Patterns of short-term and long-term surgical outcomes and prognostic factors for cervical ossification of the posterior longitudinal ligament between anterior cervical corpectomy and fusion and posterior laminoplasty
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To compare short-term and long-term surgical outcome patterns between anterior cervical corpectomy and fusion (ACCF) and laminoplasty (LP) in patients diagnosed with cervical ossification of the posterior longitudinal ligament (OPLL) and identify factors affecting surgical outcomes based on follow-up duration. During short-term follow-up period, surgical outcomes between ACCF and LP were similar. However, there were several reports that long-term surgical outcomes were superior in the ACCF compared with LP. Surgical outcomes between ACCF and LP according to follow-up period changed. This study enrolled 70 patients who underwent ACCF and 63 patients who underwent LP between 2005 and 2012. Patterns of surgical outcomes were analyzed in accordance with surgical procedures. Furthermore, these patients were divided into two subgroups in respect of follow-up duration: the short-term group (less than 48 months) and the long-term group (more than 48 months) group. Occupying ratio, type of OPLL, shape of ossified lesion, cervical sagittal alignment, grade of signal intensity on MRI, and Japanese Orthopedic Association (JOA) score were examined. Surgical outcomes of ACCF went into reverse at 48-month follow-up period. In the short-term group, JOA recovery rate had no difference between ACCF and LP. In the long-term group, the ACCF recovery rate (78.5 ± 31.0) was significantly higher than the LP recovery rate (48.4 ± 54.9) (P = 0.008). In the short-term group, old age (p = 0.011), hill shape (p = 0.013), and high grade of MRI signal intensity (p = 0.040) had negative effects on recovery rate. On the other hand, in the long-term group, LP (p = 0.021) and a high grade of MR signal intensity (p = 0.017) independently and negatively affected recovery rate. Long-term surgical outcomes of ACCF became better than those of LP at more than 48-month follow-up period. High-grade MRI signal changes and the LP surgical procedure were independent negative factors for long-term surgical outcomes in patients with OPLL. Direct decompression of the spinal cord with ACCF provides better long-term stable neurologic outcomes than LP.
KeywordsLong-term outcome Prognostic factor Cervical ossification of longitudinal ligament Anterior cervical corpectomy and fusion Laminoplasty
This study was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HC15C1288).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Approval for the current study was granted by the Institutional Review Board of our institute (approval number, 4-2012-0686).
Informed consent was obtained from all individual participants included in the study.
- 1.Chiba K, Yamamoto I, Hirabayashi H, Iwasaki M, Goto H, Yonenobu K, Toyama Y (2005) Multicenter study investigating the postoperative progression of ossification of the posterior longitudinal ligament in the cervical spine: a new computer-assisted measurement. J Neurosurg Spine 3:17–23. https://doi.org/10.3171/spi.2005.3.1.0017 CrossRefGoogle Scholar
- 2.Fujimori T, Iwasaki M, Okuda S, Takenaka S, Kashii M, Kaito T, Yoshikawa H (2014) Long-term results of cervical myelopathy due to ossification of the posterior longitudinal ligament with an occupying ratio of 60% or more. Spine 39:58–67. https://doi.org/10.1097/BRS.0000000000000054 CrossRefGoogle Scholar
- 3.Fujiyoshi T, Yamazaki M, Okawa A, Kawabe J, Hayashi K, Endo T, Furuya T, Koda M, Takahashi K (2010) Static versus dynamic factors for the development of myelopathy in patients with cervical ossification of the posterior longitudinal ligament. J Clin Neurosci 17:320–324. https://doi.org/10.1016/j.jocn.2009.06.023 CrossRefGoogle Scholar
- 6.Ikenaga M, Shikata J, Tanaka C (2006) Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy. Spine (Phila Pa 1976) 31:1568–1574; discussion 1575. https://doi.org/10.1097/01.brs.0000221985.37468.0f CrossRefGoogle Scholar
- 7.Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K, Yoshikawa H (2007) Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: part 1: clinical results and limitations of laminoplasty. Spine (Phila Pa 1976) 32:647–653. https://doi.org/10.1097/01.brs.0000257560.91147.86 CrossRefGoogle Scholar
- 8.Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K, Yoshikawa H (2007) Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: part 2: advantages of anterior decompression and fusion over laminoplasty. Spine (Phila Pa 1976) 32:654–660. https://doi.org/10.1097/01.brs.0000257566.91177.cb CrossRefGoogle Scholar
- 9.Kim B, Shin HC, Kim KN, Yi S, Shin DA, Ha Y (2015) Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament. Spine J 15:875–884. https://doi.org/10.1016/j.spinee.2015.01.028 CrossRefGoogle Scholar
- 11.Kimura A, Seichi A, Hoshino Y, Yamazaki M, Mochizuki M, Aiba A, Kato T, Uchida K, Miyamoto K, Nakahara S (2012) Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament: a retrospective, multi-institutional study. J Orthop Sci 17:667–672. https://doi.org/10.1007/s00776-012-0271-3 CrossRefGoogle Scholar
- 15.Masaki Y, Yamazaki M, Okawa A, Aramomi M, Hashimoto M, Koda M, Mochizuki M, Moriya H (2007) An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament: anterior decompression with spinal fusion versus laminoplasty. J Spinal Disord Tech 20:7–13. https://doi.org/10.1097/01.bsd.0000211260.28497.35 CrossRefGoogle Scholar
- 16.Ogawa Y, Toyama Y, Chiba K, Matsumoto M, Nakamura M, Takaishi H, Hirabayashi H, Hirabayashi K (2004) Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg Spine 1:168–174. https://doi.org/10.3171/spi.2004.1.2.0168 CrossRefGoogle Scholar
- 18.Sakai K, Okawa A, Takahashi M, Arai Y, Kawabata S, Enomoto M, Kato T, Hirai T, Shinomiya K (2012) Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty. Spine 37:367–376. https://doi.org/10.1097/BRS.0b013e31821f4a51 CrossRefGoogle Scholar
- 19.Tsuyama N (1984) Ossification of the posterior longitudinal ligament of the spine. Clin Orthop Relat Res:71–84Google Scholar
- 21.Yagi M, Ninomiya K, Kihara M, Horiuchi Y (2010) Long-term surgical outcome and risk factors in patients with cervical myelopathy and a change in signal intensity of intramedullary spinal cord on magnetic resonance imaging. J Neurosurg Spine 12:59–65. https://doi.org/10.3171/2009.5.SPINE08940 CrossRefGoogle Scholar