Abstract
This prospective multicenter study, established by the Japanese Ministry of Health, Labour and Welfare and involving 27 institutions, aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL), in order to address the controversy surrounding the role of instrumented fusion in cases of posterior surgical decompression for OPLL. 478 patients were considered for participation in the study; from among them, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, there were no significant differences among the participants in terms of patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments. The overall risk of perioperative complications was found to be lower with LM (odds ratio [OR] 0.40, p = 0.006), and the rate of C5 palsy occurrence was significantly lower with LM (OR 0.11, p = 0.0002) than with PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients who had PF was significantly smaller than in those who had LM. However, multivariable logistic regression analysis showed no significant difference among the participants in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in the LM group than in the PF group (OR 2.73, p = 0.0002). Both LM and PF for cervical myelopathy due to OPLL had resulted in comparable postoperative outcomes at 2 years after surgery.
Highlights
Sho Kobayashi[22], Satoshi Kato[23], Tetsuro Ohba[24], Satoshi Inami[25], Shunsuke Fujibayashi[26], Hiroyuki Katoh[27], Haruo Kanno[28], Yuanying Li29, Hiroshi Yatsuya[29,30], Masao Koda[8], Yoshiharu Kawaguchi[31], Katsushi Takeshita[9], Morio Matsumoto[14], Masashi Yamazaki[8], Atsushi Okawa2 & Japanese Multicenter Research Organization for Ossification of the Spinal Ligament*. This prospective multicenter study, established by the Japanese Ministry of Health, Labour and Welfare and involving 27 institutions, aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL), in order to address the controversy surrounding the role of instrumented fusion in cases of posterior surgical decompression for OPLL. 478 patients were considered for participation in the study; from among them, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements
Concerning comorbidities, there was no significant difference between the two groups with regard to diabetes mellitus, hypertension, malignancy, myocardial infarction, or collagen disease, the frequency of cerebrovascular disease was higher in the LP group than in the PF group (7.4% and 1.4%, respectively, p = 0.04)
The two exceptions were the bladder function score in JOACMEQ, which was significantly higher in the PF group than in the LP group (mean of 79.7 (33.6) compared with 72.8 (20.5); p = 0.03) and visual analog scale (VAS) pain or numbness level in the arms or hands in JOACMEQ, which was significantly higher in the PF group than in the LP group (mean (SD) of 68.0 (32.8) compared with 59.9 (32.4); p = 0.048)
Summary
Hiroaki Nakashima1*, Shiro Imagama[1], Toshitaka Yoshii[2], Satoru Egawa[2], Kenichiro Sakai[3], Kazuo Kusano[4], Yukihiro Nakagawa[5], Takashi Hirai[2], Kanichiro Wada[6], Keiichi Katsumi[7], Kengo Fujii[8], Atsushi Kimura[9], Takeo Furuya[10], Tsukasa Kanchiku[11], Yukitaka Nagamoto[12], Yasushi Oshima[13], Narihito Nagoshi[14], Kei Ando[1], Masahiko Takahata[15], Kanji Mori[16], Hideaki Nakajima[17], Kazuma Murata[18], Shunji Matsunaga[19], Takashi Kaito[20], Kei Yamada[21], Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi‐cho, Itogun, Wakayama 649‐7113, Japan. 6Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori 036‐8562, Japan. 7Department of Orthopaedic Surgery, Niigata University Medicine and Dental General Hospital, 1‐754 Asahimachidori, Chuo Ward, Niigata, Niigata 951‐8520, Japan. 8Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1‐1‐1 Tennodai, Tsukuba, Ibaraki 305‐8575, Japan. 9Department of Orthoaedics, Jichi Medical University, 3311‐1 Yakushiji, Shimotsuke, Tochigi 329‐0498, Japan. 10Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1‐8‐1 Inohana, Chuo Ward, Chiba, Chiba 260‐8670, Japan. 11Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, 111 Minami Kogushi, Ube, Yamaguchi 755‐8505, Japan. 12Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179‐3 Nagasonecho, Sakaishi, Osaka 591‐8025, Japan. 13Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7‐3‐1 Hongo, Bunkyo‐ku, Tokyo 113‐0033, Japan. 14Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku Ward, Tokyo 160‐8582, Japan. 15Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Sapporo 060‐8638, Japan. 16Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa‐cho, Seta, Otsu, Shiga 520‐2192, Japan. 17Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23‐3 Matsuoka Shimoaizuki, Eiheiji‐cho, Yoshida‐gun, Fukui 910‐1193, Japan. 18Department of Orthopaedic Surgery, Tokyo Medical University, 6‐7‐1 Nishishinjuku, Shinjuku‐ku, Tokyo 160‐0023, Japan. 19Department of Orthopaedic Surgery, Imakiire General Hospital, 4‐16 Shimotatsuocho, Kagoshimashi 892‐8502, Japan. 20Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2‐2 Yamadaoka, Suita‐shi, Osaka 565‐0871, Japan. 21Department of Orthopaedic Surgery, Kurume University School of Medicine, 67 Asahi‐machi, Kurume‐shi, Fukuoka 830‐0011, Japan. 22Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1‐20‐1 Handayama, Hamamatsu, Shizuoka 431‐3125, Japan. 23Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13‐1 Takara‐machi, Kanazawa 920‐8641, Japan. 24Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo Ward, Yamanashi 409‐3898, Japan. 25Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu‐machi, Shimotsuga‐gun, Tochigi 321‐0293, Japan. 26Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara‐cho, Shogoin, Sakyo‐ku, Kyoto 606‐8507, Japan. 27Department of Orthopaedic. This prospective multicenter study, established by the Japanese Ministry of Health, Labour and Welfare and involving 27 institutions, aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL), in order to address the controversy surrounding the role of instrumented fusion in cases of posterior surgical decompression for OPLL. OPLL progression was greater in the LM group than in the PF group (OR 2.73, p = 0.0002) Both LM and PF for cervical myelopathy due to OPLL had resulted in comparable postoperative outcomes at 2 years after surgery. Surgical decompression is indicated in cases of moderate and severe myelopathy (modified Japanese Orthopaedic Association (JOA) score ≤ 14)[3]; patients with OPLL are at a higher risk of perioperative complications than patients with other forms of DCM4. The objective of the present study was to compare postoperative outcomes between LP and PF for cervical OPLL in a propensity score-matched analysis adjusted for baseline factors and radiographical characteristics of spinal cord compression
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