OBJECTIVE: To investigate the effect of expansive open-door laminoplasty combined with single lateral mass screw fixation on the posterior longitudinal ligament ossification and cervical instability and its effect on sagittal balance. METHODS: A retrospective analysis of 65 patients with the posterior longitudinal ligament with cervical instability from May 2012 to July 2018 was conducted. The patients were divided into two groups according to the surgical method. Thirty-four patients were treated with open-door laminoplasty including 19 males and 15 females, aged 49 to 60 years old with an average age of (54.4±4.77) years old;symptoms lasted 8 to 39 months with an average of (21.0±8.2) months. Thirty-one patients were treated with single-door laminoplasty combined with single mass screw fixation including 17 males and 14 females, aged 50 to 59 years old with an average age of (55.4±3.2) years;symptoms lasted 7 to 48 months with an average of (23.7±13.1) months. General information of the two groups, including operation time, intraoperative blood loss, and postoperative complications was recorded. Sagittal vertical axis(SVA), C₀-C₂ and C₂-C₇ cobb angle were measured by X-ray before operation and at the last follow-up. Clinical efficacy was evaluated using the Japanese Orthopaedic Association(JOA) score. RESULTS: Surgery was successful in all patients. The operation time (109±15) min in the single-door laminoplasty combined with lateral mass screw fixation group was longer than that in the single-door group(128±16) min(P<0.05). There was no significant difference in intraoperative blood loss, postoperative axial symptoms and follow-up time between two groups(P>0.05). At the latest follow-up, both groups showed significant improvement in the motor and sensory components of the JOA score and the total JOA score compared to pre-surgery(P<0.05) and no significant change in bladder function score(P>0.05). There was no significant difference between two groups(P>0.05). At the latest follow-up, the C₀-C₂ Cobb angle increased in both groups compared to preoperative and more the single-door laminoplasty group(P<0.05). The angle of the C₂-C₇ Cobb angle decreased in both groups, and the reduction was greater in the single-door laminoplasty combined with lateral mass screw fixation group(P<0.05). There was a significant increase in C₂-C₇ SVA in the single-door laminoplasty group(P<0.05) and no significant change the single-door laminoplasty combined with lateral screw fixation group(P>0.05). CONCLUSION Posterior cervical laminoplasty with unilateral lateral mass screw fixation combined with single-door vertebral plate shaping surgery improves the neurological function and quality of life in patients with cervical spondylotic myelopathy complicated by ossification of the posterior longitudinal ligament and cervical instability. Compared with single-door vertebral plate shaping surgery, postoperative cervical lordosis and forward-tilt can be improved.
Humans ; Middle Aged ; Male ; Female ; Laminoplasty/methods* ; Ossification of Posterior Longitudinal Ligament/physiopathology* ; Bone Screws ; Cervical Vertebrae/physiopathology* ; Retrospective Studies ; Joint Instability/surgery*

