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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

European Spine Journal volume 22, pages 1480–1488 (2013)Cite this article

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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References

  1. Kalb S, Martirosyan NL, Perez-Orribo L, Kalani MY, Theodore N (2011) Analysis of demographics, risk factors, clinical presentation, and surgical treatment modalities for the ossified posterior longitudinal ligament. Neurosurg Focus 30(3):E11

    PubMed  Article  Google Scholar 

  2. Smith ZA, Buchanan CC, Raphael D, Khoo LT (2011) Ossification of the posterior longitudinal ligament: pathogenesis, management, and current surgical approaches. A review. Neurosurg Focus 30(3):E10

    PubMed  Article  Google Scholar 

  3. Matsunaga S, Sakou T, Arishima Y, Koga H, Hayashi K, Komiya S (2001) Quality of life in elderly patients with ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 26(5):494–498

    Article  CAS  Google Scholar 

  4. Belanger TA, Roh JS, Hanks SE, Kang JD, Emery SE, Bohlman HH (2005) Ossification of the posterior longitudinal ligament. Results of anterior cervical decompression and arthrodesis in sixty-one North American patients. J Bone Joint Surg Am 87(3):610–615

    PubMed  Article  Google Scholar 

  5. Sugrue PA, McClendon J Jr, Halpin RJ, Liu JC, Koski TR, Ganju A (2011) Surgical management of cervical ossification of the posterior longitudinal ligament: natural history and the role of surgical decompression and stabilization. Neurosurg Focus 30(3):E3

    PubMed  Article  Google Scholar 

  6. Xu J, Zhang K, Ma X, Yin Q, Wu Z, Xia H, Wang Z (2011) Systematic review of cohort studies comparing surgical treatment for multilevel ossification of posterior longitudinal ligament: anterior vs posterior approach. Orthopedics 34(8):e397–e402

    PubMed  Google Scholar 

  7. Twisk JWR (2003) Applied longitudinal data analysis for epidemiology: a practical guide. Cambridge University Press, Cambridge

    Google Scholar 

  8. Chen Y, Guo Y, Chen D, Lu X, Wang X, Tian H, Yuan W (2009) Diagnosis and surgery of ossification of posterior longitudinal ligament associated with dural ossification in the cervical spine. Eur Spine J 18(10):1541–1547

    PubMed  Article  Google Scholar 

  9. Chen Y, Guo Y, Lu X, Chen D, Song D, Shi J, Yuan W (2011) Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine. J Spinal Disord Tech 24(1):24–30

    PubMed  Article  CAS  Google Scholar 

  10. Tani S (2009) Diagnosis and management of ossification of the posterior longitudinal ligament of the cervical spine. Brain Nerve 61(11):1343–1350

    PubMed  Google Scholar 

  11. Sakai K, Okawa A, Takahashi M, Arai Y, Kawabata S, Enomoto M, Kato T, Hirai T, Shinomiya K (2012) 5-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

    PubMed  Article  Google Scholar 

  12. Yang HS, Chen DY, Lu XH, Yang LL, Yan WJ, Yuan W, Chen Y (2010) Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia. Eur Spine J 19(3):494–501

    PubMed  Article  Google Scholar 

  13. Chiba K, Kato Y, Tsuzuki N, Nagata K, Toyama Y, Iwasaki M, Yonenobu K (2005) Computer-assisted measurement of the size of ossification in patients with ossification of the posterior longitudinal ligament in the cervical spine. J Orthop Sci 10(5):451–456

    PubMed  Article  Google Scholar 

  14. Mizuno J, Nakagawa H (2006) Ossified posterior longitudinal ligament: management strategies and outcomes. Spine J 6(6 Suppl):282S–288S

    PubMed  Article  Google Scholar 

  15. Mochizuki M, Aiba A, Hashimoto M, Fujiyoshi T, Yamazaki M (2009) Cervical myelopathy in patients with ossification of the posterior longitudinal ligament. J Neurosurg Spine 10(2):122–128

    PubMed  Article  Google Scholar 

  16. Wang X, Chen Y, Chen D, Yuan W, Zhao J, Jia L, Zhao D (2009) Removal of posterior longitudinal ligament in anterior decompression for cervical spondylotic myelopathy. J Spinal Disord Tech 22(6):404–407

    PubMed  Article  Google Scholar 

  17. 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(2):168–174

    PubMed  Article  Google Scholar 

  18. 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 32(6):654–660

    PubMed  Article  Google Scholar 

  19. Tani T, Ushida T, Ishida K, Iai H, Noguchi T, Yamamoto H (2002) Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament. Spine (Phila Pa 1976) 27(22):2491–2498

    Article  Google Scholar 

  20. Saetia K, Cho D, Lee S, Kim DH, Kim SD (2011) Ossification of the posterior longitudinal ligament: a review. Neurosurg Focus 30(3):E1

    PubMed  Article  Google Scholar 

  21. Shin JH, Steinmetz MP, Benzel EC, Krishnaney AA (2011) Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament: considerations for approach selection and review of surgical outcomes. Neurosurg Focus 30(3):E8

    PubMed  Article  Google Scholar 

  22. Matsuda Y, Miyazaki K, Tada K, Yasuda A, Nakayama T, Murakami H, Matsuo M (1991) Increased MR signal intensity due to cervical myelopathy. Analysis of 29 surgical cases. J Neurosurg 74(6):887–892

    PubMed  Article  CAS  Google Scholar 

  23. Hee HT, Majd ME, Holt RT, Whitecloud TS 3rd, Pienkowski D (2003) Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord Tech 16(1):1–8 (discussion 8–9)

    PubMed  Article  Google Scholar 

  24. Matz PG, Pritchard PR, Hadley MN (2007) Anterior cervical approach for the treatment of cervical myelopathy. Neurosurgery 60(1 Suppl 1):S64–S70

    PubMed  Google Scholar 

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Conflict of interest

The authors declare no conflict of interest.

Author information

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

Keywords

  • Ossification
  • Posterior longitudinal ligament
  • Occupying ratio
  • Cervical curvature
  • Anterior surgery
  • Posterior surgery