-8670, Japan
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Ito K, Yukawa Y, Ito K, Machino M, Kanbara S, Nakashima H, Hida T, Ishiguro N, Imagama S, Kato F. Dynamic changes in the spinal cord cross-sectional area in patients with myelopathy due to cervical ossification of posterior longitudinal ligament. Spine J 2015; 15:461-6. [PMID: 25463397 DOI: 10.1016/j.spinee.2014.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/04/2014] [Accepted: 10/07/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Dynamic changes in the spinal cord cross-sectional area due to cervical ossification of the posterior longitudinal ligament (C-OPLL) are unknown, but dynamic multidetector-row computed tomography (MDCT) may be a useful tool. PURPOSE The purpose of this study was to evaluate the influence of dynamic factors on the spinal cord in patients with C-OPLL using MDCT during flexion and extension after myelography. STUDY DESIGN/SETTING This was a prospective cohort study. PATIENT SAMPLE Participants included 107 prospectively enrolled consecutive patients with C-OPLL and myelopathy. OUTCOME MEASURE The outcome measure was the extension/flexion ratio at the spinal cord cross-sectional area at the most stenotic cervical level (SCASL). METHODS Dynamic MDCT was performed, and the SCASL was measured. Patients were divided into the kyphosis group or lordosis group according to C2-C7 alignment. They were divided further into the K-line (-) group or K-line (+) group. The Japanese Orthopedic Association (JOA) score was used to determine myelopathy severity. RESULTS All patients with C-OPLL had myelopathy, with a mean JOA score of 10.7 and mean disease duration of 16.7 months. The average extension/flexion ratio at all disc levels was less than 100%, suggesting that the spinal cord was compressed more during extension. In the kyphosis group, the spinal cord was compressed slightly more during flexion than during extension. In the K-line (-) group, the spinal cord was compressed more during flexion, although C2-C7 alignment was slightly lordotic on average. Large changes in the spinal cord cross-sectional area during extension-flexion and disease duration significantly influenced the severity of myelopathy. CONCLUSIONS Dynamic MDCT was useful for evaluating dynamic changes in the spinal cord. At the most stenotic level, the spinal cord became narrower during extension at all disc levels. In the kyphosis group and K-line (-) group, it became narrower during flexion. Cervical flexion may induce greater spinal cord compression in patients with kyphosis and K-line (-).
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Affiliation(s)
- Kenyu Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan; Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan.
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Keigo Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Shunske Kanbara
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Tetsuro Hida
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
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