Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Compression Angle of Ossification of the Posterior Longitudinal Ligament and Its Clinical Significance in Cervical Myelopathy

  • Lee, Nam (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Yoon, Do Heum (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Kim, Keung Nyun (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Shin, Hyun Chul (Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shin, Dong Ah (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Ha, Yoon (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine)
  • Received : 2016.01.20
  • Accepted : 2016.06.01
  • Published : 2016.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : The correction of clinical and radiologic abnormalities in patients with symptomatic ossification of the posterior longitudinal ligament (OPLL) is the current mainstay of treatment. This study aimed to identify radiographic predictors of severity of myelopathy in patients with symptomatic OPLL. Methods : Fifty patients with symptomatic cervical OPLL were enrolled. Based on Japanese Orthopedic Association (JOA) scores, patients were divided into either the mild myelopathy (n=31) or severe myelopathy (n=19) group. All subjects underwent preoperative plain cervical roentgenogram, computed tomography (CT), and MR imaging (MRI). Radiological parameters (C2-7 sagittal vertical axis, SVA; C2-7 Cobb angle; C2-7 range of motion, ROM; OPLL occupying ratio; and compression angle) were compared. Compression angle of OPLL was defined as the angle between the cranial and caudal surfaces of OPLL at the maximum level of cord compression Results : The occupying ratio of the spinal canal, C2-7 Cobb angle, C2-7 SVA, types of OPLL, and C2-7 ROM of the cervical spine were not statistically different between the two groups. However, the OPLL compression angle was significantly greater (p=0.003) in the severe myelopathy group than in the mild myelopathy group and was inversely correlated with JOA score (r=-0.533, p<0.01). Furthermore, multivariate regression analysis demonstrated that the compression angle (B=-0.069, p<0.001) was significantly associated with JOA scores (R=0.647, p<0.005). Conclusion : Higher compression angles of OPLL have deleterious effects on the spinal cord and decrease preoperative JOA scores.

Keywords

References

  1. 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) 31 : 2998-3005, 2006 https://doi.org/10.1097/01.brs.0000250307.78987.6b
  2. Ferch RD, Shad A, Cadoux-Hudson TA, Teddy PJ : Anterior correction of cervical kyphotic deformity : effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg 100 : 13-19, 2004
  3. Fujiyoshi T, Yamazaki M, Okawa A, Kawabe J, Hayashi K, Endo T, et al. : Static versus dynamic factors for the development of myelopathy in patients with cervical ossification of the posterior longitudinal ligament. J Clin Neurosci 17 : 320-324, 2010 https://doi.org/10.1016/j.jocn.2009.06.023
  4. Gore DR, Sepic SB, Gardner GM : Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976) 11 : 521-524, 1986 https://doi.org/10.1097/00007632-198607000-00003
  5. Masaki Y, Yamazaki M, Okawa A, Aramomi M, Hashimoto M, Koda M, et al. : An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament : anterior decompression with spinal fusion versus laminoplasty. J Spinal Disord Tech 20 : 7-13, 2007 https://doi.org/10.1097/01.bsd.0000211260.28497.35
  6. Masson C, Leys D, Meder JF, Dousset V, Pruvo JP : [Spinal cord ischemia]. J Neuroradiol 31 : 35-46, 2004 https://doi.org/10.1016/S0150-9861(04)96877-0
  7. Matsunaga S, Nakamura K, Seichi A, Yokoyama T, Toh S, Ichimura S, et al. : Radiographic predictors for the development of myelopathy in patients with ossification of the posterior longitudinal ligament : a multicenter cohort study. Spine (Phila Pa 1976) 33 : 2648-2650, 2008 https://doi.org/10.1097/BRS.0b013e31817f988c
  8. Morio Y, Nagashima H, Teshima R, Nawata K : Radiological pathogenesis of cervical myelopathy in 60 consecutive patients with cervical ossification of the posterior longitudinal ligament. Spinal Cord 37 : 853-857, 1999 https://doi.org/10.1038/sj.sc.3100940
  9. Oshima Y, Seichi A, Takeshita K, Chikuda H, Ono T, Baba S, et al. : Natural course and prognostic factors in patients with mild cervical spondylotic myelopathy with increased signal intensity on T2-weighted magnetic resonance imaging. Spine (Phila Pa 1976) 37 : 1909-1913, 2012 https://doi.org/10.1097/BRS.0b013e318259a65b
  10. Pavlov H, Torg JS, Robie B, Jahre C : Cervical spinal stenosis : determination with vertebral body ratio method. Radiology 164 : 771-775, 1987 https://doi.org/10.1148/radiology.164.3.3615879
  11. Suda K, Abumi K, Ito M, Shono Y, Kaneda K, Fujiya M : Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 28 : 1258-1262, 2003
  12. Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, et al. : The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 76 suppl 1 : S14-S21, 2015
  13. Taniyama T, Hirai T, Yamada T, Yuasa M, Enomoto M, Yoshii T, et al. : Modified K-line in magnetic resonance imaging predicts insufficient decompression of cervical laminoplasty. Spine (Phila Pa 1976) 38 : 496-501, 2013 https://doi.org/10.1097/BRS.0b013e318273a4f7
  14. Tokuhashi Y, Matsuzaki H, Oda H, Uei H : Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine : usefulness of the ossification-kyphosis angle on MRI. Spine (Phila Pa 1976) 31 : E26-E30, 2006 https://doi.org/10.1097/01.brs.0000193940.75354.e5
  15. Tousignant M, de Bellefeuille L, O'Donoughue S, Grahovac S : Criterion validity of the cervical range of motion (CROM) goniometer for cervical flexion and extension. Spine (Phila Pa 1976) 25 : 324-330, 2000 https://doi.org/10.1097/00007632-200002010-00011
  16. Tsukimoto H : On an autopsied case of compression myelopathy with a callus formation in the cervical spinal canal. Nihon-geka-hokan 29 : 1003-1007, 1960
  17. Tsuyama N : Ossification of the posterior longitudinal ligament of the spine. Clin Orthop Relat Res (184) : 71-84, 1984
  18. Vedantam R, Lenke LG, Keeney JA, Bridwell KH : Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine (Phila Pa 1976) 23 : 211-215, 1998 https://doi.org/10.1097/00007632-199801150-00012

Cited by

  1. Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior lam vol.29, pp.5, 2016, https://doi.org/10.1007/s00586-019-06216-6