Perioperative Complications in Posterior Surgeries for Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Nationwide Investigation.
Journal
Clinical spine surgery
ISSN: 2380-0194
Titre abrégé: Clin Spine Surg
Pays: United States
ID NLM: 101675083
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
received:
31
07
2020
accepted:
23
06
2021
pubmed:
5
8
2021
medline:
28
1
2022
entrez:
4
8
2021
Statut:
ppublish
Résumé
This was a prospective multicenter study. The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures. We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications. Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2-C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery. In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2-C7 angle were the independent risk factors for motor palsy. Level III.
Sections du résumé
STUDY DESIGN
This was a prospective multicenter study.
OBJECTIVE
The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL).
SUMMARY OF BACKGROUND DATA
Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures.
MATERIALS AND METHODS
We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications.
RESULTS
Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2-C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery.
CONCLUSIONS
In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2-C7 angle were the independent risk factors for motor palsy.
LEVEL OF EVIDENCE
Level III.
Identifiants
pubmed: 34347632
doi: 10.1097/BSD.0000000000001243
pii: 01933606-202112000-00012
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E594-E600Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Matsunaga S, Kukita M, Hayashi K, et al. Pathogenesis of myelopathy in patients with ossification of the posterior longitudinal ligament. J Neurosurg. 2002;96:168–172.
Matsunaga S, Sakou T. Ossification of the posterior longitudinal ligament of the cervical spine: etiology and natural history. Spine (Phila Pa 1976). 2012;37:E309–E314.
Iwasaki M, Okuda S, Miyauchi A, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: part 1: clinical results and limitations of laminoplasty. Spine (Phila Pa 1976). 2007;32:647–653.
Iwasaki M, Okuda S, Miyauchi A, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: part 2: advantages of anterior decompression and fusion over laminoplasty. Spine (Phila Pa 1976). 2007;32:654–660.
Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976). 1981;6:354–364.
Kurokawa R, Kim P. Cervical laminoplasty: the history and the future. Neurol Med Chir (Tokyo). 2015;55:529–539.
Ogawa Y, Toyama Y, Chiba K, et al. Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg Spine. 2004;1:168–174.
Katsumi K, Hirano T, Watanabe K, et al. Perioperative factors associated with favorable outcomes of posterior decompression and instrumented fusion for cervical ossification of the posterior longitudinal ligament: a retrospective multicenter study. J Clin Neurosci. 2018;57:74–78.
Koda M, Furuya T, Saito J, et al. Postoperative K-line conversion from negative to positive is independently associated with a better surgical outcome after posterior decompression with instrumented fusion for K-line negative cervical ossification of the posterior ligament. Eur Spine J. 2018;27:1393–1400.
Yoshii T, Morishita S, Inose H, et al. Comparison of perioperative complications in anterior decompression with fusion and posterior decompression with fusion for cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient database. Spine (Phila Pa 1976). 2020;45:E1006–E1012.
Yoshii T, Sakai K, Hirai T, et al. Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a >/=50% canal occupying ratio: a multicenter retrospective study. Spine J. 2016;16:1351–1357.
Seichi A, Hoshino Y, Kimura A, et al. Neurological complications of cervical laminoplasty for patients with ossification of the posterior longitudinal ligament-a multi-institutional retrospective study. Spine (Phila Pa 1976). 2011;36:E998–E1003.
Tetreault L, Nakashima H, Kato S, et al. A systematic review of classification systems for cervical ossification of the posterior longitudinal ligament. Global Spine J. 2019;9:85–103.
Hirai T, Okawa A, Arai Y, et al. Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2011;36:1940–1947.
Kimura A, Seichi A, Hoshino Y, et al. Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament: a retrospective, multi-institutional study. J Orthop Sci. 2012;17:667–672.
Matsumoto M, Chiba K, Toyama Y, et al. Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine: a multi-institutional retrospective study. Spine (Phila Pa 1976). 2008;33:1034–1041.
Imagama S, Ando K, Takeuchi K, et al. Perioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study. Spine (Phila Pa 1976). 2018;43:E1389–E1397.
Kato S, Nouri A, Wu D, et al. Comparison of anterior and posterior surgery for degenerative cervical myelopathy: An MRI-Based Propensity-Score-Matched Analysis Using Data from the Prospective Multicenter AOSpine CSM North America and International Studies. J Bone Joint Surg Am. 2017;99:1013–1021.
Nakashima H, Tetreault L, Nagoshi N, et al. Comparison of outcomes of surgical treatment for ossification of the posterior longitudinal ligament versus other forms of degenerative cervical myelopathy: results from the Prospective, Multicenter AOSpine CSM-International Study of 479 Patients. J Bone Joint Surg Am. 2016;98:370–378.
Hasegawa M, Akter S, Hu H, et al. Five-year cumulative incidence of overweight and obesity, and longitudinal change in body mass index in Japanese workers: The Japan Epidemiology Collaboration on Occupational Health Study. J Occup Health. 2020;62:e12095.
Akune T, Ogata N, Seichi A, et al. Insulin secretory response is positively associated with the extent of ossification of the posterior longitudinal ligament of the spine. J Bone Joint Surg Am. 2001;83:1537–1544.
Yamada T, Yoshii T, Yamamoto N, et al. Clinical outcomes of cervical spinal surgery for cervical myelopathic patients with coexisting lumbar spinal canal stenosis (Tandem Spinal Stenosis): a retrospective analysis of 297 cases. Spine (Phila Pa 1976). 2018;43:E234–E241.
Sasaki E, Ono A, Yokoyama T, et al. Prevalence and symptom of ossification of posterior longitudinal ligaments in the Japanese general population. J Orthop Sci. 2014;19:405–411.
Fujiyoshi T, Yamazaki M, Kawabe J, et al. A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line. Spine (Phila Pa 1976). 2008;33:E990–E993.
Ma L, Liu FY, Huo LS, et al. Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis. Medicine (Baltimore). 2018;97:e11542.
Mehta AI, Babu R, Sharma R, et al. Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery. J Bone Joint Surg Am. 2013;95:323–328.
Sumiya S, Kawabata S, Ushio S, et al. Cervical spinal cord injury associated with neck flexion in posterior cervical decompression. Clin Spine Surg. 2019;32:E221–E227.
Kobayashi S, Matsuyama Y, Shinomiya K, et al. A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research. J Neurosurg Spine. 2014;20:102–107.
Fehlings MG, Smith JS, Kopjar B, et al. Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study. J Neurosurg Spine. 2012;16:425–432.
Usami Y, Nakaya Y, Hayama S, et al. Impact of multifidus muscle swelling on C5 palsy after cervical laminoplasty. Spine (Phila Pa 1976). 2020;45:E10–E17.
Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg Br. 2010;92:393–400.
Lee SH, Suk KS, Kang KC, et al. Outcomes and related factors of C5 palsy following cervical laminectomy with instrumented fusion compared with laminoplasty. Spine (Phila Pa 1976). 2016;41:E574–E579.