The application of "safe decompression area" between ligament and dura mater in the treatment of cervical ossification of the posterior longitudinal ligament via anterior corpectomy
Yang Haisong, Chen Deyu, Shi Jiangang, Xu Guohua, Chen Yu, Shi Guodong, Shi Lei, Chen Dechun
Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
Abstract：Objective To discuss the application of "safe decompression area" between posterior longitudinal ligament (PLL) and dura mater in the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) via anterior corpectomy.Methods From January 2010 to January 2014, 134 patients of cervical OPLL (88 males and 46 females) underwent anterior corpectomy were performed retrospective study. The average age was (50.5±16.7), ranging from 35 to 71 years old. There were 105 segmental-type, 12 continous-type and 17 mixed-type OPLL on sagittal CT, with all less than 3 segments. The ligament hook was inserted under the PLL through the non-ossified location. The PLL was hooked, and then a "safe decompression area" appeared between the PLL and dura mater. A Kerrison rongeur was used to resect the ossified PLL. The adhesion, cerebrospinal fluid (CSF) leakage and spinal cord injury were recorded. The Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological status before and after operation.Results There were 58 patients with an occupying rate less than 30%, 62 patients between 30% and 60%, and 14 patients more than 60%. The ossified ligaments was resected under the "safe decompression area". There were 5 patients presenting with CSF leakage after operation, one of which belonged to patients with 30% to 60% occupying rate and others belonged to cases with more than 60%. There were 97 patients with adhesion between PLL and dura mater, of which 92 patients were meticulously separated using the micro dissector. No patient presented with spinal cord injury. The postoperative JOA score was (14.9±2.7) points, having a significant improvement compared with preoperation (9.3±1.9) points (t=2.210, P﹤0.05).Conclusions The adhesion can be separated and has less excitation to the spinal cord under "safe decompression area" between PLL and dura mater.
杨海松,陈德玉,史建刚,许国华,陈宇,史国栋,石磊,陈德纯. “安全减压间隙”在前路椎体次全切除治疗颈椎后纵韧带骨化症中的应用[J]. 中华解剖与临床杂志, 2016, 21(4): 291-296.
Yang Haisong, Chen Deyu, Shi Jiangang, Xu Guohua, Chen Yu, Shi Guodong, Shi Lei, Chen Dechun. The application of "safe decompression area" between ligament and dura mater in the treatment of cervical ossification of the posterior longitudinal ligament via anterior corpectomy. Chinese Journal of Anatomy and Clinics, 2016, 21(4): 291-296.
Sakai K, Okawa A, Takahashi M, et al. Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty[J]. Spine(Phila Pa 1976), 2012, 37(5): 367-376. DOI:10.1097/BRS.0b013e31821f4a51.
[2]
Wang X, Chen D, Yuan W, et al. Anterior surgery in selective patients with massive ossification of posterior longitudinal ligament of cervical spine: technical note[J]. Eur Spine J, 2012, 21(2): 314-321. DOI:10.1007/s00586-011-1996-y.
[3]
Kommu R, Sahu BP, Purohit AK. Surgical outcome in patients with cervical ossified posterior longitudinal ligament: a single institutional experience[J]. Asian J Neurosurg, 2014, 9(4): 196-202. DOI:10.4103/1793-5482.146602.
[4]
Kimura A, Seichi A, Hoshino Y, et al. Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament: a retrospective, multi-institutional study[J]. J Orthop Sci, 2012, 17(6): 667-672. DOI:10.1007/s00776-012-0271-3.
[5]
Bilbao G, Duart M, Aurrecoechea JJ, et al. Surgical results and complications in a series of 71 consecutive cervical spondylotic corpectomies[J]. Acta Neurochir (Wien), 2010, 152(7): 1155-1163. DOI:10.1007/s00701-010-0660-3.
[6]
Hannallah D, Lee J, Khan M, et al. Cerebrospinal fluid leaks following cervical spine surgery[J]. J Bone Joint Surg Am, 2008, 90(5): 1101-1105. DOI:10.2106/JBJS.F.01114.
[7]
Li H, Dai LY. A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament[J]. Spine J, 2011, 11(11): 1049-1057. DOI:10.1016/j.spinee.2011.09.008.
An HS, Al-Shihabi L, Kurd M. Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine[J]. J Am Acad Orthop Surg, 2014, 22(7): 420-429. DOI:10.5435/JAAOS-22-07-420.
[10]
Kim B, Yoon DH, Shin HC, et al. Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament[J]. Spine J, 2015, 15(5): 875-884. DOI:10.1016/j.spinee.2015.01.028.
[11]
Chen Y, Guo Y, Lu X, et al. Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine[J]. J Spinal Disord Tech, 2011, 24(1): 24-30. DOI:10.1097/BSD.0b013e3181c7e91e.
[12]
Fujiyoshi T, Yamazaki M, Kawabe J, et al. A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line[J]. Spine(Phila Pa 1976), 2008, 33(26): E990-E993. DOI:10.1097/BRS.0b013e318188b300.
[13]
Yang H, Lu X, Wang X, et al. A new method to determine whether ossified posterior longitudinal ligament can be resected completely and safely: spinal canal "Rule of Nine" on axial computed tomography[J]. Eur Spine J, 2015, 24(8):1673-1680. DOI:10.1007/s00586-014-3539-9.
[14]
Yang H, Yang L, Chen D, et al. Implications of different patterns of "double-layer sign" in cervical ossication of the posterior longitudinal ligament[J]. Eur Spine J, 2015, 24(8): 1631-1639. DOI:10.1007/s00586-015-3914-1.
[15]
Yang H, Chen D, Lu X, et al. Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia[J]. Eur spine J, 2010, 19(3):494-501. DOI:10.1007/s00586-009-1239-7.
[16]
史建刚, 袁文. 脊柱外科手术解剖图谱[M]. 上海, 科学技术出版社, 2015: 81-82
[17]
Chen Y, Guo Y, Chen D, et al. Diagnosis and surgery of ossication of posterior longitudinal ligament associated with dural ossication in the cervical spine[J]. Eur Spine J, 2009, 18(10):1541-1547. DOI:10.1007/s00586-009-1029-2.
[18]
Mazur M, Jost GF, Schmidt MH, et al. Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature[J]. Neurosurg Focus, 2011, 30(3): E13. DOI:10.3171/2010.12.FOCUS10255.
[19]
Fengbin Y, Xinyuan L, Xiaowei L, et al. Management and outcomes of cerebrospinal fluid leak associated with anterior decompression for cervical ossification of the posterior longitudinal ligament with or without dural ossification[J]. J Spinal Disord Tech, 2015, 28(10): 389-393. DOI:10.1097/BSD.0000000000000031.
2016, Vol. 21 
