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Posterior Decompression and Fusion for Cervical OPLL: Indication and Technique

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Abstract

Surgical indication of posterior decompression and fusion (PDF) for cervical OPLL in mainly based on K-line, which is defined as that which connects the midpoints of the spinal canal at C2 and C7 in a plain lateral radiogram of the cervical spine. We defined K-line (+) as cases where the peak of ossification foci does not exceed the K-line and K-line (−) as cases where the peak of ossification foci exceeds the K-line. Previous reports revealed that laminoplasty produces a poor outcome in K-line (−) OPLL. One of the surgical options is PDF.

Generally, fixation from C2 to C7 or T1 is applied because the C2 pedicle screw is the most reliable anchor in the cervical spine, and the C7 and/or T1 pedicle screw can be inserted without risk of vertebral artery violation. A lateral mass screw is generally used as a mid-cervical fixation anchor.

PDF surgery is an option for cervical OPLL. PDF might improve the clinical outcome of OPLL patients with K-line (−).

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References

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

    Article  PubMed  Google Scholar 

  2. Matsumoto M, Chiba K, Toyama Y. Surgical treatment of ossification of the posterior longitudinal ligament and its outcomes: posterior surgery by laminoplasty. Spine (Phila Pa 1976). 2012;37:E303–8.

    Article  Google Scholar 

  3. Ogawa Y, Toyama Y, Chiba K, et al. Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg Spine. 2004;1:168–74.

    Article  Google Scholar 

  4. Mizuno J, Nakagawa H. Ossified posterior longitudinal ligament: management strategies and outcomes. Spine J. 2006;6(Suppl):282S–8S.

    Article  Google Scholar 

  5. An HS, Al-Shihabi L, Kurd M. Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine. J Am Acad Orthop Surg. 2014;22:420–9.

    Article  Google Scholar 

  6. Sodeyama T, Goto S, Mochizuki M, et al. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976). 1999;24:1527–31.

    Article  CAS  Google Scholar 

  7. Aita I, Hayashi K, Wadano Y, Yabuki T. Posterior movement and enlargement of the spinal cord after cervical laminoplasty. J Bone Joint Surg Br. 1998;80:33–7.

    Article  CAS  Google Scholar 

  8. Iwasaki M, Okuda S, Miyauchi A, et al. 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). 2007;32:647–53.

    Article  Google Scholar 

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

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  11. Fujiyoshi T, Yamazaki M, Kawabe J, et al. 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). 2008;33:E990–3.

    Article  Google Scholar 

  12. 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. 2013;22:1480–8.

    Article  Google Scholar 

  13. Yoshii T, Egawa S, Hirai T, Kaito T, Mori K, Koda M, Chikuda H, Hasegawa T, Imagama S, Yoshida M, Iwasaki M, Okawa A, Kawaguchi Y. A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical ossification of the posterior longitudinal ligament. J Orthop Sci. 2020;25(1):58–65. https://doi.org/10.1016/j.jos.2019.03.004.

    Article  PubMed  Google Scholar 

  14. Li H, Dai LY. A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament. Spine J. 2011;11:1049–57.

    Article  Google Scholar 

  15. Masaki Y, Yamazaki M, Okawa A, et al. 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. 2007;20:7–13.

    Article  Google Scholar 

  16. Azuma Y, Kato Y, Taguchi T. 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. 2010;23:166–9.

    Article  Google Scholar 

  17. Nishida N, Kanchiku T, Kato Y, et al. Cervical ossification of the posterior longitudinal ligament: biomechanical analysis of the influence of static and dynamic factors. J Spinal Cord Med. 2015;38(5):593–8.

    Article  Google Scholar 

  18. Maruo K, Moriyama T, Tachibana T, et al. 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. 2014;21:938–43.

    Article  Google Scholar 

  19. Saito J, Maki S, Kamiya K, Furuya T, Inada T, Ota M, Iijima Y, Takahashi K, Yamazaki M, Aramomi M, Mannoji C, Koda M. Outcome of posterior decompression with instrumented fusion surgery for K-line (−) cervical ossification of the longitudinal ligament. J Clin Neurosci. 2016;32:57–60.

    Article  Google Scholar 

  20. Koda M, Mochizuki M, Konishi H, Aiba A, Kadota R, Inada T, Kamiya K, Ota M, Maki S, Takahashi K, Yamazaki M, Mannoji C, Furuya T. 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. 2016;25:2294–301.

    Article  Google Scholar 

  21. Yoshii T, Sakai K, Hirai T, Yamada T, Inose H, Kato T, Enomoto M, Tomizawa S, Kawabata S, Arai Y, Okawa A. Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a ≥50% canal occupying ratio: a multicenter retrospective study. Spine J. 2016;16:1351–7.

    Article  Google Scholar 

  22. Koda M, Furuya T, Saito J, Ijima Y, Kitamura M, Ohtori S, Orita S, Inage K, Abe T, Noguchi H, Funayama T, Kumagai H, Miura K, Nagashima K, Yamazaki M. Postoperative K-line conversion from negative to positive is independently associated with a better surgical outcome after posterior decompression with instrumented fusion for K-line negative cervical ossification of the posterior ligament. Eur Spine J. 2018;27:1393–400.

    Article  Google Scholar 

  23. Kurakawa T, Miyamoto H, Kaneyama S, Sumi M, Uno K. C5 nerve palsy after posterior reconstruction surgery: predictive risk factors of the incidence and critical range of correction for kyphosis. Eur Spine J. 2016;25:2060–7.

    Article  Google Scholar 

  24. Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, Lafage V, Shaffrey CI, Schwab F, Ames CP, ISSG. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2012;71:662–9.

    Article  Google Scholar 

  25. Inada T, Furuya T, Ota M, Maki S, Ijima Y, Saito J, Kitamura M, Ohtori S, Orita S, Inage K, Yamazaki M, Koda M. Addition of instrumented fusion to laminoplasty cannot suppress postoperative sagittal balance exacerbation. J Clin Neurosci. 2017;45:214–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan

    Masao Koda, Tetsuya Abe, Toru Funayama, Hiroshi Takahashi, Hiroshi Noguchi, Kousei Miura, Katsuya Nagashima, Yosuke Shibao & Masashi Yamazaki

  2. Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Takeo Furuya

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  1. Masao Koda
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Editors and Affiliations

  1. Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Atsushi Okawa

  2. Department of Orthopaedic Surgery, Keio University, Shinjyuku-ku, Tokyo, Japan

    Morio Matsumoto

  3. Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan

    Motoki Iwasaki

  4. Department of Orthopaedic Surgery, Toyama University Hospital, Sugitani, Toyama, Japan

    Yoshiharu Kawaguchi

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Koda, M. et al. (2020). Posterior Decompression and Fusion for Cervical OPLL: Indication and Technique. In: Okawa, A., Matsumoto, M., Iwasaki, M., Kawaguchi, Y. (eds) OPLL. Springer, Singapore. https://doi.org/10.1007/978-981-15-3855-1_25

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  • DOI: https://doi.org/10.1007/978-981-15-3855-1_25

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-3854-4

  • Online ISBN: 978-981-15-3855-1

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