Abstract
ObjectiveTo explore the clinical efficacy of posterior LFF for cervical OPLL with radicular pain of upper limbsMethodsBetween January 2014 and January 2018, 48 OPLL patients with radicular pain symptoms of upper limbs who underwent a one-stage posterior laminectomy and instrumented fusion with/without foraminotomy were reviewed retrospectively and divided into two groups: LF group (laminectomy with instrumented fusion without foraminotomy) and LFF group (laminectomy with instrumented fusion and foraminotomy). Clinical data were assessed and compared between the two groups. The radicular pain of upper limbs and neck was measured using the visual analog scale (VAS). The neurological function was evaluated with the American Spinal Injury Association (ASIA) scale. Changes of sagittal alignment were investigated by postoperative plain x-ray or computed tomography (CT). Moreover, the decompression of the spinal cord was evaluated based on postoperative MRI.ResultsAll the 48 patients were followed up for 24–42 months with an average follow-up time of 31.1±5.3 months. A total of 56 cervical intervertebral foramens were enlarged in 48 patients, including 40 cases (83.3%) with 1 intervertebral foramen enlargement and 8 cases (16.7%) with 2 intervertebral foramen enlargements. There were no significant differences in intraoperative blood loss, postoperative drainage amount, Japanese Orthopaedic Association (JOA) scores, JOA recovery rates, VAS scores for neck pain, and ASIA grade between two groups. The mean operative time was shorter in the LF group compared with the LFF group. The VAS score for arm pain was significantly lower while the surgical duration was longer in group B. No statistical difference was observed between the two groups in terms of C2–C7 SVA, cervical lordosis, focal angulation at the foraminotomy segment, and local spinal cord angle. Compared with the LF group, there was no segmental kyphosis or instability where the additional posterior foraminotomy was performed in the LFF group.ConclusionsOne-stage posterior LFF can achieve satisfied clinical efficacy in improving neurological function and relieving the radicular pain of the upper limbs for OPLL patients with radiculopathy symptoms.
Highlights
Ossification of the posterior longitudinal ligament (OPLL) is a multifactorial disease manifesting as an ectopic bone formation of the posterior longitudinal ligament that causes reduced range of cervical motion and spinal cord compression [1, 2]
We performed the posterior laminectomy with instrumented fusion and foraminotomy (LFF), which can simultaneously achieve the decompression of the spinal cord and the corresponding nerve root
The inclusion criteria were as follows: (1) patients were followed-up more than 24 months, (2) patients suffered myelopathy and radiculopathy due to foraminal stenosis according to magnetic resonance imaging (MRI) or computed tomography (CT), (3) patients were treated by LF or LFF for decompression, (4) the K-line was negative
Summary
Ossification of the posterior longitudinal ligament (OPLL) is a multifactorial disease manifesting as an ectopic bone formation of the posterior longitudinal ligament that causes reduced range of cervical motion and spinal cord compression [1, 2]. Most OPLL patients suffer both myelopathy symptoms and radiculopathy pain of the upper limbs [10]. For these patients, traditional laminectomy with instrumented fusion (LF) cannot achieve effective decompression of nerve root, or even aggravate the radiculopathy symptoms and tension of nerve root due to the backward drift of the spinal cord. Kudo et al [11] reported a case of successful foraminotomy for severe bilateral C5 palsy following posterior decompression and fusion surgery for cervical OPLL. The purpose of our study is to compare retrospectively the clinical and imaging outcomes using LFF and LF for OPLL patients with myelopathy symptoms and radiculopathy pain
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