Intraoperative Evaluation Using Mobile Computed Tomography in Anterior Cervical Decompression with Floating Method for Massive Ossification of the Posterior Longitudinal Ligament

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2017 Jan 21

PMID 28103899

Citations 12

Authors

Toshitaka Yoshii

Takashi Hirai

Tsuyoshi Yamada

Hiroyuki Inose

Tsuyoshi Kato

Kenichiro Sakai

Mitsuhiro Enomoto

Shigenori Kawabata

Yoshiyasu Arai

Atsushi Okawa

Affiliations

Soon will be listed here.

Abstract

Background: An anterior decompression and fusion (ADF) with the floating method is an effective procedure for treating ossification of the posterior longitudinal ligament (OPLL), allowing a direct decompressive effect on the spinal cord. However, the procedure is skill-intensive, particularly in cases of OPLL with a high canal-occupying ratio. In such cases, there are potential risks for insufficient decompression due to the incomplete floating of the OPLL. Here, we introduce an anterior decompression procedure for massive OPLL, using an intraoperative computed tomography (CT) with a mobile scanner gantry for the intraoperative evaluation of the decompression. We further evaluated the outcomes of ADF using mobile CT in comparison with a historical control of ADF without intraoperative CT evaluation.

Methods: Fifty OPLL patients who underwent ADF with the floating method were evaluated in this study: 25 patients with intraoperative CT (CT group) and 25 patients without CT (non-CT group). In the CT group, intraoperative CT scanning was performed before freeing the ossification from the surrounding bone tissues. The reconstructed images were reviewed to evaluate the extent of bone decompression and thinning of the OPLL. After review of the images, further thinning of the OPLL or removal of surrounding bone was performed as deemed necessary, to complete the floating of the OPLL.

Results: Patients' background was similar between the CT and non-CT group. Operating time tended to be shorter for the CT group. On the postoperative CT, incomplete OPLL floating due to "impingement" between the OPLL and the medial aspect of the pedicle or uncovertebral joint was observed for four patients (16.0%) in the non-CT group, whereas insufficient decompression was not observed in the CT group.

Conclusions: Intraoperative CT imaging was effective to avoid insufficient decompression following ADF with the floating method for massive OPLL. We also consider that the intraoperative three-dimensional imaging is helpful for providing informative feedback to surgeons to improve performance in skill-intensive surgeries such as ADF with the floating method.

Citing Articles

Percutaneous Fully-endoscopic Anterior Transcorporeal Procedure for the Treatment of Isolated Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Case Report.

Li J, Ao J, Hu X, Du Q, Qin J, Ji W Orthop Surg. 2023; 16(2):514-520.

PMID: 38111022 PMC: 10834199. DOI: 10.1111/os.13966.

Augmented Reality Support for Anterior Decompression and Fusion Using Floating Method for Cervical Ossification of the Posterior Longitudinal Ligament.

Onuma H, Sakai K, Arai Y, Torigoe I, Tomori M, Sakaki K J Clin Med. 2023; 12(8).

PMID: 37109235 PMC: 10143834. DOI: 10.3390/jcm12082898.

Surgical Management of Cervical Ossification of Posterior Longitudinal Ligament: The Treatment Algorithm and Outcome.

Ng B, Tan J, Sabri S, Baharuddin A, Muhamad Ariffin M Cureus. 2023; 15(3):e36517.

PMID: 37090402 PMC: 10121251. DOI: 10.7759/cureus.36517.

Prospective Comparative Study of Dysphagia after Subaxial Cervical Spine Surgery: Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament Ossification.

Sakaki K, Sakai K, Arai Y, Torigoe I, Tomori M, Hirai T J Clin Med. 2023; 12(5).

PMID: 36902561 PMC: 10003155. DOI: 10.3390/jcm12051774.

Prospective Investigation of Surgical Outcomes after Anterior Decompression with Fusion and Laminoplasty for the Cervical Ossification of the Posterior Longitudinal Ligament: A Propensity Score Matching Analysis.

Yoshii T, Morishita S, Egawa S, Sakai K, Kusano K, Tsutsui S J Clin Med. 2022; 11(23).

PMID: 36498586 PMC: 9736093. DOI: 10.3390/jcm11237012.

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