Skip to main content
SpringerLink
Log in

Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (–) cervical ossification of the posterior longitudinal ligament

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The K-line, which is a virtual line that connects the midpoints of the anteroposterior diameter of the spinal canal at C2 and C7 in a plain lateral radiogram, is a useful preoperative predictive indicator for sufficient decompression by laminoplasty (LMP) for ossification of the posterior longitudinal ligament (OPLL). K-line is defined as (+) when the peak of OPLL does not exceed the K-line, and is defined as (–) when the peak of OPLL exceeds the K-line. For patients with K-line (–) OPLL, LMP often results in poor outcome. The aim of the present study was to compare the clinical outcome of LMP, posterior decompression with instrumented fusion (PDF) and anterior decompression and fusion (ADF) for patients with K-line (–) OPLL.

Methods

The present study included patients who underwent surgical treatment including LMP, PDF and ADF for K-line (–) cervical OPLL. We retrospectively compared the clinical outcome of those patients in terms of Japanese Orthopedic Association score (JOA score) recovery rate.

Results

JOA score recovery rate was significantly higher in the ADF group compared with that in the LMP group and the PDF group. The JOA score recovery rate in the PDF group was significantly higher than that in the LMP group.

Conclusions

LMP should not be used for K-line (–) cervical OPLL. ADF is one of the suitable surgical treatments for K-line (–) OPLL. Both ADF and PDF are applicable for K-line (–) OPLL according to indications set by each institute and surgical decisions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Smith ZA, Buchanan CC, Raphael D et al (2011) Ossification of the posterior longitudinal ligament: pathogenesis, management, and current surgical approaches. a review. Neurosurg Focus 30:E10. doi:10.3171/2011.1.FOCUS10256

    Article  PubMed  Google Scholar 

  2. Matsumoto M, Chiba K, Toyama Y (2012) Surgical treatment of ossification of the posterior longitudinal ligament and its outcomes: posterior surgery by laminoplasty. Spine (Phila Pa 1976) 37:E303–E308

    Article  Google Scholar 

  3. Ogawa Y, Toyama Y, Chiba K et al (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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. An HS, Al-Shihabi L, Kurd M (2014) Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine. J Am Acad Orthop Surg 22:420–429

    Article  PubMed  Google Scholar 

  6. Sodeyama T, Goto S, Mochizuki M et al (1999) Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976) 24:1527–1531

    Article  CAS  Google Scholar 

  7. Iwasaki M, Okuda S, Miyauchi A et al (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

    Article  Google Scholar 

  8. Ogawa Y (2009) Updates on ossification of posterior longitudinal ligament. Clinical results and problems of posterior decompression for OPLL of the cervical spine. Clin Calcium 19:1493–1498 (In Japanese)

    PubMed  Google Scholar 

  9. Nishida N, Kanchiku T, Kato Y et al (2014) Biomechanical analysis of cervical myelopathy due to ossification of the posterior longitudinal ligament: effects of posterior decompression and kyphosis following decompression. Exp Ther Med 7:1095–1099

    PubMed  PubMed Central  Google Scholar 

  10. Liu H, Li Y, Chen Y et al (2013) 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

    Article  PubMed  PubMed Central  Google Scholar 

  11. Li H, Dai LY (2011) A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament. Spine J 11:1049–1057

    Article  PubMed  Google Scholar 

  12. Fujiyoshi T, Yamazaki M, Kawabe J et al (2008) A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line. Spine (Phila Pa 1976) 33:E990–E993

    Article  Google Scholar 

  13. Masaki Y, Yamazaki M, Okawa A et al (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

    Article  PubMed  Google Scholar 

  14. Azuma Y, Kato Y, Taguchi T (2010) Etiology of cervical myelopathy induced by ossification of the posterior longitudinal ligament: determining the responsible level of OPLL myelopathy by correlating static compression and dynamic factors. J Spinal Disord Tech 23:166–169

    Article  PubMed  Google Scholar 

  15. Nishida N, Kanchiku T, Kato Y, et al (2014) Cervical ossification of the posterior longitudinal ligament: Biomechanical analysis of the influence of static and dynamic factors. J Spinal Cord Med [Epub ahead of print]

