Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament: A retrospective, multi-institutional study

Atsushi Kimura, Atsushi Seichi, Yuichi Hoshino, Masashi Yamazaki, Macondo Mochizuki, Atsuomi Aiba, Tsuyoshi Kato, Kenzo Uchida, Kei Miyamoto, Shinnosuke Nakahara, Shinichirou Taniguchi, Masashi Neo, Toshihiko Taguchi, Kenji Endo, Masahiko Watanabe, Masahito Takahashi, Takashi Kaito, Hirotaka Chikuda, Takahito Fujimori, Takui ItoAtsushi Ono, Kuniyoshi Abumi, Kei Yamada, Yukihiro Nakagawa, Yoshiaki Toyama

Research output: Contribution to journalArticle

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Abstract

Background: Anterior decompression with fusion (ADF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL) is reportedly associated with a higher incidence of complications than is laminoplasty. However, the frequency of perioperative complications associated with ADF for cervical OPLL has not been fully established. The purpose of this study was to investigate the incidence of perioperative complications, especially neurological complications, following ADF performed to relieve compressive cervical myelopathy due to cervical OPLL. Methods: Study participants comprised 150 patients who had undergone ADF for cervical OPLL at 27 institutions between 2005 and 2008. Perioperative - especially neurological - complications occurring within 2 weeks after ADF were analyzed. Preoperative imaging findings, including Cobb angle, between C2 and C7 and occupying ratio of OPLL were investigated. Multivariate analysis with logistic regression was performed to identify independent risk factors for neurological complications. Result: Three patients (2.0 %) showed deterioration of lower-extremity function after ADF. One of the three patients had not regained their preoperative level of function 6 months after surgery. Upper-extremity paresis occurred in 20 patients (13.3 %), five of whom had not returned to preoperative levels 6 months after surgery. Patients with upper-extremity paresis showed significantly higher occupying ratios of OPLL, greater blood loss, longer operation times, fusion of more segments, and higher rates of cerebrospinal fluid leakage than those without paresis. Independent risk factors for upper-extremity paresis were a high occupying ratio of OPLL and large blood loss during surgery. Conclusions: The incidences of deterioration in upper- and lower-extremity functions were 13.3 % and 2.0 %, respectively. Patients with a high occupying ratio of OPLL are at higher risk of developing neurological deterioration.

Original languageEnglish
Pages (from-to)667-672
Number of pages6
JournalJournal of Orthopaedic Science
Volume17
Issue number6
DOIs
Publication statusPublished - 2012 Nov

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Ossification of Posterior Longitudinal Ligament
Decompression
Paresis
Lower Extremity
Incidence
Spinal Cord Compression
Multivariate Analysis
Logistic Models

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament : A retrospective, multi-institutional study. / Kimura, Atsushi; Seichi, Atsushi; Hoshino, Yuichi; Yamazaki, Masashi; Mochizuki, Macondo; Aiba, Atsuomi; Kato, Tsuyoshi; Uchida, Kenzo; Miyamoto, Kei; Nakahara, Shinnosuke; Taniguchi, Shinichirou; Neo, Masashi; Taguchi, Toshihiko; Endo, Kenji; Watanabe, Masahiko; Takahashi, Masahito; Kaito, Takashi; Chikuda, Hirotaka; Fujimori, Takahito; Ito, Takui; Ono, Atsushi; Abumi, Kuniyoshi; Yamada, Kei; Nakagawa, Yukihiro; Toyama, Yoshiaki.

In: Journal of Orthopaedic Science, Vol. 17, No. 6, 11.2012, p. 667-672.

Research output: Contribution to journalArticle

Kimura, A, Seichi, A, Hoshino, Y, Yamazaki, M, Mochizuki, M, Aiba, A, Kato, T, Uchida, K, Miyamoto, K, Nakahara, S, Taniguchi, S, Neo, M, Taguchi, T, Endo, K, Watanabe, M, Takahashi, M, Kaito, T, Chikuda, H, Fujimori, T, Ito, T, Ono, A, Abumi, K, Yamada, K, Nakagawa, Y & Toyama, Y 2012, 'Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament: A retrospective, multi-institutional study', Journal of Orthopaedic Science, vol. 17, no. 6, pp. 667-672. https://doi.org/10.1007/s00776-012-0271-3
Kimura, Atsushi ; Seichi, Atsushi ; Hoshino, Yuichi ; Yamazaki, Masashi ; Mochizuki, Macondo ; Aiba, Atsuomi ; Kato, Tsuyoshi ; Uchida, Kenzo ; Miyamoto, Kei ; Nakahara, Shinnosuke ; Taniguchi, Shinichirou ; Neo, Masashi ; Taguchi, Toshihiko ; Endo, Kenji ; Watanabe, Masahiko ; Takahashi, Masahito ; Kaito, Takashi ; Chikuda, Hirotaka ; Fujimori, Takahito ; Ito, Takui ; Ono, Atsushi ; Abumi, Kuniyoshi ; Yamada, Kei ; Nakagawa, Yukihiro ; Toyama, Yoshiaki. / Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament : A retrospective, multi-institutional study. In: Journal of Orthopaedic Science. 2012 ; Vol. 17, No. 6. pp. 667-672.
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abstract = "Background: Anterior decompression with fusion (ADF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL) is reportedly associated with a higher incidence of complications than is laminoplasty. However, the frequency of perioperative complications associated with ADF for cervical OPLL has not been fully established. The purpose of this study was to investigate the incidence of perioperative complications, especially neurological complications, following ADF performed to relieve compressive cervical myelopathy due to cervical OPLL. Methods: Study participants comprised 150 patients who had undergone ADF for cervical OPLL at 27 institutions between 2005 and 2008. Perioperative - especially neurological - complications occurring within 2 weeks after ADF were analyzed. Preoperative imaging findings, including Cobb angle, between C2 and C7 and occupying ratio of OPLL were investigated. Multivariate analysis with logistic regression was performed to identify independent risk factors for neurological complications. Result: Three patients (2.0 {\%}) showed deterioration of lower-extremity function after ADF. One of the three patients had not regained their preoperative level of function 6 months after surgery. Upper-extremity paresis occurred in 20 patients (13.3 {\%}), five of whom had not returned to preoperative levels 6 months after surgery. Patients with upper-extremity paresis showed significantly higher occupying ratios of OPLL, greater blood loss, longer operation times, fusion of more segments, and higher rates of cerebrospinal fluid leakage than those without paresis. Independent risk factors for upper-extremity paresis were a high occupying ratio of OPLL and large blood loss during surgery. Conclusions: The incidences of deterioration in upper- and lower-extremity functions were 13.3 {\%} and 2.0 {\%}, respectively. Patients with a high occupying ratio of OPLL are at higher risk of developing neurological deterioration.",
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T1 - Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament

