Direct Anterior Decompression in Patients with Ossification of the Posterior Longitudinal Ligament Significantly Relieves Short-segment Spinal Cord High Signal

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2024 Nov 1

PMID 39482611

Authors

Zichuan Wu

Xuhong Zhang

Hanlin Song

Aochen Xu

Baifeng Sun

Chen Xu

Min Qi

Yang Liu

Affiliations

Soon will be listed here.

Abstract

Background: In patients with ossification of the posterior longitudinal ligament of the cervical spine (OPLL), high spinal cord signal (HCS) is frequently observed in the spinal cord of the corresponding segment. However, studies on the differences in the improvement of high spinal cord signal due to different surgical approaches are limited. The aim of this study was to investigate the improvement of high spinal cord signal in long and short segments with different choices of surgical approaches.

Methods: In this study, we conducted a meticulous review of medical records for patients diagnosed with ossification of the posterior longitudinal ligament (OPLL). Demographic variables, including gender, age, and body mass index (BMI), were systematically recorded. We evaluated the severity of neurological impairment using the Japanese Orthopaedic Association (JOA) scores both preoperatively and at multiple postoperative follow-up points. Neurological assessments were complemented by serial magnetic resonance imaging (MRI) T2-weighted imaging (T2WI) to measure the extent of high-signal changes (HCS) in the spinal cord, and the alteration of the HCS was quantified by the SCR (the ratio between the signal intensity value of the HCS region and the signal intensity value of the normal spinal cord region at C7-T1).

Results: In the short-segment high signal change (HCS) group, comparisons of JOA score improvement (Recovery1) and HCS improvement (CR1) at 6 months postoperatively did not demonstrate significant differences between the surgical approaches (P > 0.05; Table 1). However, at the 2-year follow-up, patients who underwent anterior surgery exhibited significantly greater improvements in both JOA scores (Recovery2) and HCS (CR2), with statistical significance achieved (P < 0.05; Table 1). In contrast, in the long-segment HCS group, there was no significant difference between the anterior and posterior surgical approaches in terms of JOA improvement and HCS improvement at 6 months and 2 years postoperatively (P > 0.05; Table 2).

Conclusions: In patients with OPLL who present with spinal cord high signal, anterior surgery by resection of the ossified posterior longitudinal ligament and direct decompression is more conducive to regression of small spinal cord high signal and improvement of clinical neurological function if the extent of spinal cord high signal is small.

References

Tetreault L, Goldstein C, Arnold P, Harrop J, Hilibrand A, Nouri A . Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine. Neurosurgery. 2015; 77 Suppl 4:S51-67. DOI: 10.1227/NEU.0000000000000951. View

Xu P, Zhuang J, Huang Y, Chen J, Zhong Z . Is anterior decompression and fusion superior to laminoplasty for cervical myelopathy due to ossification of posterior longitudinal ligament? A systematic review and meta-analysis. J Spinal Cord Med. 2019; 44(2):169-183. PMC: 7952055. DOI: 10.1080/10790268.2019.1579987. View

Wei L, Cao P, Xu C, Hu B, Tian Y, Yuan W . Clinical and Radiologic Results of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy in Elderly Patients with T2-Weighted Increased Signal Intensity. World Neurosurg. 2018; 112:e520-e526. DOI: 10.1016/j.wneu.2018.01.071. View

Karpova A, Arun R, Cadotte D, Davis A, Kulkarni A, OHiggins M . Assessment of spinal cord compression by magnetic resonance imaging--can it predict surgical outcomes in degenerative compressive myelopathy? A systematic review. Spine (Phila Pa 1976). 2013; 38(16):1409-21. DOI: 10.1097/BRS.0b013e31829609a0. View

Ito K, Imagama S, Ito K, Ito Z, Ando K, Kobayashi K . MRI Signal Intensity Classification in Cervical Ossification of the Posterior Longitudinal Ligament: Predictor of Surgical Outcomes. Spine (Phila Pa 1976). 2016; 42(2):E98-E103. DOI: 10.1097/BRS.0000000000001717. View

