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Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment?
Clin Spine Surg. 2016 Feb; 29(1):E9-15.CS

Abstract

STUDY DESIGN

Intervention comparison study.

OBJECTIVE

To assess postoperative cervical lordosis, clinical outcome, and progression of ossification of the posterior longitudinal ligament (OPLL) in patient of cervical spondylotic myelopathy (CSM) by the OPLL.

SUMMARY OF BACKGROUND DATA

The posterior approach is usually used for multilevel (≥3) CSM and is decided based on cervical lordosis and instability. OPLL, 1 cause of CSM, makes decreased neck motion and is progressed by neck motion. In OPLL patients, it may be asked whether motion-preserving surgery is still helpful.

MATERIALS AND METHODS

We reviewed 57 patients of CSM by OPLL who underwent 3 posterior surgeries, laminoplasty, laminectomy alone (LA), and laminectomy with fusion (LF), and followed up minimum 24 months. Postoperative cervical sagittal balance was measured using by the C2-C7 sagittal vertical axis (SVA), cervical curvature index, and C2-C7 Cobb angle. The clinical outcome was analyzed by the neck disability index and the visual analog scale for axial pain. OPLL progression was measured by length and depth growth. A linear mixed model was used to evaluate the differences between each time point and baseline score.

RESULTS

Cervical lordosis, C2-C7 Cobb angle, and cervical curvature index decreased gradually in all patients. SVA was maintained in the LF group only and increased in the others (P=0.01). Clinical outcomes, neck disability index, and visual analogue scale were evenly improved in all groups. In patients showing SVA≥40 mm at baseline, neck pain increased in the laminoplasty group but was stationary in the LF group. Progression of OPLL was observed more frequent in the LA group than in the LF group.

CONCLUSIONS

Posterior surgeries resulted in clinical improvements although with loss of cervical lordosis in CSM with OPLL patients. OPLL may worsen more frequently after LA. LF and laminoplasty are preferable techniques in this condition, with the former better for patients with high baseline SVA distances.

Authors+Show Affiliations

*Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam†Department of neurosurgery, Konyang University Hospital, Daejeon, Republic of Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25075990

Citation

Lee, Chang-Hyun, et al. "Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment?" Clinical Spine Surgery, vol. 29, no. 1, 2016, pp. E9-15.
Lee CH, Jahng TA, Hyun SJ, et al. Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment? Clin Spine Surg. 2016;29(1):E9-15.
Lee, C. H., Jahng, T. A., Hyun, S. J., Kim, K. J., & Kim, H. J. (2016). Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment? Clinical Spine Surgery, 29(1), E9-15. https://doi.org/10.1097/BSD.0000000000000058
Lee CH, et al. Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment. Clin Spine Surg. 2016;29(1):E9-15. PubMed PMID: 25075990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment? AU - Lee,Chang-Hyun, AU - Jahng,Tae-Ahn, AU - Hyun,Seung-Jae, AU - Kim,Ki-Jeong, AU - Kim,Hyun-Jib, PY - 2014/7/31/entrez PY - 2014/7/31/pubmed PY - 2016/10/25/medline SP - E9 EP - 15 JF - Clinical spine surgery JO - Clin Spine Surg VL - 29 IS - 1 N2 - STUDY DESIGN: Intervention comparison study. OBJECTIVE: To assess postoperative cervical lordosis, clinical outcome, and progression of ossification of the posterior longitudinal ligament (OPLL) in patient of cervical spondylotic myelopathy (CSM) by the OPLL. SUMMARY OF BACKGROUND DATA: The posterior approach is usually used for multilevel (≥3) CSM and is decided based on cervical lordosis and instability. OPLL, 1 cause of CSM, makes decreased neck motion and is progressed by neck motion. In OPLL patients, it may be asked whether motion-preserving surgery is still helpful. MATERIALS AND METHODS: We reviewed 57 patients of CSM by OPLL who underwent 3 posterior surgeries, laminoplasty, laminectomy alone (LA), and laminectomy with fusion (LF), and followed up minimum 24 months. Postoperative cervical sagittal balance was measured using by the C2-C7 sagittal vertical axis (SVA), cervical curvature index, and C2-C7 Cobb angle. The clinical outcome was analyzed by the neck disability index and the visual analog scale for axial pain. OPLL progression was measured by length and depth growth. A linear mixed model was used to evaluate the differences between each time point and baseline score. RESULTS: Cervical lordosis, C2-C7 Cobb angle, and cervical curvature index decreased gradually in all patients. SVA was maintained in the LF group only and increased in the others (P=0.01). Clinical outcomes, neck disability index, and visual analogue scale were evenly improved in all groups. In patients showing SVA≥40 mm at baseline, neck pain increased in the laminoplasty group but was stationary in the LF group. Progression of OPLL was observed more frequent in the LA group than in the LF group. CONCLUSIONS: Posterior surgeries resulted in clinical improvements although with loss of cervical lordosis in CSM with OPLL patients. OPLL may worsen more frequently after LA. LF and laminoplasty are preferable techniques in this condition, with the former better for patients with high baseline SVA distances. SN - 2380-0194 UR - https://www.unboundmedicine.com/medline/citation/25075990/Expansive_Laminoplasty_Versus_Laminectomy_Alone_Versus_Laminectomy_and_Fusion_for_Cervical_Ossification_of_the_Posterior_Longitudinal_Ligament:_Is_There_a_Difference_in_the_Clinical_Outcome_and_Sagittal_Alignment L2 - https://doi.org/10.1097/BSD.0000000000000058 DB - PRIME DP - Unbound Medicine ER -