  16. Maruo K, Moriyama T, Tachibana T et al (2014) The impact of dynamic factors on surgical outcomes after double-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg Spine 21:938–943

    Article  PubMed  Google Scholar 

  17. Fujiyoshi T, Yamazaki M, Okawa A et al (2011) Outcome of posterior decompression surgery for cervical OPLL patients of the K-line (-) group: laminoplasty versus posterior decompression with instrumented fusion. J Spine Res 2:231–235

    Google Scholar 

  18. Hirabayashi K, Toyama Y (1997) Choice of surgical procedure for cervical ossification of the posterior longitudinal ligaments. In: Yonenobu K, Sakou T, Ono K (eds) Ossification of the posterior longitudinal ligament. Springer-Verlag, Tokyo p 135–42

  19. Japanese Orthopaedic Association (1994) Scoring system for cervical myelopathy. Nippon Seikeigeka Gakkai Zasshi 68:490–503 (in Japanese)

    Google Scholar 

  20. Fujimori T, Iwasaki M, Okuda S et al (2014) Long-term results of cervical myelopathy due to ossification of the posterior longitudinal ligament with an occupying ratio of 60% or more. Spine (Phila Pa 1976) 39:58–67

  21. Kim B, Yoon do H, Shin HC et al (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

    Article  PubMed  Google Scholar 

  22. Sakai K, Okawa A, Takahashi M et al (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 (Phila Pa 1976) 37:367–376

  23. Mochizuki M, Aiba A, Hashimoto M et al (2009) Cervical myelopathy in patients with ossification of the posterior longitudinal ligament. J Neurosurg Spine 10:122–128

    Article  PubMed  Google Scholar 

  24. Chen Y, Yang L, Liu Y et al (2014) Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament. PLoS One 9:e102008. doi:10.1371/journal.pone.0102008

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kimura A, Seichi A, Hoshino Y et al (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

    Article  PubMed  Google Scholar 

  26. Yang H, Yang L, Chen D, Wang X, Lu X, Yuan W (2015) Implications of different patterns of “double-layer sign” in cervical ossification of the posterior longitudinal ligament. Eur Spine J 24:1631–1639

    Article  PubMed  Google Scholar 

  27. Yang H, Lu X, Wang X et al (2015) A new method to determine whether ossified posterior longitudinal ligament can be resected completely and safely: spinal canal “Rule of Nine” on axial computed tomography. Eur Spine J 24:1673–1680

    Article  PubMed  Google Scholar 

  28. Goel A, Nadkarni T, Shah A, Rai S, Rangarajan V, Kulkarni A (2015) Is Only Stabilization the Ideal Treatment for Ossified Posterior Longitudinal Ligament? Report of Early Results with a Preliminary Experience in 14 Patients. World Neurosurg 84:813–819

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 2608670, Japan

    Masao Koda, Taigo Inada, Koshiro Kamiya, Mitsutoshi Ota, Satoshi Maki, Kazuhisa Takahashi & Takeo Furuya

  2. Department of Orthopedic Surgery, Numazu City Hospital, Numazu, Japan

    Makondo Mochizuki, Atsuomi Aiba & Ryo Kadota

  3. Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan

    Hiroaki Konishi

  4. Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan

    Masashi Yamazaki

  5. Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan

    Chikato Mannoji

Authors
  1. Masao Koda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Makondo Mochizuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroaki Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atsuomi Aiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryo Kadota
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Taigo Inada
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koshiro Kamiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mitsutoshi Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Satoshi Maki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kazuhisa Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masashi Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Chikato Mannoji
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Takeo Furuya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masao Koda.

Ethics declarations

Conflict of interest

The authors have no conflict of interest about the present manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koda, M., Mochizuki, M., Konishi, H. et al. Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (–) cervical ossification of the posterior longitudinal ligament. Eur Spine J 25, 2294–2301 (2016). https://doi.org/10.1007/s00586-016-4555-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4555-8

Keywords

Search

Navigation