Comparison of clinical and radiological outcomes in cervical laminoplasty versus laminectomy with fusion in patients with ossification of the posterior longitudinal ligament
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This study aimed to comparatively assess cervical sagittal alignment, progression of ossification of the posterior longitudinal ligament (OPLL), and health-related quality of life (HRQOL) outcomes between patients who underwent cervical laminoplasty (CL) and those who underwent cervical laminectomy with fusion (LF) for cervical OPLL at more than three levels. We retrospectively evaluated consecutive 91 patients with cervical OPLL undergoing CL (n = 49) or LF (n = 42) who were followed up for at least 24 months (mean 38.6 months). We analyzed radiological measurements (C2–7 sagittal vertical axis [C2–7 SVA], C0–2 angle, C2–7 lordotic angle, T1 slope, and range of motion [ROM]), OPLL thickness, and clinical outcomes (visual analog scale [VAS], neck disability index [NDI], Short Form-36, and Japanese Orthopaedic Association [JOA] scores). Compared with preoperative levels, postoperative C2–7 SVA increased significantly increased in the LF (15.05 mm) and CL (7.86 mm) groups (P = 0.0021). Loss of cervical lordosis and ROM was significantly larger in the cervical LF group (P = 0.0296, P = 0.0004). Improvements in HRQOL, JOA recovery ratio, and VAS were similar between both groups, while NDI improved more significantly in the CL group (P = 0.0425). The postoperative neck VAS correlated positively with the change (Δ) of C2–7 SVA (P = 0.0174) and negatively with the change (Δ) of C2–7 lordotic angle (P = 0.0354). Progression of OPLL thickness in the LF (0.31 ± 0.37 mm) was significantly smaller than in the CL group (1.09 ± 0.64 mm) (P < 0.0001). CL was superior to LF in preserving cervical ROM, preoperative cervical lordosis, and minimizing neck disability. The stabilization obtained by adding instrumented fusion could suppress the progression of OPLL thickness.
KeywordsLaminoplasty Laminectomy with fusion Ossification of posterior longitudinal ligament Sagittal alignment Cervical myelopathy
The authors wish to thank Hyun Kyung Park, PhD, for her contributions in drafting the manuscript and revising it for important intellectual content.
JJS analyzed the data and drafted the manuscript. YH revised the manuscript critically for important intellectual content and approved the final version to be submitted. All authors have read and approved the final manuscript.
This work was supported by the 2018 Inje University research grant.
Compliance with ethical standards
This study was approved by the local ethical committee and the institutional review board (SGPAIK 2018-05-014).
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent from each patient is not required; instead, an ethical approval has been made by the regional ethics board.
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