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A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line.

Abstract：

STUDY DESIGN:To report a new index, the K-line, for deciding the surgical approach for cervical ossification of the posterior longitudinal ligament (OPLL). OBJECTIVE:To analyze the correlation between the K-line-based classification of cervical OPLL patients and their surgical outcome. SUMMARY OF BACKGROUND DATA:Previous studies showed that kyphotic alignment of the cervical spine and a large OPLL are major factors causing poor surgical outcome after laminoplasty for cervical OPLL patients. However, no report has evaluated these 2 factors in 1 parameter. METHODS:The K-line was defined as a line that connects the midpoints of the spinal canal at C2 and C7. Twenty-seven patients who had cervical OPLL and underwent posterior decompression surgery were classified into 2 groups according to their K-line classification. OPLL did not exceed the K-line in the K-line (+) group and did exceed it in the K-line (-) group. By intraoperative ultrasonography, we evaluated the posterior shift of the spinal cord after the posterior decompression procedure. The Japanese Orthopedic Association scores before surgery and 1 year after surgery were evaluated, and the recovery rate was calculated. RESULTS:Eight patients were classified as K-line (-), and 19 patients were classified as K-line (+). The mean recovery rate was 13.9% in the K-line (-) group and 66.0% in the K-line (+) group (P < 0.01). Ultrasonography showed that the posterior shift of the spinal cord was insufficient in the K-line (-) group. CONCLUSION:The present results demonstrate that a sufficient posterior shift of the spinal cord and neurologic improvement will not be obtained after posterior decompression surgery in the K-line (-) group. Our new index, the K-line, is a simple and practical tool for making decisions regarding the surgical approach for cervical OPLL patients.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Fujiyoshi T,Yamazaki M,Kawabe J,Endo T,Furuya T,Koda M,Okawa A,Takahashi K,Konishi H

doi

10.1097/BRS.0b013e318188b300

subject

Has Abstract

pub_date

2008-12-15 00:00:00

pages

E990-3

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-200812150-00022

journal_volume

pub_type

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A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line.