Direct anterior decompression in patients with ossification of the posterior longitudinal ligament significantly relieves short-segment spinal cord high signal.
Anterior approaches
Cervical spondylotic myelopathy
High cord signals
Magnetic resonance imaging
Ossification of the posterior longitudinal ligament
Posterior approaches
Signal change ratio
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
31 Oct 2024
31 Oct 2024
Historique:
received:
27
06
2024
accepted:
23
10
2024
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
1
11
2024
Statut:
epublish
Résumé
In patients with ossification of the posterior longitudinal ligament of the cervical spine (OPLL), high spinal cord signal (HCS) is frequently observed in the spinal cord of the corresponding segment. However, studies on the differences in the improvement of high spinal cord signal due to different surgical approaches are limited. The aim of this study was to investigate the improvement of high spinal cord signal in long and short segments with different choices of surgical approaches. In this study, we conducted a meticulous review of medical records for patients diagnosed with ossification of the posterior longitudinal ligament (OPLL). Demographic variables, including gender, age, and body mass index (BMI), were systematically recorded. We evaluated the severity of neurological impairment using the Japanese Orthopaedic Association (JOA) scores both preoperatively and at multiple postoperative follow-up points. Neurological assessments were complemented by serial magnetic resonance imaging (MRI) T2-weighted imaging (T2WI) to measure the extent of high-signal changes (HCS) in the spinal cord, and the alteration of the HCS was quantified by the SCR (the ratio between the signal intensity value of the HCS region and the signal intensity value of the normal spinal cord region at C7-T1). In the short-segment high signal change (HCS) group, comparisons of JOA score improvement (Recovery1) and HCS improvement (CR1) at 6 months postoperatively did not demonstrate significant differences between the surgical approaches (P > 0.05; Table 1). However, at the 2-year follow-up, patients who underwent anterior surgery exhibited significantly greater improvements in both JOA scores (Recovery2) and HCS (CR2), with statistical significance achieved (P < 0.05; Table 1). In contrast, in the long-segment HCS group, there was no significant difference between the anterior and posterior surgical approaches in terms of JOA improvement and HCS improvement at 6 months and 2 years postoperatively (P > 0.05; Table 2). In patients with OPLL who present with spinal cord high signal, anterior surgery by resection of the ossified posterior longitudinal ligament and direct decompression is more conducive to regression of small spinal cord high signal and improvement of clinical neurological function if the extent of spinal cord high signal is small.
Sections du résumé
BACKGROUND
BACKGROUND
In patients with ossification of the posterior longitudinal ligament of the cervical spine (OPLL), high spinal cord signal (HCS) is frequently observed in the spinal cord of the corresponding segment. However, studies on the differences in the improvement of high spinal cord signal due to different surgical approaches are limited. The aim of this study was to investigate the improvement of high spinal cord signal in long and short segments with different choices of surgical approaches.
METHODS
METHODS
In this study, we conducted a meticulous review of medical records for patients diagnosed with ossification of the posterior longitudinal ligament (OPLL). Demographic variables, including gender, age, and body mass index (BMI), were systematically recorded. We evaluated the severity of neurological impairment using the Japanese Orthopaedic Association (JOA) scores both preoperatively and at multiple postoperative follow-up points. Neurological assessments were complemented by serial magnetic resonance imaging (MRI) T2-weighted imaging (T2WI) to measure the extent of high-signal changes (HCS) in the spinal cord, and the alteration of the HCS was quantified by the SCR (the ratio between the signal intensity value of the HCS region and the signal intensity value of the normal spinal cord region at C7-T1).
RESULTS
RESULTS
In the short-segment high signal change (HCS) group, comparisons of JOA score improvement (Recovery1) and HCS improvement (CR1) at 6 months postoperatively did not demonstrate significant differences between the surgical approaches (P > 0.05; Table 1). However, at the 2-year follow-up, patients who underwent anterior surgery exhibited significantly greater improvements in both JOA scores (Recovery2) and HCS (CR2), with statistical significance achieved (P < 0.05; Table 1). In contrast, in the long-segment HCS group, there was no significant difference between the anterior and posterior surgical approaches in terms of JOA improvement and HCS improvement at 6 months and 2 years postoperatively (P > 0.05; Table 2).
CONCLUSIONS
CONCLUSIONS
In patients with OPLL who present with spinal cord high signal, anterior surgery by resection of the ossified posterior longitudinal ligament and direct decompression is more conducive to regression of small spinal cord high signal and improvement of clinical neurological function if the extent of spinal cord high signal is small.
Identifiants
pubmed: 39482611
doi: 10.1186/s12891-024-07991-0
pii: 10.1186/s12891-024-07991-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
872Informations de copyright
© 2024. The Author(s).