OBJECTIVE: To evaluate the feasibility, safety, and early effectiveness of percutaneous endoscopic thoracic spine surgery via the trench technique for ventral decompression in central calcified thoracic disc herniation (CCTDH) and thoracic ossification of the posterior longitudinal ligament (T-OPLL). METHODS: Seven patients with single-segment CCTDH or T-OPLL admitted between June 2017 and May 2020 and meeting the selection criteria were retrospectively analyzed. There were 3 males and 4 females with an average age of 51.7 years ranging from 41 to 62 years. There were 2 patients with T-OPLL (T _{1, 2} in 2 cases) and 5 patients with CCTDH (T _{1, 2} in 1 case, T _{7, 8} in 1 case, T _{10, 11} in 2 cases, T _{11, 12} in 1 case). Five patients with thoracic axial pain and intercostal neuralgia had a preoperative visual analogue scale (VAS) score of 6.0 (5.0, 6.5), and 7 patients had a preoperative Japanese Orthopaedic Association (JOA) score of 21 (21.0, 22.0). Transforaminal approach was used in 4 cases and transpedicular approach in 3 cases. Ventral decompression of thoracic spinal cord was performed by thoracic endoscopy combined with trench technique. The operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications were recorded. Thoracic spine CT and MRI were performed preoperatively and postoperatively to evaluate the surgical decompression, VAS score was used to evaluate the pain of thoracic back and lower limbs, and JOA score was used to evaluate the functional recovery. Modified MacNab criteria was used to evaluate the effectiveness. RESULTS: All surgeries were successfully completed. The operation time ranged from 60 to 100 minutes, with an average of 80.4 minutes; the intraoperative blood loss ranged from 40 to 75 mL, with an average of 57.1 mL; the postoperative hospital stay ranged from 4 to 7 days, with an average of 5.4 days. CT and MRI examinations indicated that the decompression was adequate. All 7 patients were followed up 3-22 months, with an average of 13.3 months. One case developed postoperative wound infection, and 1 case developed pneumonia; the remaining patients did not have any complications such as wound infection or cerebrospinal fluid leakage. Five patients with thoracic axial pain and intercostal neuralgia had VAS scores of 2.0 (1.5, 2.5) at 1 day after operation and 2.0 (1.0, 2.0) at last follow-up, both of which were significantly lower than the preoperative scores ( P<0.05). At 1 day after operation, the JOA scores for all 7 patients were 22.0 (21.0, 24.0), which showed no significant difference compared to the preoperative score ( P>0.05); however, at last follow-up, the score improved to 24.0 (24.0, 26.0), which was significant compared to the preoperative scores ( P<0.05). At last follow-up, the effectiveness was assessed using the modified MacNab criteria, the results were excellent in 2 cases, good in 3 cases, fair in 2 cases, and the excellent and good rate was 71.4%. CONCLUSION Using the trench technique, percutaneous endoscopic thoracic spine surgery can achieve the ventral decompression in CCTDH and T-OPLL, providing a new approach for surgical treatment of CCTDH and T-OPLL.
Humans ; Middle Aged ; Male ; Female ; Thoracic Vertebrae/surgery* ; Decompression, Surgical/methods* ; Adult ; Intervertebral Disc Displacement/surgery* ; Spinal Cord Compression/etiology* ; Treatment Outcome ; Ossification of Posterior Longitudinal Ligament/surgery* ; Endoscopy/methods*

OBJECTIVE: To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C ₂ segment. METHODS: The literature about the surgery for cervical OPLL involving C ₂ segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized. RESULTS: For cervical OPLL involving the C ₂ segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification. CONCLUSION OPLL involving the C ₂ segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C ₂ segment.
Humans ; Longitudinal Ligaments/surgery* ; Ossification of Posterior Longitudinal Ligament/surgery* ; Treatment Outcome ; Osteogenesis ; Decompression, Surgical/methods* ; Cervical Vertebrae/surgery* ; Laminoplasty/methods* ; Kyphosis/surgery* ; Retrospective Studies

OBJECTIVE: To analyze the effect of short-segment circumferential decompression and the nerve function improvement in 30 cases of multilevel thoracic OPLL assisted by intraoperative ultrasound. METHODS: A total of 30 patients with multilevel thoracic OPLL from January 2016 to January 2021 were enrolled, all of whom were located by intraoperative ultrasound and underwent circumferential decompression. There were 14 males and 16 females, with an average age of (49.3±11.4) years. The initial symptoms were mainly numbness and weakness of lower limbs (83.3%), and the mean duration of symptoms was (33.9±42.9) months (1-168 months). Neurological function was assessed by the Modified Japanese Orthopedic Association (mJOA) score (0-11) preoperative and at the last follow-up, in which the rate of neurological improvement was calculated by the Harabayashi method. The patients were divided into excellent improved group and poor improved group according to the improvement of neurological function. The age, body mass index (BMI), duration of symptoms, operation time, blood loss, mJOA score, surgical level, and cerebrospinal fluid leakage of the two groups were collected and analyzed for statistical differences. The factors influencing the improvement of neurological function were analyzed by univariate and multivariate Logisitic regression analysis. RESULTS: The mean operation time was 137.4±33.8 (56-190) min, and the mean blood loss was (653.7±534.2) mL (200－3 000 mL). The preoperative mJOA score was 6.0±2.1 (2－9), and the last follow-up mJOA score was 7.6±1.9 (4－11), which was significantly improved in all the patients (P < 0.001). The average improvement rate of neurological function was 38.1%±24.4% (14.3%－100%), including 75%－100% in 4 cases, 50%－74% in 3 cases, 25%－49% improved in 14 cases, and 0%－24% in 9 cases. There was significant difference in intraoperative blood loss between the excellent improved group and the poor improved group (P=0.047). Intraoperative blood loss was also an independent risk factor in regression analysis of neurological improvement. CONCLUSION Thoracic circumferential decompression assisted with intraoperative ultrasound can significantly improve the neurological function of patients with multilevel OPLL and achieve good efficacy. The improvement rate of nerve function can be improved effectively by controlling intraoperative blood loss.
Adult ; Blood Loss, Surgical ; Decompression, Surgical/methods* ; Female ; Humans ; Longitudinal Ligaments/surgery* ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament/surgery* ; Osteogenesis ; Retrospective Studies ; Spinal Fusion/methods* ; Thoracic Vertebrae/surgery* ; Treatment Outcome

