Tags

Type your tag names separated by a space and hit enter

Removal of posterior longitudinal ligament in anterior decompression for cervical spondylotic myelopathy.
J Spinal Disord Tech. 2009 Aug; 22(6):404-7.JS

Abstract

STUDY DESIGN

The clinical and radiologic results of the patients with removed posterior longitudinal ligament (PLL) were compared with those of the patients with preserved PLL in the treatment of cervical spondylotic myelopathy (CSM).

OBJECTIVE

To investigate effect of resection of the PLL in anterior decompression for CSM.

SUMMARY OF BACKGROUND DATA

Anterior decompression has been proved to be effective in the treatment of CSM, and the pathogenic matters including herniated disc, proliferative osteophyte, and ossification of posterior longitudinal ligament should be definitely removed. However, it still remains controversial to remove degenerative or hypertrophic PLL, considering the potential risks of dura tears and neurologic injury.

METHODS

Between March 1997 and December 2002, 58 patients who underwent anterior decompression for CSM were included in this study. Among them, the PLL was removed in 31 patients (PLL removed group) and that was preserved in the other 27 patients (PLL preserved group). The clinical [Japanese Orthopedic Association (JOA) score] and radiologic (diameter of the spinal cord on magnetic resonance image) results were compared between 2 groups. The risk of complications and reoperation was also evaluated.

RESULTS

With a 12-month follow-up, the mean JOA score increased from 10.4+/-1.8 to 15.2+/-1.2 in PLL removed group and that increased from 10.7+/-1.6 to 14.6+/-1.1 in PLL preserved group. The improvement rate between 2 groups was significantly different (74%+/-23% vs. 63%+/-21%, P<0.01). Radiologic study showed that the increase of diameter of the spinal cord in PLL removed group was significantly greater than that in PLL preserved group (3.78+/-1.25 mm vs. 2.02+/-1.03 mm P<0.01). Only 1 patient with PLL removed developed cerebrospinal fluid leakage after operation, and 8 patients (5 with PLL preserved and 3 with PLL removed) need posterior revision surgery.

CONCLUSIONS

Removal of PLL was generally safe and helpful to get more decompression in anterior approach for CSM, although more technically demanding.

Authors+Show Affiliations

Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19652565

Citation

Wang, Xinwei, et al. "Removal of Posterior Longitudinal Ligament in Anterior Decompression for Cervical Spondylotic Myelopathy." Journal of Spinal Disorders & Techniques, vol. 22, no. 6, 2009, pp. 404-7.
Wang X, Chen Y, Chen D, et al. Removal of posterior longitudinal ligament in anterior decompression for cervical spondylotic myelopathy. J Spinal Disord Tech. 2009;22(6):404-7.
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. Journal of Spinal Disorders & Techniques, 22(6), 404-7. https://doi.org/10.1097/BSD.0b013e318187039f
Wang X, et al. Removal of Posterior Longitudinal Ligament in Anterior Decompression for Cervical Spondylotic Myelopathy. J Spinal Disord Tech. 2009;22(6):404-7. PubMed PMID: 19652565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Removal of posterior longitudinal ligament in anterior decompression for cervical spondylotic myelopathy. AU - Wang,Xinwei, AU - Chen,Yu, AU - Chen,Deyu, AU - Yuan,Wen, AU - Zhao,Jie, AU - Jia,Lianshun, AU - Zhao,Dinglin, PY - 2009/8/5/entrez PY - 2009/8/5/pubmed PY - 2009/11/17/medline SP - 404 EP - 7 JF - Journal of spinal disorders & techniques JO - J Spinal Disord Tech VL - 22 IS - 6 N2 - STUDY DESIGN: The clinical and radiologic results of the patients with removed posterior longitudinal ligament (PLL) were compared with those of the patients with preserved PLL in the treatment of cervical spondylotic myelopathy (CSM). OBJECTIVE: To investigate effect of resection of the PLL in anterior decompression for CSM. SUMMARY OF BACKGROUND DATA: Anterior decompression has been proved to be effective in the treatment of CSM, and the pathogenic matters including herniated disc, proliferative osteophyte, and ossification of posterior longitudinal ligament should be definitely removed. However, it still remains controversial to remove degenerative or hypertrophic PLL, considering the potential risks of dura tears and neurologic injury. METHODS: Between March 1997 and December 2002, 58 patients who underwent anterior decompression for CSM were included in this study. Among them, the PLL was removed in 31 patients (PLL removed group) and that was preserved in the other 27 patients (PLL preserved group). The clinical [Japanese Orthopedic Association (JOA) score] and radiologic (diameter of the spinal cord on magnetic resonance image) results were compared between 2 groups. The risk of complications and reoperation was also evaluated. RESULTS: With a 12-month follow-up, the mean JOA score increased from 10.4+/-1.8 to 15.2+/-1.2 in PLL removed group and that increased from 10.7+/-1.6 to 14.6+/-1.1 in PLL preserved group. The improvement rate between 2 groups was significantly different (74%+/-23% vs. 63%+/-21%, P<0.01). Radiologic study showed that the increase of diameter of the spinal cord in PLL removed group was significantly greater than that in PLL preserved group (3.78+/-1.25 mm vs. 2.02+/-1.03 mm P<0.01). Only 1 patient with PLL removed developed cerebrospinal fluid leakage after operation, and 8 patients (5 with PLL preserved and 3 with PLL removed) need posterior revision surgery. CONCLUSIONS: Removal of PLL was generally safe and helpful to get more decompression in anterior approach for CSM, although more technically demanding. SN - 1539-2465 UR - https://www.unboundmedicine.com/medline/citation/19652565/Removal_of_posterior_longitudinal_ligament_in_anterior_decompression_for_cervical_spondylotic_myelopathy_ L2 - http://dx.doi.org/10.1097/BSD.0b013e318187039f DB - PRIME DP - Unbound Medicine ER -