T2 - A retrospective, multi-institutional study

AU - Kimura, Atsushi

AU - Seichi, Atsushi

AU - Hoshino, Yuichi

AU - Yamazaki, Masashi

AU - Mochizuki, Macondo

AU - Aiba, Atsuomi

AU - Kato, Tsuyoshi

AU - Uchida, Kenzo

AU - Miyamoto, Kei

AU - Nakahara, Shinnosuke

AU - Taniguchi, Shinichirou

AU - Neo, Masashi

AU - Taguchi, Toshihiko

AU - Endo, Kenji

AU - Watanabe, Masahiko

AU - Takahashi, Masahito

AU - Kaito, Takashi

AU - Chikuda, Hirotaka

AU - Fujimori, Takahito

AU - Ito, Takui

AU - Ono, Atsushi

AU - Abumi, Kuniyoshi

AU - Yamada, Kei

AU - Nakagawa, Yukihiro

AU - Toyama, Yoshiaki

PY - 2012/11

Y1 - 2012/11

N2 - Background: Anterior decompression with fusion (ADF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL) is reportedly associated with a higher incidence of complications than is laminoplasty. However, the frequency of perioperative complications associated with ADF for cervical OPLL has not been fully established. The purpose of this study was to investigate the incidence of perioperative complications, especially neurological complications, following ADF performed to relieve compressive cervical myelopathy due to cervical OPLL. Methods: Study participants comprised 150 patients who had undergone ADF for cervical OPLL at 27 institutions between 2005 and 2008. Perioperative - especially neurological - complications occurring within 2 weeks after ADF were analyzed. Preoperative imaging findings, including Cobb angle, between C2 and C7 and occupying ratio of OPLL were investigated. Multivariate analysis with logistic regression was performed to identify independent risk factors for neurological complications. Result: Three patients (2.0 %) showed deterioration of lower-extremity function after ADF. One of the three patients had not regained their preoperative level of function 6 months after surgery. Upper-extremity paresis occurred in 20 patients (13.3 %), five of whom had not returned to preoperative levels 6 months after surgery. Patients with upper-extremity paresis showed significantly higher occupying ratios of OPLL, greater blood loss, longer operation times, fusion of more segments, and higher rates of cerebrospinal fluid leakage than those without paresis. Independent risk factors for upper-extremity paresis were a high occupying ratio of OPLL and large blood loss during surgery. Conclusions: The incidences of deterioration in upper- and lower-extremity functions were 13.3 % and 2.0 %, respectively. Patients with a high occupying ratio of OPLL are at higher risk of developing neurological deterioration.

AB - Background: Anterior decompression with fusion (ADF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL) is reportedly associated with a higher incidence of complications than is laminoplasty. However, the frequency of perioperative complications associated with ADF for cervical OPLL has not been fully established. The purpose of this study was to investigate the incidence of perioperative complications, especially neurological complications, following ADF performed to relieve compressive cervical myelopathy due to cervical OPLL. Methods: Study participants comprised 150 patients who had undergone ADF for cervical OPLL at 27 institutions between 2005 and 2008. Perioperative - especially neurological - complications occurring within 2 weeks after ADF were analyzed. Preoperative imaging findings, including Cobb angle, between C2 and C7 and occupying ratio of OPLL were investigated. Multivariate analysis with logistic regression was performed to identify independent risk factors for neurological complications. Result: Three patients (2.0 %) showed deterioration of lower-extremity function after ADF. One of the three patients had not regained their preoperative level of function 6 months after surgery. Upper-extremity paresis occurred in 20 patients (13.3 %), five of whom had not returned to preoperative levels 6 months after surgery. Patients with upper-extremity paresis showed significantly higher occupying ratios of OPLL, greater blood loss, longer operation times, fusion of more segments, and higher rates of cerebrospinal fluid leakage than those without paresis. Independent risk factors for upper-extremity paresis were a high occupying ratio of OPLL and large blood loss during surgery. Conclusions: The incidences of deterioration in upper- and lower-extremity functions were 13.3 % and 2.0 %, respectively. Patients with a high occupying ratio of OPLL are at higher risk of developing neurological deterioration.

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