Comparison of outcomes in open-door laminoplasty versus laminectomy and instrumented fusion in patients with ossification of the posterior longitudinal ligament involving multiple levels
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20254200Keywords:
Ossification of the posterior longitudinal ligament, Laminoplasty, Laminectomy, Continuous and mixed type of OPLLAbstract
Background: This study aims to determine, in cases of multi-level ossification of the posterior longitudinal ligament (OPLL), expansive open-door laminoplasty (LP) is a better option than laminectomy and instrumented fusion (LMF).
Methods: A total of 44 cases were included and divided into group LP (n=22) and group LMF (n=22). Patients, who underwent surgical treatment for continuous and mixed type multi-level OPLL between January 2010- December 2021 were retrospectively reviewed. The cervical lordosis was evaluated by C2-7 Cobb angle and cervical sagittal balance by C2-C7 sagittal vertical axis (SVA). Range of motion (ROM), Japanese Orthopedic Association (JOA), visual analog scale (VAS) and neck disability index (NDI) were used to assess clinical outcomes.
Results: The LP group had significantly lower blood loss (280±50 ml vs. 450±70 ml) and shorter operative time (120±15 min vs. 160±20 min) compared to LMF. LP preserved cervical lordosis (4±1.5° vs. 7±2°, p=0.001) and ROM (8±2° vs. 14±3°, p=0.003) more effectively. NDI improvement was greater in the LP group (27±5 vs. 20±6, p=0.021). OPLL progression was higher in LP (1.2±0.3 mm vs. 0.5±0.2 mm, p=0.017). LP was associated with higher postoperative kyphosis (32% vs. 14%, p=0.038) and kyphotic change rate (28% vs. 10%, p=0.029), but lower incidence of axial pain (14% vs. 27%, p=0.043).
Conclusions: Compared with the LMF, the LP is recommended for cases with OPLL and straight cervical lordosis ensuring comparable neurological recovery, improved neck ROM, less axial pain and better neck function improvement. The stabilization obtained by adding instrumented fusion could suppress progression of OPLL thickness.
References
Le HV, Wick JB, Van BW, Klineberg EO. Ossification of the Posterior Longitudinal Ligament: Pathophysiology, Diagnosis, and Management. J Am Acad Orthop Surg. 2022;30(17):820-30.
Kwok SSS, Cheung JPY. Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches. BMC Musculoskelet Disord. 2020;21(1):823.
Park S, Lee DH, Lee C, Hwang CJ, Yang JJ, Cho JH. Anterior Decompression and Fusion for the Treatment of Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament: A Narrative Review. Asian Spine J. 2023;17(3):582-94.
Yoshii T. Anterior Cervical Decompression for Cervical OPLL: Technique, Complications, and Long-Term Results. In: Okawa A, Matsumoto M, Iwasaki M, Kawaguchi Y. (eds) OPLL. Springer, Singapore. 2020.
Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 2: Advantages of anterior decompression and fusion over laminoplasty. Spine (Phila Pa 1976). 2007;32(6):654-60.
Li C, Mei Y, Li L, Li Z, Huang S. Posterior Decompression and Fusion with Vertical Pressure Procedure in the Treatment of Multilevel Cervical OPLL with Kyphotic Deformity. Orthop Surg. 2022;14(9):2361-8.
Chiba K, Ogawa Y, Ishii K, Takaishi H, Nakamura M, Maruiwa H, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy--average 14-year follow-up study. Spine (Phila Pa 1976). 2006;31(26):2998-3005.
Pettersson SD, Skrzypkowska P, Ali S, Szmuda T, Krakowiak M, Počivavšek T, et al. Predictors for cervical kyphotic deformity following laminoplasty: a systematic review and meta-analysis. J Neurosurg Spine. 2022;38(1):4-13.
Lee JJ, Kim HC, Jeon HS, An SB, Kim TW, Shin DA, et al. Laminectomy with instrumented fusion vs. laminoplasty in the surgical treatment of cervical ossification of the posterior longitudinal ligament: A multicenter retrospective study. J Clin Neurosci. 2021;94:271-80.
Ma L, Liu FY, Huo LS, Zheng-QZ, Xian-Ze S, Feng L, et al. Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(29):e11542.
Shimokawa N. A Commentary on Predicting Neck Dysfunction After Open-Door Cervical Laminoplasty-A Prospective Cohort Patient-Reported Outcome Measurement Study. Neurospine. 2024;21(4):1066-7.
Chen X, Fan Y, Chen J, Tu H. Clinical efficacy and complications of 10 surgical interventions for cervical ossification of the posterior longitudinal ligament: an updated systematic review and network meta-analysis. J Orthop Surg Res. 2025;20(1):576.
Choi JH, Shin JJ, Kim TH, Shin HS, Hwang YS, Park SK. Does intramedullary signal intensity on MRI affect the surgical outcomes of patients with ossification of posterior longitudinal ligament? J Korean Neurosurg Soc. 2014;56(2):121-9.
Eli I, Ghogawala Z. Surgical Treatment of Cervical Spondylotic Myelopathy. In: Fu KMG, Wang MY, Virk MS, Dimar II JR, Mummaneni PV. (eds) Treatment of Spine Disease in the Elderly. Springer, Cham. 2023.
Xia C, Shi F, Chen C, Lv J, Chen Q. Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy [retracted in: J Healthc Eng. 2023;2023:9865031.
Sun N, Jiang C, Liu Y. Surgical options for ossification of the posterior longitudinal ligament of the cervical spine: a narrative review. J Orthop Surg Res. 2024;19(1):707.
Downloads
Published
How to Cite
Issue
Section
