Posterior Decompression Surgery Research Articles

Decompression surgery for lumbar spinal canal stenosis in octogenarians; a single center experience of 121 consecutive patients

Introduction: With increasing age, ubiquitous degeneration processes lead to a narrowing of the spinal canal. Degenerative lumbar spinal stenosis (DLSS) causes functional disability and is associated with back and lower extremity pain in older individuals. The goal of this study was to determine if decompression surgery can be performed safely and provide a stable benefit in our octogenarian patient population.Methods: In this retrospective study, 121 patients over the age of 80 (mean age: 82.7 years SD: 2.4 years) with the diagnosis of central spinal canal stenosis who underwent posterior decompression surgery without fusion for DLSS between January 2006 and August 2013 were followed up from November to December 2013. Peri- and post-operative complications were recorded. Walking distances and visual analogue scale (VAS) scores were determined before surgery and at follow up time (mean follow up time 36 months). Patient’s satisfaction with treatment was documented with the overall satisfaction degree scale in Zurich Claudicatio Questionnaire (ZCQ).Results: The peri-operative complication rate was 6.6% with five dural tears, two wound infections and one epidural haematoma. Four patients required revision surgery (three re-decompression and one secondary spondylodesis). Walking distance improved from 147 meters (SD ±110 m) to 340 m (SD ±170 m) p < .001. Pain improved with change of the VAS scores from 7.2 (SD ±1.2) to 4.5 (SD ±1.0), p < .001. The overall satisfaction scale in ZCQ was 2.2 at follow up.Conclusion: A minimal surgical intervention, namely decompression, improves walking ability, decreases pain and has marginal potential for complications in patients with DLSS who are over 80 years old.

Patient Satisfaction with Posterior Decompression Surgery for Cervical Ossification of the Posterior Longitudinal Ligament: Prognostic Radiographic Factors and Patient-Reported Outcomes for the Effectiveness of Surgical Treatment

To identify the prognostic factors associated with patient satisfaction after double-door laminoplasty for cervical compression myelopathy due to ossification of the posterior longitudinal ligament (OPLL). The study group comprised 44 patients (30males and 14 females) with OPLL who underwent double-door laminoplasty at our institution with a minimum follow-up of 1 year. The mean patient age was 63.8 years (range, 48-86 years). We evaluated the patients' postoperative satisfaction using a questionnaire and divided them into 2 groups, satisfied and dissatisfied. We assessed various radiographic parameters. The patient-reported outcomes, including the Short Form-36 Physical Component Summary (SF-36 PCS), Neck Disability Index, neck pain, arm pain, and Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), were assessed and used to evaluate the effectiveness of surgical treatment according to the concept of minimum clinically important difference (MCID). The satisfied group comprised 29 patients (65.9%). The dissatisfied group had a higher percentage of hill-shaped ossifications compared with the satisfied group (46.7% vs 17.2%; P= 0.04). The satisfied group had a higher proportion of patients with SF-36 PCS reaching the MCID threshold value (81.8% vs 14.3%; P < 0.01) and with effective surgical treatment as evaluated by the JOACMEQ lower extremity function domain (61.5% vs 10.0%; P < 0.01). Patient satisfaction after laminoplasty was insufficient in patients with a hill-shaped ossification. The patients with OPLL who were able to recognize a difference in their clinical physical function, especially lower extremity function, were satisfied after laminoplasty.

Outcome of posterior decompression with instrumented fusion surgery for K-line (−) cervical ossification of the longitudinal ligament

We investigated the outcome of posterior decompression and instrumented fusion (PDF) surgery for patients with K-line (−) ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, who may have a poor surgical prognosis. We retrospectively analyzed the outcome of a series of 27 patients who underwent PDF without correction of cervical alignment for K-line (−) OPLL and were followed-up for at least 1 year after surgery. We had performed double-door laminoplasty followed by posterior instrumented fusion without excessive correction of cervical spine alignment. The preoperative Japanese Orthopedic Association (JOA) score for cervical myelopathy was 8.0 points and postoperative JOA score was 11.9 points on average. The mean JOA score recovery rate was 43.6%. The average C2–C7 angle was 2.2° preoperatively and 3.1° postoperatively. The average maximum occupation ratio of OPLL was 56.7%. In conclusion, PDF without correcting cervical alignment for patients with K-line (−) OPLL showed moderate neurological recovery, which was acceptable considering K-line (−) predicts poor surgical outcomes. Thus, PDF is a surgical option for such patients with OPLL.

