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Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament

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Abstract

Objective

Factors impacting surgical options and outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) were explored.

Methods

A retrospective analysis was conducted of 127 eligible cervical OPLL patients (61 males, 66 females) aged 41–70 years (mean 55.2 years) selected from 152 total OPLL patients treated from 2002 to 2006, with 5–10-year (mean 6.8 years) follow-up. Patients underwent anterior subtotal corpectomy with ossification ligament resection (anterior surgery, n = 68) or posterior cervical double-door laminoplasty (posterior surgery, n = 59). Radiographic assessments of cervical curvature, T2-weighted MRI (MRIT2) signal, and OPLL occupying ratio were correlated with surgical strategy before surgery and at 1, 5 weeks, and 5 years.

Results

Lordosis increased following anterior surgery, though kyphosis improved by 10.3 %. The canal stenosis occupying ratio was >50 %, and short-term improvement following anterior surgery was significantly higher than posterior surgery (P > 0.0001). Superior neurological function was observed in patients with unchanged versus high spinal MRIT2 signals (P = 0.0434). No significant differences were observed in short-term outcomes between anterior and posterior surgeries in high spinal MRIT2 signal patients, but anterior surgery produced significantly better long-term outcomes at 1 week (P = 0.7564) and 1 year (P = 0.0071). Complications occurred in five anterior and three posterior surgeries.

Conclusion

Preoperative assessment of cervical curvature, MRIT2 signal, and occupying ratio can be used to guide clinical surgical approach selection to potentially produce better long-term outcomes in patients with OPLL.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Orthopaedic Department, Qilu Hospital of Shandong University, Jinan, 250012, China

    Haichun Liu, Yi Li, Yunzhen Chen & Wenliang Wu

  2. Orthopaedic Department, Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China

    Debo Zou

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  1. Haichun Liu
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  2. Yi Li
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  3. Yunzhen Chen
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  4. Wenliang Wu
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Corresponding author

Correspondence to Yunzhen Chen.

Electronic supplementary material

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586_2013_2707_MOESM1_ESM.tif

Case 1 A patient with C5/6 OPLL is shown, presenting with neurological symptoms. Adequate decompression of C5/6 was performed followed by long-segment fixation. a Preoperative AP film; b Preoperative lateral film; c Preoperative CT sagittal reconstruction; d CT scan before surgery; and e AP film after anterior surgical approach; and f Lateral view after anterior surgical approach

586_2013_2707_MOESM2_ESM.tif

Case 2 The patient exhibited osteophytes of C4/C5 complicated by OPLL of C5/C6, and presented with significant neurological symptoms. Subtotal corpectomy of C5/C6 was performed for adequate decompression. a Preoperative lateral view; b Preoperative sagittal reconstruction; c Preoperative CT scan; d Preoperative spinal MRIT2 view; e Preoperative spinal MRIT2 view; and f Lateral view after anterior surgical approach

586_2013_2707_MOESM3_ESM.tif

Case 3 The patient underwent partial removal of the PLL posterior to the C3 during anterior surgery due to failure to adequately expose the C3 vertebral body. Symptomatic manifestations were not greatly improved following anterior surgery; however, the patient voluntarily refused second posterior surgery. A 69-year-old patient was followed for 5 years and thereafter lost to follow-up for unknown reasons. MRI was not performed because of internal fixation materials. Notably, other similar cases were preferentially treated with posterior surgery. a Preoperative lateral view; b Preoperative CT scan; c Preoperative MRIT2 signal change; and d Postoperative lateral radiograph view 30

586_2013_2707_MOESM4_ESM.tif

Case 4 The patient exhibited severe long-segment OPLL from C2 to C7 accompanied by severe neurological symptoms and was treated with posterior cervical open-door decompression. a Preoperative lateral view; b Preoperative CT cross-sectional view; c No change of preoperative T2 signal; and d 4Postoperative MRIT2-weighted after posterior surgical approach

586_2013_2707_MOESM5_ESM.tif

Case 5 The patient exhibited very small spinal canal space, and severe neurological symptoms resulting in tetraplegia. Initially, posterior surgery was performed, resulting in recovery of sensory function but not motor function. Symptoms reoccurred after 5 years. At this time, anterior surgery was performed, and the OPLL was resected, resulting in significantly improved neurological symptoms. This patient was included in the posterior surgery group. a Preoperative sagittal reconstruction; b Preoperative MRIT2-weighted view; c Preoperative lateral view; and d Postoperative sagittal reconstruction

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Liu, H., Li, Y., Chen, Y. et al. Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament. Eur Spine J 22, 1480–1488 (2013). https://doi.org/10.1007/s00586-013-2707-7

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  • DOI: https://doi.org/10.1007/s00586-013-2707-7

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