Références
Ikegawa S. Genomic study of ossification of the posterior longitudinal ligament of the spine. Proc Jpn Acad Ser B Phys Biol Sci. 2014;90:405–12.
doi: 10.2183/pjab.90.405
pubmed: 25504229
Tetreault L, Goldstein CL, Arnold P, Harrop J, Hilibrand A, Nouri A, et al. Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine. Neurosurgery. 2015;77(Supplement 1):S51–67.
doi: 10.1227/NEU.0000000000000951
pubmed: 26378358
An HS, Al-Shihabi L, Kurd M. Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine. J Am Acad Orthop Surg. 2014;22:420–9.
doi: 10.5435/JAAOS-22-07-420
pubmed: 24966248
Matsunaga S, Sakou T. Ossification of the Posterior Longitudinal Ligament of the Cervical Spine: Etiology and Natural History. Spine. 2012;37:E309–14.
doi: 10.1097/BRS.0b013e318241ad33
pubmed: 22146284
Aljuboori Z, Boakye M. The Natural History of Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: A Review Article. Cureus. 2019;11: e5074.
pubmed: 31516784
Vedantam A, Jonathan A, Rajshekhar V. Association of magnetic resonance imaging signal changes and outcome prediction after surgery for cervical spondylotic myelopathy: Clinical article. J Neurosurg Spine. 2011;15:660–6.
doi: 10.3171/2011.8.SPINE11452
pubmed: 21923236
Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K. MR T2 Image Classification in Cervical Compression Myelopathy: Predictor of Surgical Outcomes. Spine. 2007;32:1675–8.
doi: 10.1097/BRS.0b013e318074d62e
pubmed: 17621217
de Rota JJF, Meschian S, de Rota AF, Urbano V, Barón M. Cervical spondylotic myelopathy due to chronic compression: the role of signal intensity changes in magnetic resonance images. J Neurosurg Spine. 2007;6(1):17–22.
Machino M, Ando K, Kobayashi K, Ito K, Tsushima M, Morozumi M, et al. Alterations in Intramedullary T2-weighted Increased Signal Intensity following Laminoplasty in Cervical Spondylotic Myelopathy Patients: Comparison Between Pre- and Postoperative Magnetic Resonance Images. Spine. 2018;43:1595–601.
doi: 10.1097/BRS.0000000000002674
pubmed: 29649088
Karpova A, Arun R, Cadotte D, Davis A, Kulkarni A, O’Higgins M, et al. Assessment of Spinal Cord Compression by Magnetic Resonance Imaging—Can It Predict Surgical Outcomes in Degenerative Compressive Myelopathy? A Systematic Review Spine. 2013;38:1409–21.
pubmed: 23591658
Zhang Y, Shen Y, Wang L, Ding W, Xu J, He J. Magnetic Resonance T2 Image Signal Intensity Ratio and Clinical Manifestation Predict Prognosis After Surgical Intervention for Cervical Spondylotic Myelopathy. Spine. 2010;35:E396–9.
doi: 10.1097/BRS.0b013e3181c6dbc4
pubmed: 20393392
Chen X, Shan T, Li Y. Prognostic effect of increased postoperative MRI T2WI high signal intensity in degenerative cervical myelopathy. Spine J. 2022;22:1964–73.
doi: 10.1016/j.spinee.2022.07.097
pubmed: 35878755
Kato S, Nouri A, Wu D, Nori S, Tetreault L, Fehlings MG. 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;99:1013–21.
doi: 10.2106/JBJS.16.00882
pubmed: 28632590
Feng F, Ruan W, Liu Z, Li Y, Cai L. Anterior versus posterior approach for the treatment of cervical compressive myelopathy due to ossification of the posterior longitudinal ligament: A systematic review and meta-analysis. Int J Surg. 2016;27:26–33.
doi: 10.1016/j.ijsu.2016.01.038
pubmed: 26804354
Liu X, Min S, Zhang H, Zhou Z, Wang H, Jin A. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: a systematic review and meta-analysis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2014;23:362–72.
doi: 10.1007/s00586-013-3043-7
Qin R, Chen X, Zhou P, Li M, Hao J, Zhang F. Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament: a meta-analysis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2018;27:1375–87.
doi: 10.1007/s00586-017-5451-6
Lee JJ, Lee N, Oh SH, Shin DA, Yi S, Kim KN, et al. Clinical and radiological outcomes of multilevel cervical laminoplasty versus three-level anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy. Quant Imaging Med Surg. 2020;10:2112–24.
doi: 10.21037/qims-20-220
pubmed: 33139991
pmcid: 7547256
Xu P, Zhuang J-S, Huang Y-S, Chen J-T, Zhong Z-M. Is anterior decompression and fusion superior to laminoplasty for cervical myelopathy due to ossification of posterior longitudinal ligament? A systematic review and meta-analysis. J Spinal Cord Med. 2021;44:169–83.
doi: 10.1080/10790268.2019.1579987
pubmed: 30888255
Wang L-F, Zhang Y-Z, Shen Y, Su Y-L, Xu J-X, Ding W-Y, et al. Using the T2-weighted magnetic resonance imaging signal intensity ratio and clinical manifestations to assess the prognosis of patients with cervical ossification of the posterior longitudinal ligament. J Neurosurg Spine. 2010;13:319–23.
doi: 10.3171/2010.3.SPINE09887
pubmed: 20809723
Ito K, Imagama S, Ito K, Ito Z, Ando K, Kobayashi K, et al. MRI Signal Intensity Classification in Cervical Ossification of the Posterior Longitudinal Ligament: Predictor of Surgical Outcomes. Spine. 2017;42:E98–103.
doi: 10.1097/BRS.0000000000001717
pubmed: 27244260
Wei L, Cao P, Xu C, Hu B, Tian Y, Yuan W. Clinical and Radiologic Results of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy in Elderly Patients with T2-Weighted Increased Signal Intensity. World Neurosurg. 2018;112:e520–6.
doi: 10.1016/j.wneu.2018.01.071
pubmed: 29366997
Shin J, Jin B-H, Kim K-S, Cho Y, Cho WH. Intramedullary high signal intensity and neurological status as prognostic factors in cervical spondylotic myelopathy. Acta Neurochir (Wien). 2010;152:1687–94.
doi: 10.1007/s00701-010-0692-8
pubmed: 20512384