Resection of Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament from a Posterior Approach under Intraoperative Neurophysiological Monitoring for Paralysis after Posterior Decompression and Fusion Surgery.

Study Design Prospective clinical study. Objective Posterior decompression and fusion surgery for beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) generally has a favorable outcome. However, some patients require additional surgery for postoperative severe paralysis, a condition that is inadequately discussed in the literature. The objective of this study was to describe the efficacy of a procedure we refer to as “resection at an anterior site of the spinal cord from a posterior approach” (RASPA) for severely paralyzed patients after posterior decompression and fusion surgery for beak-type T-OPLL. Methods Among 58 consecutive patients who underwent posterior decompression and fusion surgery for beak-type T-OPLL since 1999, 3 with postoperative paralysis (5%) underwent RASPA in our institute. Clinical records, the Japanese Orthopaedic Association score, gait status, intraoperative neurophysiological monitoring (IONM) findings, and complications were evaluated in these cases. Results All three patients experienced a postoperative decline in Manual Muscle Test (MMT) scores of 0 to 2 after the first surgery. RASPA was performed 3 weeks after the first surgery. All patients showed gradual improvements in MMT scores for the lower extremity and in ambulatory status; all could walk with a cane at an average of 4 months following RASPA surgery. There were no postoperative complications. Conclusions RASPA surgery for beak-type T-OPLL after posterior decompression and fusion surgery resulted in good functional outcomes as a salvage surgery for patients with severe paralysis. Advantages of RASPA include a wide working space, no spinal cord retraction, and additional decompression at levels without T-OPLL resection and spinal cord shortening after additional dekyphosis and compression maneuvers. When used with IONM, this procedure may help avoid permanent postoperative paralysis.

A Case of Successful Foraminotomy for Severe Bilateral C5 Palsy following Posterior Decompression and Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament.

We report a very rare (5~7%) case of bilateral C5 palsy after cervical surgery. A 71-year-old male patient with cervical ossification of posterior longitudinal ligament (OPLL) with foraminal stenosis at bilateral C4/5 underwent posterior decompression and fusion surgery. After surgery, muscle weakness in his both deltoid and biceps was detected and gradually deteriorated to complete paralysis. Postoperative MRI showed sufficient decompression of the spinal cord and posterior shifting. Subsequently, an additional bilateral foraminotomy at C4/5 was performed, with a suspicion that bilateral foraminal stenosis at C4/5 may have been the cause of the paresis. After foraminotomy, muscular contraction was seen in both deltoid and biceps. Finally, complete motor recovery was achieved in a year. Although the gold standard procedure for the prevention and treatment of postoperative C5 palsy has not yet been established, an additional foraminotomy may be recommended for severe C5 palsy in cases of foraminal stenosis even after the occurrence of palsy.

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures.

Study DesignRetrospective case-control study.PurposeTo determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach.Overview of LiteratureKissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine.MethodsThe present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica.ResultsStepwise logistic regression revealed kissing spine (p=0.024; odds ratio, 3.80) and foraminal stenosis (p<0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis.ConclusionsWhen a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.

Classification of Chronic Back Muscle Degeneration after Spinal Surgery and Its Relationship with Low Back Pain.

Study DesignRetrospective case series.PurposeTo classify back muscle degeneration using magnetic resonance imaging (MRI) and investigate its relationship with back pain after surgery.Overview of LiteratureBack muscle injury and degeneration often occurs after posterior lumbar surgery, and the degeneration may be a cause of back pain. However, the relationship between back muscle degeneration and back pain remains controversial.MethodsA total of 84 patients (average age, 65.1 years; 38 men, 46 women) with lumbar spinal stenosis underwent posterior decompression surgery alone. MRI (1.5 tesla) was evaluated before and more than a year after surgery in all patients. Muscle on MRI was classified into three categories: low intensity in T1-weighted imaging, high intensity in T2-weighted imaging (type 1), high intensity in both T1- and T2-weighted images (type 2), and low intensity in both T1- and T2-weighted imaging (type 3). The prevalence of the types and their relationship with back pain (determined on a visual analog scale) were evaluated.ResultsMRI revealed muscle degeneration in all patients after surgery (type 1, 6%; type 2, 82%; and type 3, 12%). Type 2 was significantly more frequent compared with types 1 and 3 (p<0.01). Low back pain was significantly improved after surgery (p<0.01). Low back pain was not associated with any MRI type of muscle degeneration after surgery (p>0.05).ConclusionsVarious pathologies of back muscle degeneration after posterior lumbar surgery were revealed. Type 2 (fatty) change was most frequent, and other patients had type 3 (scar) or type 1 (inflammation or water-like) changes. According to the Modic classification of bone marrow changes, Modic type 1 change is associated with inflammation and back pain. However, no particular type of back muscle degeneration was correlated with back pain after surgery.

