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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 Dec; 21(6):938-43.JN

Abstract

OBJECT

Laminoplasty is the preferred operation for most patients with cervical myelopathy due to multilevel ossification of the posterior longitudinal ligament (OPLL). Recent studies have demonstrated several significant risk factors for poor clinical outcomes after laminoplasty, including older age, lower preoperative Japanese Orthopaedic Association (JOA) score, postoperative change in cervical alignment, cervical kyphosis, and high occupying ratio of the OPLL (that is, the ratio of the greatest anteroposterior thickness of the OPLL to the anteroposterior diameter of the spinal canal at the same level on a lateral image). However, the impact of dynamic factors on clinical outcomes is unclear. The purpose of this study is to assess the impact of dynamic factors on the clinical outcome after laminoplasty for cervical myelopathy due to OPLL.

METHODS

A consecutive series of patients who underwent laminoplasty for cervical myelopathy due to OPLL between 2003 and 2009 was retrospectively reviewed. The indication for laminoplasty at the authors' hospital included preoperative straight or lordotic alignment of the cervical spine and an occupying ratio of OPLL less than 60%. The JOA score and recovery rate were used to evaluate clinical outcomes. A poor clinical outcome was defined as a recovery rate of less than 50%. Patient factors examined along with outcome included age, preoperative JOA score, preoperative somatosensory evoked potentials, preoperative motor evoked potentials, body mass index, and presence of high intensity on MRI. Radiographic measures included the preoperative C2-7 lordotic angle, preoperative C2-7 range of motion (ROM), preoperative segmental ROM at the level of myelopathy, and the occupying ratio of OPLL.

RESULTS

There were 45 patients (33 males and 12 females). The mean follow-up period was 4 years (range 2-6.8 years). The mean patient age was 66.9 years (range 50-85 years). The mean JOA score significantly increased from 9.1 before surgery to 13.1 at the final follow-up. The mean recovery rate was 51.2%. Nineteen patients (42%) had a recovery rate of less than 50%. Patient factors were not associated with surgical outcomes. Only the preoperative C2-7 ROM was significantly greater in the poor surgical outcome group (23.1° vs 14.1°). Receiver operating characteristic curve analysis showed that the optimal preoperative C2-7 ROM cutoff was 20°. Logistic regression analysis revealed that patients with a preoperative C2-7 ROM of greater than 20° had a 4.6 times higher risk (p = 0.021) of a poor clinical outcome, indicating that dynamic factors may have an impact on the surgical outcome of laminoplasty.

CONCLUSIONS

Fusion surgery may be a useful strategy in patients with preoperative hypermobility of the cervical spine.

Authors+Show Affiliations

Departments of 1 Orthopaedic Surgery and.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

25279653

Citation

Maruo, Keishi, 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." Journal of Neurosurgery. Spine, vol. 21, no. 6, 2014, pp. 938-43.
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(6):938-43.
Maruo, K., Moriyama, T., Tachibana, T., Inoue, S., Arizumi, F., Daimon, T., & Yoshiya, S. (2014). The impact of dynamic factors on surgical outcomes after double-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. Journal of Neurosurgery. Spine, 21(6), 938-43. https://doi.org/10.3171/2014.8.SPINE131197
Maruo K, 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(6):938-43. PubMed PMID: 25279653.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of dynamic factors on surgical outcomes after double-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. AU - Maruo,Keishi, AU - Moriyama,Tokuhide, AU - Tachibana,Toshiya, AU - Inoue,Shinichi, AU - Arizumi,Fumihiro, AU - Daimon,Takashi, AU - Yoshiya,Shinichi, Y1 - 2014/10/03/ PY - 2014/10/4/entrez PY - 2014/10/4/pubmed PY - 2015/2/5/medline KW - BMI = body mass index KW - C2–7 range of motion KW - JOA = Japanese Orthopaedic Association KW - MEP = motor evoked potential KW - OPLL = ossification of the posterior longitudinal ligament KW - ROC = receiver operating characteristic KW - ROM = range of motion KW - SSEP = somatosensory evoked potential KW - cervical spine KW - dynamic factors KW - laminoplasty KW - ossification of the posterior longitudinal ligament KW - surgical outcomes SP - 938 EP - 43 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 21 IS - 6 N2 - OBJECT: Laminoplasty is the preferred operation for most patients with cervical myelopathy due to multilevel ossification of the posterior longitudinal ligament (OPLL). Recent studies have demonstrated several significant risk factors for poor clinical outcomes after laminoplasty, including older age, lower preoperative Japanese Orthopaedic Association (JOA) score, postoperative change in cervical alignment, cervical kyphosis, and high occupying ratio of the OPLL (that is, the ratio of the greatest anteroposterior thickness of the OPLL to the anteroposterior diameter of the spinal canal at the same level on a lateral image). However, the impact of dynamic factors on clinical outcomes is unclear. The purpose of this study is to assess the impact of dynamic factors on the clinical outcome after laminoplasty for cervical myelopathy due to OPLL. METHODS: A consecutive series of patients who underwent laminoplasty for cervical myelopathy due to OPLL between 2003 and 2009 was retrospectively reviewed. The indication for laminoplasty at the authors' hospital included preoperative straight or lordotic alignment of the cervical spine and an occupying ratio of OPLL less than 60%. The JOA score and recovery rate were used to evaluate clinical outcomes. A poor clinical outcome was defined as a recovery rate of less than 50%. Patient factors examined along with outcome included age, preoperative JOA score, preoperative somatosensory evoked potentials, preoperative motor evoked potentials, body mass index, and presence of high intensity on MRI. Radiographic measures included the preoperative C2-7 lordotic angle, preoperative C2-7 range of motion (ROM), preoperative segmental ROM at the level of myelopathy, and the occupying ratio of OPLL. RESULTS: There were 45 patients (33 males and 12 females). The mean follow-up period was 4 years (range 2-6.8 years). The mean patient age was 66.9 years (range 50-85 years). The mean JOA score significantly increased from 9.1 before surgery to 13.1 at the final follow-up. The mean recovery rate was 51.2%. Nineteen patients (42%) had a recovery rate of less than 50%. Patient factors were not associated with surgical outcomes. Only the preoperative C2-7 ROM was significantly greater in the poor surgical outcome group (23.1° vs 14.1°). Receiver operating characteristic curve analysis showed that the optimal preoperative C2-7 ROM cutoff was 20°. Logistic regression analysis revealed that patients with a preoperative C2-7 ROM of greater than 20° had a 4.6 times higher risk (p = 0.021) of a poor clinical outcome, indicating that dynamic factors may have an impact on the surgical outcome of laminoplasty. CONCLUSIONS: Fusion surgery may be a useful strategy in patients with preoperative hypermobility of the cervical spine. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/25279653/The_impact_of_dynamic_factors_on_surgical_outcomes_after_double_door_laminoplasty_for_ossification_of_the_posterior_longitudinal_ligament_of_the_cervical_spine_ L2 - https://thejns.org/doi/10.3171/2014.8.SPINE131197 DB - PRIME DP - Unbound Medicine ER -