Ossification of the posterior longitudinal ligament - Results of anterior cervical decompression and arthrodesis in sixty-one North American patients

被引:63
作者
Belanger, TA [1 ]
Roh, JS [1 ]
Hanks, SE [1 ]
Kang, JD [1 ]
Emery, SE [1 ]
Bohlman, HH [1 ]
机构
[1] Case Western Reserve Univ, Univ Hosp, Spine Inst, Sch Med, Cleveland, OH 44106 USA
关键词
D O I
10.2106/JBJS.C.01711
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Ossification of the posterior longitudinal ligament is commonly associated with cervical myelopathy. Surgical treatment is a matter of controversy. We report on a series of patients who were managed with anterior cervical decompression and arthrodesis for the treatment of cervical myelopathy associated with ossification of the posterior longitudinal ligament. Methods: We retrospectively reviewed the records for all sixty-five patients who had been managed with anterior decompression and arthrodesis for the treatment of cervical ossification of the posterior longitudinal ligament and associated neurologic compression from 1982 to 2001. Sixty-one patients (thirty-nine men and twenty-two women) were followed for at least two years (or until the time of death). The average number of vertebrae resected was 2.2. The average duration of follow-up for the sixty surviving patients was four years (range, two years to fifteen years and four months). The preoperative, six-week postoperative, and final follow-up clinical status (including neurological function as assessed with the Nurick grading system) was recorded for each patient. Results: Fifty-six of the sixty-one patients had neurological improvement, with an average improvement of 1.5 Nurick grades at the time of the final follow-up. Eight patients had absent dura at the time of surgery and, of these, five had development of a cerebrospinal fluid fistula. Eight patients had development of new neurological signs and/or symptoms in the upper extremity postoperatively. Eight patients required reoperation because of a painful pseudarthrosis (one patient), strut-graft dislodgment (three), cerebrospinal fluid leakage (three), or compression of a nerve root caudad to the area of the original procedure (one). One patient died as the result of cardiac arrest on the third postoperative day. Fifty-eight patients had an osseous fusion, one had an asymptomatic nonunion, and one had a symptomatic pseudarthrosis that was treated with revision surgery. Conclusions: Anterior decompression and arthrodesis is an effective way to achieve pain relief and neurological improvement in North American patients of non-Asian descent who have cervical myelopathy associated with ossification of the posterior longitudinal ligament. The risk of durocutaneous fistula, graft dislodgment, and postoperative neurological symptoms appears to be high in patients with cervical myelopathy associated with this condition.
引用
收藏
页码:610 / 615
页数:6
相关论文
共 21 条
[1]   ANTERIOR DECOMPRESSION FOR OSSIFICATION OF THE POSTERIOR LONGITUDINAL LIGAMENT OF THE CERVICAL-SPINE [J].
ABE, H ;
TSURU, M ;
ITO, T ;
IWASAKI, Y ;
KOIWA, M .
JOURNAL OF NEUROSURGERY, 1981, 55 (01) :108-116
[2]  
Belanger T A, 2001, J Am Acad Orthop Surg, V9, P258
[3]   Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy - Two to seventeen-year follow-up [J].
Emery, SE ;
Bohlman, HH ;
Bolesta, MJ ;
Jones, PK .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1998, 80A (07) :941-951
[4]   UPPER-AIRWAY OBSTRUCTION AFTER MULTILEVEL CERVICAL CORPECTOMY FOR MYELOPATHY [J].
EMERY, SE ;
SMITH, MD ;
BOHLMAN, HH .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1991, 73A (04) :544-551
[5]   THE SURGICAL-MANAGEMENT OF OSSIFICATION OF THE POSTERIOR LONGITUDINAL LIGAMENT IN 43 NORTH AMERICANS [J].
EPSTEIN, NE .
SPINE, 1994, 19 (06) :664-672
[6]   OSSIFICATION OF THE POSTERIOR LONGITUDINAL LIGAMENT IN EVOLUTION IN 12 PATIENTS [J].
EPSTEIN, NE .
SPINE, 1994, 19 (06) :673-681
[7]   Identification of ossification of the posterior longitudinal ligament extending through the dura on preoperative computed tomographic examinations of the cervical spine [J].
Epstein, NE .
SPINE, 2001, 26 (02) :182-186
[8]   CERVICAL-SPINE STENOSIS SECONDARY TO OSSIFICATION OF THE POSTERIOR LONGITUDINAL LIGAMENT [J].
HARSH, GR ;
SYPERT, GW ;
WEINSTEIN, PR ;
ROSS, DA ;
WILSON, CB .
JOURNAL OF NEUROSURGERY, 1987, 67 (03) :349-357
[9]   ANTERIOR CERVICAL VERTEBRECTOMY AND INTERBODY FUSION FOR MULTI-LEVEL SPONDYLOSIS AND OSSIFICATION OF THE POSTERIOR LONGITUDINAL LIGAMENT [J].
KOJIMA, T ;
WAGA, S ;
KUBO, Y ;
KANAMARU, K ;
SHIMOSAKA, S ;
SHIMIZU, T .
NEUROSURGERY, 1989, 24 (06) :864-872
[10]   Hypertrophy of the posterior longitudinal ligament is a prodromal condition to ossification - A cervical myelopathy case report [J].
Kondo, S ;
Onari, K ;
Watanabe, K ;
Hasegawa, T ;
Toguchi, A ;
Mihara, H .
SPINE, 2001, 26 (01) :110-114