Surgical Outcomes of the Ossification of the Posterior Longitudinal Ligament According to the Involvement of the C2 Segment

The complex structure around the upper cervical spine makes surgical treatment difficult. the present study aimed to analyze how patients with ossification of the longitudinal ligament (OPLL) involving the C2 were managed and to compare the surgical outcomes according to the C2 involvement. Ninety-five patients with cervical OPLL who underwent surgical treatment were divided into C2 involvement (C2+ group, 40 patients) or none (C2- group, 55 patients). In the C2+ group, subanalysis was conducted to according to the C2 surgery (C2 surgery+ group, 14 patients). All patients had a minimum of 1 year of follow-up with a mean of 51.36 months. The most common location of the narrowest space available for the spinal cord was C2 and C5 in the C2+ and C2- groups, respectively. In the C2+ group, a longer OPLL with thickened diameter was radiographically demonstrated, but clinical outcomes were not different from the C2- group. In the C2 surgery+ group, the narrowest spinal cord was common in the C2 (50.0%), and an extension of the signal change of spinal cord to the C2 was observed in 4 patients, showing a statistical difference. C2 surgery was performed in all patients using the posterior approach and it did not result in different clinical outcomes or surgery-related complications. An anterior surgical approach was deemed risky given the chance of the development of complications. Both of C2 involvement from OPLL and surgery including the C2 did not affect clinical outcomes. The posterior decompressive surgery is safer and more effective than the anterior approach regarding the development of surgery-related complications.

Efficacy of Posterior Segmental Decompression Surgery for Pincer Mechanism in Cervical Spondylotic Myelopathy

Retrospective case-controlled study using propensity score matching. We aimed to evaluate the efficacy of cervical microendoscopic laminoplasty (CMEL) of the articular segment in patients with cervical spondylotic myelopathy (CSM) by comparing the clinical results of CMEL with conventional expansive laminoplasty (ELAP) for CSM. A total of 259 patients undergoing CMEL or ELAP surgery for CSM at authors' institute were reviewed. The patients were matched according to calculated propensity scores in a logistic regression model adjusted for age, sex, and preoperative severity of disorders and divided into the CMEL and ELAP groups. All patients were followed postoperatively for more than 2 years. The preoperative and 2-year follow-up evaluations included neurological assessment (Japanese Orthopaedic Association [JOA] score), recovery rates, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), axial pain (visual analog scale), and the Short Form 36 questionnaire (SF-36). There were 71 patients in each group (47 males and 24 females each). The mean ages of the CMEL and ELAP groups were 63.8 and 62.8 years, respectively. There was no significant difference in the preoperative JOA score between groups. The mean numbers of surgically affected levels in the ELAP and CMEL groups were 3.2 and 1.8 discs, respectively (P ≤ 0.05). The groups exhibited similar recoveries of JOA, JOACMEQ, and SF-36 scores postoperatively. Sagittal alignment was maintained in both groups. However, postoperative neck axial complaints were significantly reduced in the CMEL group. CMEL may be a useful and effective surgical procedure for CSM, providing similar results as ELAP. CMEL for CSM is indicated for posterior decompression of the articular segment along with a pincer mechanism. This minimally invasive technique may have potential advantages compared with conventional ELAP, and may provide an alternative surgical option. 4.

Manual muscle test at C5 palsy onset predicts the likelihood of and time to C5 palsy resolution

