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Long-term outcome of laminectomy and instrumented fusion for cervical ossification of the posterior longitudinal ligament

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Abstract

Between January 2000 and December 2003, a total of 83 patients (64 men and 19 women, average age: 56.4 years, range: 42–78 years) who underwent posterior laminectomy and instrumented fusion for ossification of the posterior longitudinal ligament (OPLL) were included in this study to investigate the long-term outcome of this surgical option and clarify which factors affect the prognosis. After an average 4.8-year follow-up, the mean Japanese Orthopaedic Association (JOA) score significantly increased from 9.2 ± 1.3 points before operation to 14.2 ±  0.9 points at the latest follow-up (P < 0.01). The improvement rate (IR) of neurological function ranged from 11.1 to 87.5%, with a mean of 62.4 ± 13.2%. Among 83 patients, 59 (71.1%) patients had a good prognosis (IR ≥ 50%), and the other 24 (28.9%) patients had a poor prognosis (IR < 50%). Postoperative nerve root palsy was the main complication in this series. Radiographic study showed that whilst improving cervical lordosis could provide a better decompression effect and good prognosis, it could have simultaneously contributed to the high incidence of postoperative nerve root palsy.

Résumé

Entre janvier 2000 et décembre 2003, 83 patients (64 hommes et 19 femmes) dont la moyenne d’âge était de 56,4 ans (42 – 78) ont bénéficié d’une laminectomie supérieure avec instrumentation et greffe pour une opération visant une OPLL avec évaluation du pronostic à long terme et détermination des facteurs pouvant le modifier. Après un suivi de 4 à 8 ans, le score de la JOA a été nettement amélioré passant de 9,2 (± 1,3) avant l’opération à 14,2 (± 0,9), au dernier suivi (p < 0,01). Le taux d’amélioration neurologique (IR) est passé de 11,1% à 87,5% avec une moyenne de 62,4% ± 13,2%. Parmi ces 83 patients, 59 (71,1%) avaient un bon pronostic (IR 50%) et les autres, 24 (28,9%) avaient un mauvais pronostic (IR < 50%). La paralysie des fibres nerveuses est la complication la plus importante dans cette série. L’étude radiographique montre que l’amélioration de la lordose cervicale permet un effet de décompression plus important et un meilleur pronostic mais a contribué de façon simultanée à un taux important de paralysie des racines nerveuses en post-opérartoire.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China

    Yu Chen, Yongfei Guo, Deyu Chen, Xinwei Wang, Xuhua Lu & Wen Yuan

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  1. Yu Chen
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  2. Yongfei Guo
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  3. Deyu Chen
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  4. Xinwei Wang
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  5. Xuhua Lu
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  6. Wen Yuan
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Correspondence to Deyu Chen.

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Chen, Y., Guo, Y., Chen, D. et al. Long-term outcome of laminectomy and instrumented fusion for cervical ossification of the posterior longitudinal ligament. International Orthopaedics (SICOT) 33, 1075–1080 (2009). https://doi.org/10.1007/s00264-008-0609-9

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  • DOI: https://doi.org/10.1007/s00264-008-0609-9

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