Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Analysis of Factors Contributing to Repeat Surgery in Multi-Segments Cervical Ossification of Posterior Longitudinal Ligament

  • Jeon, Ikchan (Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine) ;
  • Cho, Yong Eun (Department of Neurosurgery, Gangnam Severance Hospital, The Spinal and Spinal Cord Institute, Yonsei University College of Medicine)
  • Received : 2017.01.05
  • Accepted : 2017.06.23
  • Published : 2018.03.01
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Abstract

Objective : Cervical ossification of the posterior longitudinal ligament (OPLL) can be treated via anterior or posterior approach, or both. The optimal approach depends on the characteristics of OPLL and cervical curvature. Although most patients can be successfully treated by a single surgery with the proper approach, renewed or newly developed neurological deterioration often requires repeat surgery. Methods : Twenty-seven patients with renewed or newly developed neurological deterioration requiring salvage surgery for multi-segment cervical OPLL were enrolled. Ten patients (group AP) underwent anterior approach, and 17 patients (group PA) underwent posterior approach at the initial surgery. Clinical and radiological data from initial and repeat surgeries were obtained and analyzed retrospectively. Results : The intervals between the initial and repeat surgeries were $102.80{\pm}60.08months$ (group AP) and $61.00{\pm}8.16months$ (group PA) (p<0.05). In group AP, the main OPLL lesions were removed during the initial surgery. There was a tendency that the site of main OPLL lesions causing renewed or newly developed neurological deterioration were different from that of the initial surgery (8/10, p<0.05). Repeat surgery was performed for progressed OPLL lesions at another segment as the main pathology. In group PA, the main OPLL lesions at the initial surgery continued as the main pathology for repeat surgery. Progression of kyphosis in the cervical curvature (Cobb's angle on C2-7 and segmental angle on the main OPLL lesion) was noted between the initial and repeat surgeries. Group PA showed more kyphotic cervical curvature compared to group AP at the time of repeat surgery (p<0.05). Conclusion : The reasons for repeat surgery depend on the type of initial surgery. The main factors leading to repeat surgery are progression of remnant OPLL at a different segment in group AP and kyphotic change of the cervical curvature in group PA.

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References

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