The primary objective of this study was to identify time to and prognostic factors of C5 palsy resolution. All patients over a 7year period who experienced C5 palsy following a posterior decompression and instrumented fusion surgery were retrospectively reviewed. C5 palsy resolution was defined as a recovery of deltoid muscle function equal to or greater than the preoperative condition as defined by the manual muscle test (MMT). Of the 511 patients who met the selection criteria, 8.6% (n=44) experienced C5 palsy. MMT information was available for 43 patients; 81.4% (n=35) had full resolution from their condition. Of the 35 patients who resolved, the median MMT score at onset was 3−. Following a discrete-time proportional hazards model, the hazards of C5 palsy resolution increased by 19% for every one-grade increase in MMT score at symptom onset (hazard ratio [HR]=1.19, p=0.005). Moreover, males displayed a 71% lower hazard of resolution than females (HR=0.29, p=0.003). Following an adjusted Kaplan–Meier analysis, the median time to C5 palsy resolution was between 6months and 1year. In a multiple linear regression, a lower MMT score at the onset of C5 palsy predicted a longer time to C5 palsy resolution (coefficient=−0.19, p=0.003). Time to C5 palsy onset was not statistically associated with hazards of palsy resolution (p=0.381) or time to resolution (p=0.121). A higher MMT score at the onset of C5 palsy statistically significantly predicted a higher chance of resolution and a shorter recovery time. Female sex was also associated with a higher hazard of resolution.

Histological study of the occipital bone from patients with Chiari I malformation.

This study is focused on the histologic characteristics of occipital bone removed during Chiari I decompression in the hope of discovering unique features that may be related to the pathogenesis of this condition. Ten consecutive pediatric patients with Chiari I malformation underwent standard posterior fossa decompression surgery. Bone that was removed from the posterior fossa was sent for histological examination. Bone from age-matched controls also underwent histological analysis. For all study and control specimens, bony samples were found to be made up of dense lamellar bone without marrow elements. In all aspects, histologically, the bone tissue had a normal appearance compared to control samples. Although many authors have mentioned that the occipital bone in patients with Chiari I malformation is abnormal on imaging or at operation (e.g., thinned, thickened), based on our study, there is no histological difference between the occipital bone removed at operation and controls.

Surgical Treatment of Cervical Spondylotic Myelopathy Associated Hypertension--A Retrospective Study of 309 Patients.

Hypertension is the most prevalent cardiovascular disease, and various risk factors are known to be involved in it. Cervical spondylotic myelopathy (CSM) is the most common non-traumatic cause of myelopathy, which displays neurological symptoms and may induce systemic symptoms. To date, it is still unknown whether CSM is associated with hypertension, and if so, whether the decompression operations can attenuate CSM associated hypertension. Here, a total of 309 patients with CSM who received anterior or posterior decompression surgery were enrolled as subjects. Blood pressure measurements were performed before and within one week after the surgery. Among the 309 subjects, 144 (46.6%) of them exhibited hypertension before surgery, a significantly higher ratio than that of the whole population. One week after surgery, blood pressure of 106 (73.6%) patients turned back to normal. Blood pressure of another 37(25.7%) patients decreased with different degrees, although still higher than normal. Moreover, it appears that both approaches were effective in improving blood pressure, while the posterior approach was more effective in decreasing systolic blood pressure. We speculate this type of hypertension might result from hyperactivity of sympathetic nervous system as the heart rate of these patients decreased after surgery as well. Collectively, compression of spinal cord in CSM patients might be associated with hypertension, and decompression surgery largely attenuated this type of hypertension. These findings prove CSM to be a potential associated factor of high blood pressure and may shed light on therapies of hypertension in clinics.

NEW APPROACHES TO SURGICAL TREATMENT OF RECURRENT LUMBAR INTERVERTEBRAL DISC HERNIATION

Objective. To assess feasibility of the proposed anterior decompression and stabilization surgery without meningoradiculolysis for recurrent herniation of the lumbar intervertebral disc. Material and Methods . Prospective randomized controlled study involved comparative evaluation of two essentially different surgical interventions performed in 130 patients with recurrent disc herniation during 2005-2012. The control group included 62 patients who underwent posterior decompression and stabilization surgery with meningoradiculolysis for the removal of herniated disc. The study group included 68 patients who underwent the proposed anterior decompression and stabilization surgery, which differs by an obligate opening of the spinal canal and intervertebral foramen to remove the disc herniation through an anterior approach without meningoradiculolysis. Results . Immediate results of anterior and posterior decompression and stabilization operations are comparable, though posterior interventions are more frequently associated with iatrogenic injury to posterior nerve roots caused by intervertebral implant insertion and meningoradiculolysis required before the disc herniation removal. Long-term outcomes of anterior operations are reliably better. Conclusion . Anterior decompression and stabilization operations for recurrent disc herniation compare favorably to posterior ones, since they are less traumatizing to the nerve roots and prevent herniation recurrence and epidural fibrosis progression.

