Anterior controllable antedisplacement fusion as a choice for 28 patients of cervical ossification of the posterior longitudinal ligament with dura ossification: the risk of cerebrospinal fluid leakage compared with anterior cervical corpectomy and fusion.

PURPOSE: To compare the incidence rate of cerebrospinal fluid (CSF) leakage between anterior controllable antedisplacement fusion (ACAF) and anterior cervical corpectomy and fusion (ACCF) in the treatment of ossification of the posterior longitudinal ligament (OPLL) with dura ossification (DO). METHODS: In the period from June 2015 to June 2017, ACAF and ACCF were performed on patients with OPLL with DO. Double-layer sign was observed on axial bone window of CT images. The operation duration, blood loss, and hospital stay were measured. Radiologic assessment included occupying rate, type and extent of OPLL, decompression width, postoperative area of the spinal canal, and anteroposterior diameter of the spinal cord. The JOA scoring system was used to evaluate the neurological status. Surgery-related complications such as CSF leakage and spinal cord or nerve injury were all recorded. RESULTS: There were 28 patients in ACAF group and 31 in ACCF group. On cross-sectional CT, decompression width and postoperative spinal canal area were both significantly larger in the ACAF group than that in the ACCF group (P < 0.01). The anteroposterior diameter of the spinal cord was significantly larger in the ACAF group (P < 0.05). Mean JOA score was better in the ACAF group (P < 0.05). In the ACCF group, seven (22.6%) patients had CSF leakage. However, only one (3.6%) presented with CSF leakage in the ACAF group. The difference of incidence rate of CSF leakage was significant (P < 0.01). CONCLUSIONS: ACAF, which can significantly reduce CSF leakage and achieve good neurological recovery, is a good option to treat cervical OPLL with DO. These slides can be retrieved under Electronic Supplementary Material.

Comparison of anterior corpectomy and fusion versus laminoplasty for the treatment of cervical ossification of posterior longitudinal ligament: a meta-analysis.

OBJECTIVE The purpose of this study was to compare the effectiveness and safety of anterior corpectomy and fusion (ACF) with laminoplasty for the treatment of patients diagnosed with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS The authors searched electronic databases for relevant studies that compared the use of ACF with laminoplasty for the treatment of patients with OPLL. Data extraction and quality assessment were conducted, and statistical software was used for data analysis. The random effects model was used if there was heterogeneity between studies; otherwise, the fixed effects model was used. RESULTS A total of 10 nonrandomized controlled studies involving 819 patients were included. Postoperative Japanese Orthopaedic Association (JOA) score (p = 0.02, 95% CI 0.30-2.81) was better in the ACF group than in the laminoplasty group. The recovery rate was superior in the ACF group for patients with an occupying ratio of OPLL of ≥ 60% (p < 0.00001, 95% CI 21.27-34.44) and for patients with kyphotic alignment (p < 0.00001, 95% CI 16.49-27.17). Data analysis also showed that the ACF group was associated with a higher incidence of complications (p = 0.02, 95% CI 1.08-2.59) and reoperations (p = 0.002, 95% CI 1.83-14.79), longer operation time (p = 0.01, 95% CI 17.72 -160.75), and more blood loss (p = 0.0004, 95% CI 42.22-148.45). CONCLUSIONS For patients with an occupying ratio ≥ 60% or with kyphotic cervical alignment, ACF appears to be the preferable treatment method. Nevertheless, laminoplasty seems to be effective and safe enough for patients with an occupying ratio < 60% or with adequate cervical lordosis. However, it must be emphasized that a surgical strategy should be made based on the individual patient. Further randomized controlled trials comparing the use of ACF with laminoplasty for the treatment of OPLL should be performed to make a more convincing conclusion.

Outcomes of secondary laminoplasty for patients with unsatisfactory results after anterior multilevel cervical surgery.

OBJECTIVE: To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty. METHODS: Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed. RESULTS: With a mean follow-up of 29.7±12.1 months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p<0.05) and maintained thereafter (p>0.05). Mean VAS score decreased postoperatively (p<0.05). Lordotic angle maintained during the entire follow up (p>0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively. CONCLUSION: Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications.