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Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament.
J Neurosurg Spine. 2017 Apr; 26(4):466-473.JN

Abstract

OBJECTIVE

Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL. After posterior surgery, some patients require revision surgery because of late neurological deterioration due to kyphotic changes in cervical alignment or OPLL progression. Here, the authors retrospectively investigated the surgical results and complications of revision ACDF after initial posterior surgery for OPLL.

METHODS

This was a single-center, retrospective study. Between 2006 and 2013, 19 consecutive patients with cervical OPLL who underwent revision ACDF at the authors' institution after initial posterior surgery were evaluated. The mean age at the time of revision ACDF was 66 ± 7 years (± SD; range 53-78 years). The mean interval between initial posterior surgery and revision ACDF was 63 ± 53 months (range 3-235 months).

RESULTS

The mean follow-up period after revision ACDF was 41 ± 26 months (range 24-108 months). Before revision ACDF, the mean maximum thickness of the ossified posterior longitudinal ligament was 7.2 ± 1.5 mm (range 5-10 mm), and the mean C2-7 angle was 1.3° ± 14° (range -40° to 24°). The K-line was plus (OPLL did not exceed the K-line) in 8 patients and minus in 11 (OPLL exceeded the K-line). The mean Japanese Orthopaedic Association score improved from 10 ± 3 (range 3-15) before revision ACDF to 11 ± 4 (range 4-15) at the last follow-up, and the mean improvement rate was 18% ± 18% (range 0%-60%). A total of 16 surgery-related complications developed in 12 patients (63%). The main complication was an intraoperative CSF leak in 8 patients (42%). Neurological function worsened in 5 patients (26%). The deterioration was due to spinal cord herniation through a defective dura mater in 1 patient, unidentified in 1 patient, and C-5 palsy that gradually recovered in 3 patients. Reintubation, delirium, and hoarseness were observed in 1 patient each (5%). No patient required reoperation for reconstruction failure, and all patients eventually had a solid bony fusion.

CONCLUSIONS

ACDF as revision surgery after initial posterior surgery for cervical myelopathy due to OPLL is associated with a high incidence of intraoperative CSF leakage and an extremely low improvement rate. The authors think that while the use of revision ACDF must be limited, it is indispensable in special cases, such as progressing myelopathy following posterior surgery due to a very large beak-type OPLL that exceeds the K-line. Postoperative OPLL progression and/or kyphotic changes can possibly cause later neurological deterioration. Fusion should be recommended at the initial surgery for many cases of cervical OPLL to prevent such a challenging revision surgery.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, Kyoto, Japan.Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, Kyoto, Japan.Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, Kyoto, Japan.Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, Kyoto, Japan.Department of Orthopaedic Surgery, Spine Center, Gakkentoshi Hospital, Kyoto, Japan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28128699

Citation

Odate, Seiichi, et al. "Surgical Results and Complications of Anterior Decompression and Fusion as a Revision Surgery After Initial Posterior Surgery for Cervical Myelopathy Due to Ossification of the Posterior Longitudinal Ligament." Journal of Neurosurgery. Spine, vol. 26, no. 4, 2017, pp. 466-473.
Odate S, Shikata J, Soeda T, et al. Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament. J Neurosurg Spine. 2017;26(4):466-473.
Odate, S., Shikata, J., Soeda, T., Yamamura, S., & Kawaguchi, S. (2017). Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament. Journal of Neurosurgery. Spine, 26(4), 466-473. https://doi.org/10.3171/2016.9.SPINE16430
Odate S, et al. Surgical Results and Complications of Anterior Decompression and Fusion as a Revision Surgery After Initial Posterior Surgery for Cervical Myelopathy Due to Ossification of the Posterior Longitudinal Ligament. J Neurosurg Spine. 2017;26(4):466-473. PubMed PMID: 28128699.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament. AU - Odate,Seiichi, AU - Shikata,Jitsuhiko, AU - Soeda,Tsunemitsu, AU - Yamamura,Satoru, AU - Kawaguchi,Shinji, Y1 - 2017/01/27/ PY - 2017/1/28/pubmed PY - 2017/4/8/medline PY - 2017/1/28/entrez KW - ACDF = anterior cervical decompression and fusion KW - JOA = Japanese Orthopaedic Association KW - OPLL = ossification of the PLL KW - PCDF = posterior cervical decompression and fusion KW - PLL = posterior longitudinal ligament KW - anterior cervical decompression and fusion KW - cerebrospinal fluid leak KW - cervical laminoplasty KW - cervical myelopathy KW - ossification of the posterior longitudinal ligament KW - revision surgery SP - 466 EP - 473 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 26 IS - 4 N2 - OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL. After posterior surgery, some patients require revision surgery because of late neurological deterioration due to kyphotic changes in cervical alignment or OPLL progression. Here, the authors retrospectively investigated the surgical results and complications of revision ACDF after initial posterior surgery for OPLL. METHODS This was a single-center, retrospective study. Between 2006 and 2013, 19 consecutive patients with cervical OPLL who underwent revision ACDF at the authors' institution after initial posterior surgery were evaluated. The mean age at the time of revision ACDF was 66 ± 7 years (± SD; range 53-78 years). The mean interval between initial posterior surgery and revision ACDF was 63 ± 53 months (range 3-235 months). RESULTS The mean follow-up period after revision ACDF was 41 ± 26 months (range 24-108 months). Before revision ACDF, the mean maximum thickness of the ossified posterior longitudinal ligament was 7.2 ± 1.5 mm (range 5-10 mm), and the mean C2-7 angle was 1.3° ± 14° (range -40° to 24°). The K-line was plus (OPLL did not exceed the K-line) in 8 patients and minus in 11 (OPLL exceeded the K-line). The mean Japanese Orthopaedic Association score improved from 10 ± 3 (range 3-15) before revision ACDF to 11 ± 4 (range 4-15) at the last follow-up, and the mean improvement rate was 18% ± 18% (range 0%-60%). A total of 16 surgery-related complications developed in 12 patients (63%). The main complication was an intraoperative CSF leak in 8 patients (42%). Neurological function worsened in 5 patients (26%). The deterioration was due to spinal cord herniation through a defective dura mater in 1 patient, unidentified in 1 patient, and C-5 palsy that gradually recovered in 3 patients. Reintubation, delirium, and hoarseness were observed in 1 patient each (5%). No patient required reoperation for reconstruction failure, and all patients eventually had a solid bony fusion. CONCLUSIONS ACDF as revision surgery after initial posterior surgery for cervical myelopathy due to OPLL is associated with a high incidence of intraoperative CSF leakage and an extremely low improvement rate. The authors think that while the use of revision ACDF must be limited, it is indispensable in special cases, such as progressing myelopathy following posterior surgery due to a very large beak-type OPLL that exceeds the K-line. Postoperative OPLL progression and/or kyphotic changes can possibly cause later neurological deterioration. Fusion should be recommended at the initial surgery for many cases of cervical OPLL to prevent such a challenging revision surgery. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/28128699/Surgical_results_and_complications_of_anterior_decompression_and_fusion_as_a_revision_surgery_after_initial_posterior_surgery_for_cervical_myelopathy_due_to_ossification_of_the_posterior_longitudinal_ligament_ L2 - https://thejns.org/doi/10.3171/2016.9.SPINE16430 DB - PRIME DP - Unbound Medicine ER -