Clinical results and limitations of indirect decompression in spinal stenosis with laterally implanted interbody cages: results from a prospective cohort study

The lateral approach for anterior interbody fusion allows placement of a large footprint intervertebral spacer to indirectly decompress the neural elements through disc height restoration and resultant soft tissue changes. However, it is not well understood under what circumstances indirect decompression in lateral approach surgery is sufficient. This report aimed to evaluate clinical scenarios where indirect decompression was and was not sufficient in symptom resolution when using lateral interbody fusion. A prospective study was undertaken of 122 consecutive patients treated with lateral interbody fusion without direct decompression. Pre- and postoperative symptomatology was assessed to evaluate the extent of neural decompression following implantation with a lateral polyetheretherketone spacer. Failure to improve or resolve preoperative radicular pain was considered a failure of indirect decompression and indicated these patients for additional posterior decompressive surgery. Unplanned second stage decompression was required in 11 patients. Of these patients, 7/11 early in this series had pathology that was underappreciated including spondylolisthesis from high grade facet arthropathy with instability (3), bony lateral recess stenosis (3) and both spondylolisthesis/stenosis (1). Three patients had iatrogenic leg pain through cage misplacement. There was one failure of indirect decompression that could not be explained through retrospective analysis of the patient's record. Indirect decompression clearly has a role in minimizing the amount of surgery that is required. However, it is important to consider the circumstances where this technique may be effective and preoperative considerations that may improve patient selection.

A very rare complication of the posterior fossa decompression surgery: lumbar pneumorrhachis

A 33-year-old man referred to our radiology department with severe low back pain for 3 weeks. He underwent a posterior fossa decompression surgery because of the presence of the Arnold-Chiari malformation 1 month ago. Thus, the patient underwent computed tomography imaging examinations to understand the possible causes of the low back pain. Posterior lamina of the first cervical vertebrae and posteroinferior part of the occipital bone of the skull has been removed to relieve pressure (Figure, Left).

Cervical myelopathy: Posterior decompression and fusion

Posterior cervical decompression and fusion with instrumentation is a well-proven surgical option for patients with multilevel cervical spondylotic myelopathy with or without radiculopathy. With appropriate preoperative workup and patient selection, the majority of patients with cervical spondylotic processes achieve good or excellent results with posterior decompression and fusion surgery. Posterior decompression and fusion techniques are technically demanding operations that should be performed by surgeons who are familiar with the appropriate techniques and possible complications.

Classification of Chronic Back Muscle Degeneration after Spinal Surgery, and Its Relationship to Low Back Pain

Introduction Back muscle injury and degeneration often occurs after posterior lumbar surgery, and back muscle degeneration may be a cause of back pain after surgery. However, the relationship between back muscle degeneration and back pain remains controversial. In the current study, we aimed to classify back muscle degeneration using MRI and investigate its relationship with back pain after surgery. Materials and Methods A total of 84 patients (average age: 65.1 years, 38 men, 46 women) with lumbar spinal stenosis underwent only posterior decompression surgery. MRI (1.5 T) was evaluated before and more than a year after surgery in all patients. Muscle on MRI was classified into three categories: low intensity in T1-weighted image, high in T2-weighted image (type 1), high in both T1- and T2-weighted images (type 2), and low in both T1- and T2-weighted images (type 3). The proportion of types and their relationship with back pain (visual analog scale: VAS) was evaluated. Results MRI revealed muscle degeneration in all patients after surgery (type 1: 6%, type 2: 82%, and type 3: 12%). Type 2 was significantly frequent as compared with types 1 and 3 ( p &lt; 0.01). Low back pain before surgery (average: VAS 7.5) significantly improved after surgery (average: VAS 2.0) ( p &lt; 0.01). Low back pain was not associated with any muscle degeneration MRI types after surgery ( p &gt; 0.05). Conclusion The current study showed the pathology of back muscle degeneration was various after posterior lumbar surgery. Type 2 (fatty change) was most frequent, and some patients were classified into type 3 (scar change), and type 1 (inflammation or water-like change). Modic classification is used for bone marrow change, and type 1 is associated with inflammation and back pain. However, no type of back muscle degeneration was correlated with back pain after surgery. Disclosure of Interest None declared

Morphological Characteristics of Cervical Spine in Patients With Athetoid Cerebral Palsy and the Accuracy of Pedicle Screw Placement