OBJECTIVETo explore the clinical efficacy of unilateral open-door laminoplasty combined with foraminotomy for cervical ossification of posterior longitudinal ligament(OPLL).

METHODSThe clinical data of 45 patients with OPLL underwent surgical treatment between September 2011 and September 2015 were retrospectively analyzed. There were 26 males and 19 females with a mean age of 53.6 years old(ranged from 28 to 71 years). Among them, 24 cases received the surgery of unilateral open-door cervical laminoplasty combined with foraminotomy(combined group), and 21 cases received a single unilateral open-door cervical laminoplasty(single group). Operation time, intraoperative blood loss, complications including C₅ nerve root palsy and axial symptoms were compared between two groups. Pre-and post-operative Japanese Orthopedic Association(JOA) score, improvement rate of neurological function, Neck Disability Index(NDI) score, and cervical Cobb angle were recorded and analyzed between the two groups.

RESULTSAll the patients were followed up for 12-24 months, with an average of (14.3±2.8) months for combined groups and (13.7±3.1) months for single group, and no significant difference was found between the two groups(>0.05). There was no significant difference in operation time and intraoperative blood loss between two groups(>0.05). Postoperative JOA scores obtained obvious improvement in all patients(<0.05). However, there was no significant difference between two groups for the improvement rate of neurological function(>0.05). At final follow-up, NDI scores of combined group and single group were 13.6±1.8 and 16.1±2.4 respectively, there was significant difference between two groups(<0.05). The incidence of C₅ nerve root palsy was lower in combined group(4.2%) than that of single group (28.6%). There was no significant difference in incidence rate of axial symptoms between two groups(>0.05). There was no significant difference in cervical Cobb angle between pre-and post-operative conditions, or between two groups(>0.05).

CONCLUSIONSUnilateral open-door cervical laminoplasty combined with foraminotomy is an effective method to treat cervical OPLL, which could provide sufficient decompression of spinal cord and nerve root, prevent the C₅ nerve root palsy.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Female ; Foraminotomy ; Humans ; Laminoplasty ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; surgery ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the clinical effects of 360 degree circular decompression and transpedicle screw fixation to treat the ossification of thoracic posterior longitudinal ligament by posterior approach.

METHODSFrom December 2009 to November 2013, 18 patients with ossification of thoracic posterior longitudinal ligament ossification were treated with 360 degree circle decompression and transpedicle screw fixation by posterior approach. There were 8 males and 10 females,ranging in age from 32 to 67 years old, with an average of 51 years old. Four patients were accompanied with ligamentum flavum ossification. Longitudinal ossifications in 5 cases were located in the upper thoracic vertebra and 13 cases in the middle and lower thoracic vertebra. Five cases were typical type, 4 cases were segmental type, 6 cases were continuous type and 3 cases were mixed type. All the patients had the posterior spinal canal decompression combined with longitudinal ligament resection, interbody fusion with bone graft and internal fixation surgeries. The operation time,blood loss and complications were recorded. JOA score were applied to evaluate the neurological function recovery pre-surgery, 2 days post-surgery and the latest follow-up. The surgery effects were evaluated by Epstein-Schwall method.

