Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine

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Object. Numerous surgical procedures have been developed for treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, and these can be performed via three approaches: anterior, posterior, or combined anterior—posterior. The optimal approach in cases involving OPLL-induced cervical myelopathy, however, remains controversial. To address this issue, the authors assessed the benefits and limitations of expansive open-door laminoplasty for OPLL-related myelopathy by evaluating mid- and long-term clinical results.

Methods. Clinical results obtained in 72 patients who underwent expansive open-door laminoplasty between 1983 and 1997 and who were followed for at least 5 years were assessed using the Japanese Orthopaedic Association (JOA) scoring system. The mean preoperative JOA score was 9.2 ± 0.4; at 3 years postoperatively, the JOA score was 14.2 ± 0.3 and the recovery rate (calculated using the Hirabayashi method) was 63.1 ± 4.5%, both having reached their highest level. These favorable results were maintained up to 5 years after surgery. An increase in cervical myelopathy due to progression of the ossified ligament was observed in only two of 30 patients who could be followed for more than 10 years. Severe surgery-related complications were not observed. Preoperative JOA score, age at the time of surgery, and duration between onset of initial symptoms and surgery affected clinical results.

Conclusions. Mid-term and long-term results of expansive open-door laminoplasty were satisfactory. Considering factors that affected surgical results, early surgery is recommended for OPLL of the cervical spine.

Article Information

Address reprint requests to: Yoshiaki Toyama, M.D., Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, 160–8582, Japan. email: toyama@sc.itc.keio.ac.jp.

© AANS, except where prohibited by US copyright law.

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    Diagrams. a: A line is drawn between the lower posterior edge of C-2 and C-7 (this line is defined as A). Perpendicular lines are drawn from the lower posterior edge of the C3–6 vertebral bodies to this line, and the length of these lines is defined as a1–4. If every Line a1–4 is anterior to A and one of them is longer than 2 mm, the curvature is defined as lordotic. If every Line a1–4 is posterior to A and one of them is longer than 2 mm, the curvature is defined as kyphotic. If every Line a1–4 is less than 2 mm, the curvature is defined as straight. If line a1–4 exist anterior and posterior and one of them is more than 2 mm, the curvature is defined as sigmoid. The degree of curvature is calculated using the Ishihara index: index = (a1 + a2 + a3 + a4)/the length of A. b: Perpendicular lines are drawn from the lower posterior edge of the C3–6 to A, and the length between posterior margin of OPLL on each line and A is defied as Line a′1–4. The degree of curvature including the OPLL region is calculated as follows: index (OPLL) = (a′1 + a′2 ± a′3 + a′4)/the length of A.

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    Bar graph depicting changes in JOA scores and recovery rates. Bl = bladder function; L/E = lower-extremity function; Tr = trunk function; U/E = upper-extremity function.

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    Representative radiographs (a–c) and magnetic resonance image (d) obtained in a 55-year-old man who suffered late-onset deterioration caused by the progression of ossification. In this case, the cervical spine ankylosed at the C2–4 and C5–7 regions separately after surgery, and a 10-mm posterior progression of the ossified ligament was observed at the mobile C4–5 segment. Preoperative upper-extremity JOA and trunk score was 3, which improved to 8 at 1 year; however, it decreased to 5 at 10 years. The images were obtained before (a), 1 year after (b), and 10 years after (c and d) open-door laminoplasty.

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