A retrospective study. To investigate the morphology of the cervical spine in patients with athetoid cerebral palsy (CP), and to evaluate its relationship with the breach of cervical pedicle screws. Cervical pedicle screws have been increasingly used in surgery for patients with CP, but screw misplacement is not uncommon. Although the altered morphology of the cervical spine in patients with CP may result in this high breach rate, few studies have examined the cervical pedicle profile. We retrospectively analyzed 31 patients with cervical myelopathy with CP, as well as 30 patients with cervical spondylotic myelopathy (CSM), who underwent posterior decompression surgery. The pedicle outer diameter, inner diameter, transverse angle and lateral mass deformity were investigated by obtaining preoperative computed tomographic scans. The accuracy of the placement of 56 pedicle screws used in fusion surgery for 12 patients with CP was also analyzed using postoperative computed tomographic scans. The outer diameter of the pedicle in CP was in the range from 3.3 to 9.6 mm, and was larger than that in CSM at all cervical levels except for C7. Pedicle sclerosis was more frequently observed in CP than in CSM (23% vs. 7.3%, P < 0.001). The transverse angle at C3 and C4 was larger, and lateral mass deformity was more frequently observed in CP than in CSM. The critical breach of pedicle screws in CP was found in 29%. A multivariate analysis revealed that pedicle sclerosis was associated with an increased risk of breach (odds ratio: 6.3; 95% confidence interval: 1.03-39.0; P = 0.047). The pedicle diameter in patients with CP was relatively large, but pedicle sclerosis, a wide transverse angle and lateral mass deformity were frequently observed. Sclerotic pedicles were associated with a higher risk of critical breach. N/A.

Depression contributed an unsatisfactory surgery outcome among the posterior decompression of the cervical spondylotic myelopathy patients: a prospective clinical study

Posterior decompression surgery was performed on 610 patients (mean age 62 years) with clinically and radiologically defined cervical spondylotic myelopathy (CSM) at Tianjin Medical University General Hospital, between October 2007 and October 2011. After 2-year follow-up, we had a full data sets from 396 patients with normal mood or continued depression during the whole process to be compared. Depression was assessed with the 21-item Beck Depression Inventory. Physical functioning and pain were assessed with the modified Japanese Orthopedic Association (mJOA) scoring system, neck disability index (NDI), and visual analog scale (VAS). There were statistically significant differences from baseline to 2-year follow-up between normal mood (n = 258) and continuous depression (n = 138) groups in mJOA score (6.76 ± 3.12 vs. 1.42 ± 0.56, respectively; p < 0.01), VAS (23.85 ± 20.79 vs. 16.08 ± 19.76, respectively; p < 0.01), and NDI (21.11 ± 11.36 vs. 7.31 ± 2.18; p < 0.05). The adverse consequences of depression are supported by previous findings that patients with depression suffer more unsatisfactory surgery outcome than the patients with normal mood. We emphasize that patients with continuous depression show poorer improvement after posterior decompression in CSM patients with respect to symptom severity, pain intensity, and the disability score than patients without depression at any stage.

Does intramedullary signal intensity on MRI affect the surgical outcomes of patients with ossification of posterior longitudinal ligament?

ObjectivesPatients with cervical ossification of posterior longitudinal ligament (OPLL) are susceptible to cord injury, which often develops into myelopathic symptoms. However, little is known regarding the prognostic factors that are involved in minor trauma. We evaluated the relationship between minor trauma and neurological outcome of OPLL and investigated the prognostic factors with a focus on compressive factors and intramedullary signal intensity (SI).MethodsA total of 74 patients with cervical myelopathy caused by OPLL at more than three-levels were treated with posterior decompression surgeries. We surveyed the space available for spinal cord (SAC), the severity of SI change on T2-weighted image, and diabetes mellitus (DM). The neurological outcome using Japanese Orthopedic Association (JOA) scale was assessed at admission and at 12-month follow-up.ResultsAmong the variables tested, preoperative JOA score, severity of intramedullary SI, SAC, and DM were significantly related to neurological outcome. The mean preoperative JOA were 11.3±1.9 for the 41 patients who did not have histories of trauma and 8.0±3.1 for the 33 patients who had suffered minor traumas (p<0.05). However, there were no significant differences in the recovery ratios between those two groups.ConclusionsInitial neurological status and high intramedullary SI in the preoperative phase were related to poorer postoperative outcomes. Moreover, the patients with no histories of DM and larger SACs exhibited better improvement than did the patients with DM and smaller SACs. Although the initial JOA scores were worse for the minor trauma patients than did those who had no trauma prior to surgery, minor trauma exerted no direct effects on the surgical outcomes.