RESULTSThe operation time ranged from 3 to 6 hours (mean, 4.2 hours). The blood loss ranged from 800 to 4 000 ml (mean, 1 800 ml). All the patients were followed up, and the duration ranged from 6 months to 3 years, with a mean of 1.8 years. The JOA score increased from preoperative 4.30 ± 2.60 to 7.60 ± 2.40 2 days after surgery, and 7.80 ± 1.90 at the latest follow-up (t = 4.61, P < 0.001). The JOA scores between 2 days after surgery and the latest follow-up had no significant differences (t = 0.28,P = 0.78). The neurological recovery rate was 74% 2 days after surgery and 71% at the latest follow-up. There were 4 cases got an excellent result,10 good,3 fair and 1 poor according to Epstein-Schwall evaluation method. Four patients had cerebrospinal fluid leakage, 3 patients had intercostal nerve paralysis or pain, and 1 patient had superficial incision infection. The neurological function in 3 patients became worse in the second day posteratively , and among them, 2 patients were recovered at the latest follow-up and 1 patient had no changes. All the patients got fusion of bone graft and no internal fixation loosening and fractures occurred.

CONCLUSION360 degree circular decompression and transpedicle screw fixation can resect different types of thoracic longitudinal ligament ossification, and can achieve a good clinical effect.

Adult ; Aged ; Decompression, Surgical ; methods ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; surgery ; Thoracic Vertebrae ; surgery

BACKGROUNDOssification of the ligamentum flavum (OLF) has been widely recognized as one of the main causes of thoracic spinal canal stenosis and thoracic myelopathy. Decompression is the only effective strategy for treating thoracic myelopathy caused by OLF. The purpose of this study was to describe the clinical outcomes of computer-assisted minimally invasive spine surgery (CAMISS) for posterior decompression in patients with thoracic myelopathy caused by OLF.

METHODSIn all cases, the surgical procedure was performed with the assistance of an intraoperative three-dimensional navigation system. Decompression of the spinal cord was performed with a high-speed drill; the supraspinal ligaments and spinous process were partially preserved. The outcomes were evaluated by a modified Japanese Orthopedic Association (JOA) scoring system and recovery rates.

RESULTSThe mean duration of follow-up for the 14 cases was 3.9 years. All patients experienced neurological recovery, the mean JOA score improving from 6.1 points preoperatively to 8.6 points at final follow-up and the mean rate of recovery being 52.7% (excellent in two cases, good in eight, fair in three, and unchanged in one).

CONCLUSIONCAMISS is a safe and effective procedure for resection of the OLF in the thoracic spine.

Adult ; Aged ; Female ; Humans ; Ligamentum Flavum ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Ossification of Posterior Longitudinal Ligament ; surgery ; Thoracic Vertebrae ; surgery

BACKGROUNDThe treatment strategies for multilevel thoracic ossification of the posterior longitudinal ligaments (T-OPLL) were rarely reported. The aim of this study was to investigate the clinical outcomes and complications of circumferential decompression for multilevel T-OPLL and compare two different methods in the management of the OPLL (resection or floating).

METHODSData of sequentially treated patients who received surgical treatment for thoracic spinal stenosis caused by multilevel T-OPLL from January 2005 to February 2012 were retrospectively reviewed. Based on the surgical approaches applied, the patients were divided into two groups. Group A consisted the patients who received posterior decompression and group B consisted the patients who received circumferential decompression via the posterior approach. Group B was further divided into two subgroups: subgroup 1 (the resection group) where the OPLL was completely resected and subgroup 2 (the floating group) where the OPLL was floated.

RESULTSA total of 49 patients were included in the study. Fourteen patients with single posterior decompression were included in group A and 35 patients who received circumferential decompression were included in group B. In group B, 29 patients had complete resection of the ossified posterior longitudinal ligaments, while the other six underwent a flotation procedure. The follow-up data were available in 39 patients. Mean JOA scores improved from 5.4 ± 1.8 to 7.5 ± 2.8 in group A and from 3.7 ± 1.8 to 7.9 ± 2.4 in group B. The main complications included cerebrospinal fluid (CSF) leakage and postoperative neurologic deterioration (ND). Twenty-three of the 25 cases with postoperative CSF leakage achieved a complete recovery at the last follow-up and 12 of the 15 cases with ND achieved some neurological improvement at the last follow-up.