Ikegawa S . Genomic study of ossification of the posterior longitudinal ligament of the spine. Proc Jpn Acad Ser B Phys Biol Sci. 2014; 90(10):405-12. PMC: 4335137. DOI: 10.2183/pjab.90.405. View

Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K . MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. Spine (Phila Pa 1976). 2007; 32(15):1675-8. DOI: 10.1097/BRS.0b013e318074d62e. View

Wang L, Zhang Y, Shen Y, Su Y, Xu J, Ding W . Using the T2-weighted magnetic resonance imaging signal intensity ratio and clinical manifestations to assess the prognosis of patients with cervical ossification of the posterior longitudinal ligament. J Neurosurg Spine. 2010; 13(3):319-23. DOI: 10.3171/2010.3.SPINE09887. View

Shin J, Jin B, Kim K, Cho Y, Cho W . Intramedullary high signal intensity and neurological status as prognostic factors in cervical spondylotic myelopathy. Acta Neurochir (Wien). 2010; 152(10):1687-94. DOI: 10.1007/s00701-010-0692-8. View

10.

Matsunaga S, Sakou T . Ossification of the posterior longitudinal ligament of the cervical spine: etiology and natural history. Spine (Phila Pa 1976). 2011; 37(5):E309-14. DOI: 10.1097/BRS.0b013e318241ad33. View

11.

Qin R, Chen X, Zhou P, Li M, Hao J, Zhang F . Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament: a meta-analysis. Eur Spine J. 2018; 27(6):1375-1387. DOI: 10.1007/s00586-017-5451-6. View

12.

Vedantam A, Jonathan A, Rajshekhar V . Association of magnetic resonance imaging signal changes and outcome prediction after surgery for cervical spondylotic myelopathy. J Neurosurg Spine. 2011; 15(6):660-6. DOI: 10.3171/2011.8.SPINE11452. View

13.

Fernandez de Rota J, Meschian S, Fernandez de Rota A, Urbano V, Baron M . Cervical spondylotic myelopathy due to chronic compression: the role of signal intensity changes in magnetic resonance images. J Neurosurg Spine. 2007; 6(1):17-22. DOI: 10.3171/spi.2007.6.1.4. View

14.

Zhang Y, Shen Y, Wang L, Ding W, Xu J, He J . Magnetic resonance T2 image signal intensity ratio and clinical manifestation predict prognosis after surgical intervention for cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2010; 35(10):E396-9. DOI: 10.1097/BRS.0b013e3181c6dbc4. View

15.

Liu X, Min S, Zhang H, Zhou Z, Wang H, Jin A . Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: a systematic review and meta-analysis. Eur Spine J. 2013; 23(2):362-72. PMC: 3906468. DOI: 10.1007/s00586-013-3043-7. View

16.

Lee J, Lee N, Oh S, Shin D, Yi S, Kim K . Clinical and radiological outcomes of multilevel cervical laminoplasty versus three-level anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy. Quant Imaging Med Surg. 2020; 10(11):2112-2124. PMC: 7547256. DOI: 10.21037/qims-20-220. View

17.

Chen X, Shan T, Li Y . Prognostic effect of increased postoperative MRI T2WI high signal intensity in degenerative cervical myelopathy. Spine J. 2022; 22(12):1964-1973. DOI: 10.1016/j.spinee.2022.07.097. View

18.

An H, Al-Shihabi L, Kurd M . Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine. J Am Acad Orthop Surg. 2014; 22(7):420-9. DOI: 10.5435/JAAOS-22-07-420. View

19.

Feng F, Ruan W, Liu Z, Li Y, Cai L . Anterior versus posterior approach for the treatment of cervical compressive myelopathy due to ossification of the posterior longitudinal ligament: A systematic review and meta-analysis. Int J Surg. 2016; 27:26-33. DOI: 10.1016/j.ijsu.2016.01.038. View

20.

Kato S, Nouri A, Wu D, Nori S, Tetreault L, Fehlings M . Comparison of Anterior and Posterior Surgery for Degenerative Cervical Myelopathy: An MRI-Based Propensity-Score-Matched Analysis Using Data from the Prospective Multicenter AOSpine CSM North America and International Studies. J Bone Joint Surg Am. 2017; 99(12):1013-1021. DOI: 10.2106/JBJS.16.00882. View