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Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy.

Abstract The retrospective study aimed to investigate the indication for hypertrophy posterior longitudinal ligament (HPLL) removal in anterior decompression for cervical spondylotic myelopathy (CSM). A total of 138 consecutive patients with CSM were divided into 2 groups with developmental cervical stenosis (DCS) (group S) and non-DCS (group N), according to the Pavlov ratio. These 2 groups were subdivided into 2 further subgroups, according to whether HPLL was removed or preserved: group SR (49 patients) and group SP (32 patients) in group S, group NR (21 patients) and group NP (36 patients) in group N. The modified Japanese Orthopedic Association score (mJOA), the modified recovery rate (mRR), quality of life (QoL), and relevant clinical data were used for clinical and radiological evaluation. The mJOA scores improved from 7.3 ± 2.2 to 15.0 ± 1.8 in the SR group and from 7.9 ± 2.3 to 14.2 ± 1.5 in the SP group (P = .036), with postoperative QoL significantly higher in the SR group than the SP group. A reduction in the diameter of enlarged spinal canals occurred at a significantly faster rate in the SP group compared with the SR group (P = .002). Multivariate regression analyses showed removal of HPLL correlated with mJOA scores (coefficient = 7.337, P = .002), mRR (%) (coefficient = 9.117, P = .005), PCS (coefficient = 12.129, P < .001), and MCS (coefficient = 14.31, P < .001) in the S group at 24 months postoperatively, while removal of HPLL did not correlate with clinical outcomes in the N group. The HPLL should, therefore, be removed when mobility was reduced and the spinal cord remained compressed after anterior decompression procedures in the patients with DCS. However, in non-DCS patients, it remains unclear as to whether removal of HPLL provides any clinical benefit, thus, HPLL removal may not be necessary.
PMID
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Removal of posterior longitudinal ligament in anterior decompression for cervical spondylotic myelopathy.

Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28591038
OWN - NLM
STAT- MEDLINE
DA  - 20170607
DCOM- 20170706
LR  - 20170706
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 23
DP  - 2017 Jun
TI  - Indication for hypertrophy posterior longitudinal ligament removal in anterior
      decompression for cervical spondylotic myelopathy.
PG  - e7043
LID - 10.1097/MD.0000000000007043 [doi]
AB  - The retrospective study aimed to investigate the indication for hypertrophy
      posterior longitudinal ligament (HPLL) removal in anterior decompression for
      cervical spondylotic myelopathy (CSM). A total of 138 consecutive patients with
      CSM were divided into 2 groups with developmental cervical stenosis (DCS) (group 
      S) and non-DCS (group N), according to the Pavlov ratio. These 2 groups were
      subdivided into 2 further subgroups, according to whether HPLL was removed or
      preserved: group SR (49 patients) and group SP (32 patients) in group S, group NR
      (21 patients) and group NP (36 patients) in group N. The modified Japanese
      Orthopedic Association score (mJOA), the modified recovery rate (mRR), quality of
      life (QoL), and relevant clinical data were used for clinical and radiological
      evaluation. The mJOA scores improved from 7.3 +/- 2.2 to 15.0 +/- 1.8 in the SR
      group and from 7.9 +/- 2.3 to 14.2 +/- 1.5 in the SP group (P = .036), with
      postoperative QoL significantly higher in the SR group than the SP group. A
      reduction in the diameter of enlarged spinal canals occurred at a significantly
      faster rate in the SP group compared with the SR group (P = .002). Multivariate
      regression analyses showed removal of HPLL correlated with mJOA scores
      (coefficient = 7.337, P = .002), mRR (%) (coefficient = 9.117, P = .005), PCS
      (coefficient = 12.129, P &lt; .001), and MCS (coefficient = 14.31, P &lt; .001) in the 
      S group at 24 months postoperatively, while removal of HPLL did not correlate
      with clinical outcomes in the N group. The HPLL should, therefore, be removed
      when mobility was reduced and the spinal cord remained compressed after anterior 
      decompression procedures in the patients with DCS. However, in non-DCS patients, 
      it remains unclear as to whether removal of HPLL provides any clinical benefit,
      thus, HPLL removal may not be necessary.
FAU - Bai, Chengrui
AU  - Bai C
AD  - aDepartment of Orthopedics, Beijing Friendship Hospital Affiliated of Capital
      Medical University, Beijing bDepartment of Orthopedics, Xiangya Hospital, Central
      South University, Changsha, China.
FAU - Li, Kanghua
AU  - Li K
FAU - Guo, Ai
AU  - Guo A
FAU - Fei, Qi
AU  - Fei Q
FAU - Li, Dong
AU  - Li D
FAU - Li, Jinjun
AU  - Li J
FAU - Wang, Bingqiang
AU  - Wang B
FAU - Yang, Yong
AU  - Yang Y
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Cervical Vertebrae/diagnostic imaging/*surgery
MH  - Decompression, Surgical/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Longitudinal Ligaments/diagnostic imaging/*surgery
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Quality of Life
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Spinal Cord Compression/diagnostic imaging/etiology/*surgery
MH  - Spondylosis/complications/diagnostic imaging/*surgery
MH  - Treatment Outcome
PMC - PMC5466216
EDAT- 2017/06/08 06:00
MHDA- 2017/07/07 06:00
CRDT- 2017/06/08 06:00
AID - 10.1097/MD.0000000000007043 [doi]
AID - 00005792-201706090-00014 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jun;96(23):e7043. doi: 10.1097/MD.0000000000007043.