CONCLUSIONSCircumferential decompression via the posterior approach is an effective surgical method for thoracic spinal stenosis caused by multilevel OPLL of the thoracic spine. Patients who receive complete resection of the ossified posterior longitudinal ligaments may have better recovery rate than the "floating" group.

Adult ; Decompression, Surgical ; methods ; Female ; Humans ; Longitudinal Ligaments ; pathology ; surgery ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; surgery ; Retrospective Studies ; Thoracic Vertebrae ; surgery ; Treatment Outcome

BACKGROUNDSurgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion (PTTIF) may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.

METHODSSixteen patients with thoracic myelopathy due to concurrent OLF and OPLL at the same level underwent PTTIF. We investigated clinical outcomes and neurological improvements. Magnetic resonance imaging (MRI) was performed on all patients preoperatively and postoperatively, and intramedullary signal changes were evaluated.

RESULTSThe mean operating time was 275 minutes, and the mean operative bleeding amount was 1031 ml. Cerebrospinal fluid leakage occurred in three patients and healed well after repair. Neurological symptom deterioration occurred in one patient, but the patient recovered to nearly the preoperative level after methylprednisolone treatment. The follow-up period ranged from 28 to 47 months. The mean score on the Japanese Orthopedic Association scale improved from 4.3±1.2 preoperatively to 7.3±1.7 at 3 months postoperatively to 8.5±1.5 at the final follow-up (P < 0.01), with a recovery rate of (63.6±20.0)%. Postoperative images showed a significant improvement in local kyphosis (P < 0.01). Eleven patients (68.8%) showed increased signal intensity (ISI) on preoperative T2-weighted MRI. At the final follow-up, the intramedullary ISI totally recovered in five patients. Neurological improvement was worse in patients with persistent ISI than in the other patients (P < 0.05).

CONCLUSIONSPTTIF is an effective therapeutic option for combined OPLL and OLF and provides satisfactory neurological recovery and stabilized thoracic fusion through a single posterior approach. Intramedullary signal changes do not always indicate a poor prognosis; only irreversible ISI is correlated with a poor clinical result.

Adult ; Aged ; Decompression, Surgical ; Female ; Humans ; Ligamentum Flavum ; pathology ; surgery ; Longitudinal Ligaments ; pathology ; surgery ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; pathology ; surgery ; Spinal Cord Diseases ; pathology ; surgery

OBJECTIVETo evaluate the clinical effect of different surgical approaches for treating cervical ossification of the posterior longitudinal ligament (OPLL) with spinal cord signal change.

METHODSThirty-eight patients with OPLL with spinal cord signal change were treated from January 2005 to January 2011. Surgical removal via an anterior approach or partial decompression was performed in 10 cases (group A), posterior approach open-door laminoplasty with decompression, bone grafting and internal fixation was performed in 12 cases (group B), and opening the cervical spinal meninges to relieve the pressure was performed in 16 cases (group C) on the basis of the procedures in group B. All the patients were followed up and the pre- and postoperative JOA scores, improvement ratio and inter-body implant fusion were evaluated. Imaging examinations including X-rays, CT and MRI were also performed pre- and postoperatively, and the surgical complications were recorded.

RESULTSAt 12 months postoperatively, the mean improvement rates in groups A, B, and C were 52.39%, 55.15%, and 60.32%, respectively, with the mean JOA scores of 13.54∓0.56, 13.56∓1.26, and 14.70∓1.41, respectively. The JOA scores and improvement rates significantly increased after the surgeries. One patient in group A became paraplegic after the operation with cerebrospinal fluid leakage, and one patient in group B and one in group C reported numbness of the upper limb. Group C showed a shorter postoperative recovery time without severe complications.

CONCLUSIONPosterior open-door laminoplasty, decompression, bone grafting and internal fixation can be an effective approach for treatment of cervical OPLL with spinal cord signal change and requires shorter rehabilitation time after the operation.

Aged ; Cervical Vertebrae ; pathology ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; pathology ; surgery ; Spinal Cord Compression ; etiology ; surgery ; Treatment Outcome