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Neurological Complications of Cervical Laminoplasty for Patients With Ossification of the Posterior Longitudinal Ligament—A multi-Institutional Retrospective Study

Seichi, Atsushi MDa; Hoshino, Yuichi MDa; Kimura, Atsushi MDa; Nakahara, Shinnosuke MDb; Watanabe, Masahiko MDc; Kato, Tsuyoshi MDd; Ono, Atsushie; Kotani, Yoshihisa MDf; Mitsukawa, Mamoru MDg; Ijiri, Kosei MDh; Kawahara, Norio MDi; Inami, Satoshi MDj; Chikuda, Hirotaka MDk; Takeshita, Katsushi MDk; Nakagawa, Yukihiro MDl; Taguchi, Toshihikom; Yamazaki, Masashi MDn; Endo, Kenji MDo; Sakaura, Hironobu MDp; Uchida, Kenzo MDq; Kawaguchi, Yoshiharu MDr; Neo, Masashi MDs; Takahashi, Masahito MDt; Harimaya, Katsumi MDu; Hosoe, Hideo MDv; Imagama, Shiro MDw; Taniguchi, Shinichiro MDx; Ito, Takui MDy; Kaito, Takashi MDz; Chiba, Kazuhiro MDaa; Matsumoto, Morio MDaa; Toyama, Yoshiaki MDaa

doi: 10.1097/BRS.0b013e3181fda7fa
Clinical Case Series

Study Design. Retrospective multi-institutional study.

Objective. To investigate the incidence of neurological deficits after cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data. According to analysis of long-term results, laminoplasty for cervical OPLL has been reported as a safe and effective alternative procedure with few complications. However, perioperative neurological complication rates of laminoplasty for cervical OPLL have not been well described.

Methods. Subjects comprised 581 patients (458 men and 123 women; mean age: 62 ± 10 years; range: 30–86 years) who had undergone laminoplasty for cervical OPLL at 27 institutions between 2005 and 2008. Continuous-type OPLL was seen in 114, segmental-type in 146, mixed-type in 265, local-type in 24, and not judged in 32 patients. Postoperative neurological complications within 2 weeks after laminoplasty were analyzed in detail. Cobb angle between C2 and C7 (C2/C7 angle), maximal thickness, and occupying rate of OPLL were investigated. Pre- and postoperative magnetic resonance imaging was performed on patients with postoperative neurological complications.

Results. Open-door laminoplasty was conducted in 237, double-door laminoplasty in 311, and other types of laminoplasty in 33 patients. Deterioration of lower-extremity function occurred after laminoplasty in 18 patients (3.1%). Causes of deterioration were epidural hematoma in 3, spinal cord herniation through injured dura mater in 1, incomplete laminoplasty due to vertebral artery injury while making a trough in 1, and unidentified in 13 patients. Prevalence of unsatisfactory recovery not reaching preoperative level by 6-month follow-up was 7/581 (1.2%). Mean occupying rate of OPLL for patients with deteriorated lower-extremity function was 51.2 ± 13.6% (range, 21.0%–73.3%), significantly higher than the 42.3 ± 13.0% for patients without deterioration. OPLL thickness was also higher in patients with deterioration (mean, 6.6 ± 2.2 mm) than in those without deterioration (mean, 5.7 ± 2.0 mm). No significant difference in C2/C7 lordotic angle was seen between groups.

Conclusion. Although most neurological deterioration can be expected to recover to some extent, the frequency of short-term neurological complications was higher than the authors expected.

This study examined surgical outcomes on a national scale from representative samples of hospitals performing laminoplasty for cervical ossification of the posterior longitudinal ligament between 2005 and 2008. Deterioration of lower-extremity function after laminoplasty occurred in 18 of the 581 patients (3.1%). The frequency of short-term neurological complications was higher than the authors expected.

a Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan.

b Department of Orthopaedic Surgery, National Okayama Medical Center, Okayama, Japan.

c Department of Orthopaedic Surgery, Tokai University, Isehara, Japan.

d Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.

e Department of Orthopaedic Surgery, Hirosaki University, Hirosaki, Japan.

f Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan.

g Department of Orthopaedic Surgery, Kurume University.

h Department of Orthopaedic Surgery, Kagoshima University.

i Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.

j Department of Orthopaedic Surgery, Dokkyo Medical University, Shimotsuga, Japan.

k Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan.

l Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.

m Department of Orthopaedic Surgery, Yamaguchi University, Ube, Japan.

n Department of Orthopaedic Surgery, Chiba University, Chiba, Japan.

o Department of Ortho­paedic Surgery, Tokyo Medical University, Tokyo, Japan.

p Department of Orthopaedic Surgery, Osaka University, Osaka, Japan.

q Department of Orthopaedic Surgery, the University of Fukui.

r Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan.

s Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan.

t Department of Orthopaedic Surgery, Kyorin University.

u Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan.

v Department of Orthopaedic Surgery, Gifu University, Gifu, Japan.

w Department of Orthopaedic Surgery, Nagoya University, Nagoya, Japan.

x Department of Orthopaedic Surgery, Kochi University, Nangoku, Japan.

y Department of Orthopaedic Surgery, Niigata University.

z Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, Kawachi-Nagano, Japan.

aa Department of Orthopaedic Surgery, Keio University, Tokyo, Japan.

Acknowledgment date: March 30, 2010; First Revision: September 14, 2010; Accept: September 18, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal funds were received to support this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Conflict of interest: This work was supported by a Health Labor Sciences Research Grant. All study protocols were approved by the institutional review board at the Japanese Society for Spine Surgery and Related Research.

© 2011 Lippincott Williams & Wilkins, Inc.