Abstract
Study design
Biomechanical study.
Objective
Cervical ossification of the posterior longitudinal ligament (C-OPLL) causes myelopathy. Though posterior decompression for C-OPLL showed positive results, poor outcomes were seen in patients with a kyphotic alignment. Posterior decompression with fusion (PDF) tends to show better results compared to posterior decompression. The aim of this study is to evaluate the effects of the posterior procedures for C-OPLL.
Setting
Yamaguchi University.
Methods
Based on 3D finite element C2-C7 spine created from medical images and a spinal cord, the following compression models were created: the intact model, K-line 0 mm model, and K-line 2 mm model. These models were used to analyze the effects of posterior decompression with varied lengths of fixation. The stress of the spinal cord was calculated for intact, K-line 0 mm, and K-line 2 mm as preoperative models, and laminectomy (LN)-K-line 0 mm, PDF (C4-C5)-K-line 0 mm, PDF (C3-C6)-K-line 0 mm, LN-K-line 2 mm, PDF (C4-C5)-K-line 2 mm, and PDF (C3-C6)-K-line 2 mm model as operative models in a neutral, flexion, and extension.
Results
As the compression increased, stress on the spinal cord increased compared to the intact model. In the neutral, posterior decompression decreased the stress of the spinal cord. However, in flexion and extension, the stress on the spinal cord for LN-K-line 0 or 2 mm, PDF (C4-C5)-K-line 0 or 2 mm, and PDF (C3-C6)-K-line 0 or 2 mm models decreased by more than 40%, 43%, and 70% respectively compared to the K-line 0 or 2 mm model.
Conclusions
In kyphotic C-OPLL, it is essential to control intervertebral mobility in the posterior approach.
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Data availability
The data presented in this study are available.
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Acknowledgements
The authors express their thanks to the members of the Medical and Mechanical Engineering Laboratory of the same college and the graduate students at this laboratory for their co-operation.
Funding
This work was supported by JSPS KAKENHI grant JP 15K20002.
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Conceptualization: N.N. Data curation and Formal analysis: T.A., R.T. and F.J. Funding acquisition: N.N. Methodology: N.N., Y.I., H.S, and M.F. Project administration: N.N. and C.X. Supervision: T.S. Validation: T.A., R.T. and N.N Visualization: T.S. Writing—original draft: N.N. Writing—review & editing, Y.K., and J.O. All authors have read and agreed to the published version of the manuscript.
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The present study was approved by the Ethics Committee at the Center for Clinical Research, Yamaguchi University Hospital (Ube, Japan; approval no. H28-054). Written informed consent for this study and its publication was obtained from all subjects.
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Nishida, N., Jiang, F., Asano, T. et al. Effect of posterior decompression with and without fixation on a kyphotic cervical spine with ossification of the posterior longitudinal ligament. Spinal Cord 61, 133–138 (2023). https://doi.org/10.1038/s41393-022-00857-z
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DOI: https://doi.org/10.1038/s41393-022-00857-z
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