Impact of preoperative cervical sagittal alignment for cervical myelopathy caused by ossification of the posterior longitudinal ligament on surgical treatment |
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| Institution: | 1. Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Japan;2. Department of Orthopedic Surgery, Tokyo Medical and Dental University, Japan;1. Jichi Medical University Hospital Life Saving Emergency Center,Shimotsuke, Japan;2. Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan;3. Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan;1. Y?ld?r?m Beyaz?t University Faculty of Medicine, Ankara City Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Turkey;2. Y?ld?r?m Beyaz?t University Faculty of Medicine, Ankara City Hospital, Department of Radiology, Ankara, Turkey;3. Ankara City Hospital, Department of Orthopedics and Traumatology, 06000, Ankara, Turkey;1. Shinoro Orthopedic, 4-5-3-9, Shinoro, Kita-ku, Sapporo, Hokkaido, Japan;2. Graduate School of Health Sciences, Hirosaki University, 66-1, Honcho, Hirosaki-city, Aomori, 036-8564, Japan;3. Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte-city, Saitama, 340-0145, Japan;4. Department of Physical Therapy, Kakeyu Hospital, 1308, Kakeyuonsen, Ueda-city, Nagano, 386-0396, Japan;1. Istanbul University-Cerrahpasa, Institute of Graduate Studies, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey;2. Istanbul University-Cerrahpasa, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey;3. Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey;1. Department of Orthopedics, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, USA;2. Midwestern University College of Osteopathic Medicine, 19555 N 59th Ave, Glendale, AZ, 85308, USA;3. Department of Orthopedics, Phoenix Children Hospital, Phoenix, 1919 E Thomas Rd, Phoenix, AZ, 85016, USA;1. Nagayama Rheumatology and Orthopaedic Clinic, 4-3-25 Hiokisounishi-machi, Higashi-ku, Sakai, 599-8114, Japan;2. Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan;3. Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan;4. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan;5. Department of Rheumatology, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan;6. Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan;7. Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan |
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| Abstract: | BackgroundSurgical procedures for cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) are often chosen based on OPLL size and cervical spine alignment. Recently, cervical sagittal alignment based on sagittal vertical axis (SVA) has received increased attention as an important determinant of radiological and clinical outcomes after surgery. This study aimed to investigate the impact of SVA-based cervical sagittal alignment on surgical treatment for cervical OPLL by reviewing a previous retrospective cohort in which its concept was not taken into account in the surgical procedure choices.MethodsWe reviewed a total of 96 consecutive patients who underwent surgery for cervical myelopathy caused by OPLL from 2008 to 2014. We performed anterior decompression with fusion (ADF) or posterior decompression with fusion (PDF) on patients with massive OPLL or kyphotic alignment, and we performed laminoplasty (LAMP) on patients without massive OPLL or kyphotic alignment. CSVA (center of gravity of the head - C7 SVA), CL (C2-7 lordotic angle) and C7 slope were measured in cervical X-ray at standing position. Clinical results were evaluated using C-JOA score. We divided patients into two subgroups based on the preoperative CSVA: the Low-CSVA (CSVA <40 mm) and High-CSVA (CSVA ≥40 mm) subgroups.ResultsIn the Low-CSVA subgroup, none of the three operations had an effect on the CL. In contrast, in the High-CSVA subgroup, while ADF and PDF had no effect on the CL, LAMP worsened the CL postoperatively. The recovery rates of the C-JOA scores in the Low-CSVA subgroup showed no significant differences among the three operations; however in the High-CSVA subgroup, LAMP resulted in worse recovery rate of the C-JOA score than ADF or PDF.ConclusionsLAMP is not suitable for patients with cervical myelopathy caused by OPLL who have high CSVA alignment, even in cases without massive OPLL or kyphotic alignment. |
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