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Journal of Korean Neurosurgical Society > Volume 43(6); 2008 > Article
Journal of Korean Neurosurgical Society 2008;43(6): 259-264.
doi: https://doi.org/10.3340/jkns.2008.43.6.259
Post-Laminectomy Kyphosis in Patients with Cervical Ossification of the Posterior Longitudinal Ligament: Does It Cause Neurological Deterioration?.
Won Sang Cho, Chun Kee Chung, Tae Ahn Jahng, Hyun Jib Kim
1Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Korea. chungc@snu.ac.kr
2Department of Neurosurgery, Seoul National University, Bundang Hospital, Seongnam, Korea.
Total laminectomy (TL) is an effective surgical technique for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) along multiple levels. However, kyphosis and probable neurological deterioration have been frequently reported after laminectomy. We analyzed the changes in the cervical curvature after TL and subsequent changes in neurological status.
We retrospectively reviewed the records of 14 patients who underwent TL for the treatment of cervical OPLL between Jan. 1998 and Dec. 2003. TL was selected according to the previously determined criteria. The curvature of the cervical spine was visualized on a lateral cervical spine X-ray and measured using Ishihara's Curvature Index (CI) before the operation and at the last follow-up examination. Perioperative neurological status was estimated using the modified Japanese Orthopedic Association score and the Improvement Rate (IR) at the same time as the images were evaluated.
The mean age of the patients was 57 years, the male/female ratio was 10:4, and the mean follow-up period was 41 months. The mean number of OPLL was 4.9, and the mean number of operated levels was also 4.9. The CI decreased after TL (p=0.002), which was indicative of a kyphotic change. However, this kyphotic change showed no correlation with the length of the follow-up period, number of operated levels and preoperative CI. Neurological examination at the last follow-up showed an improved neurological status in all patients (p=0.001). There was no neurological deterioration in any case during the follow-up period. Moreover, there was no correlation between IR and the degree of kyphotic change. Postoperative complications, such as C5 radiculopathy and epidural bleeding, resolved spontaneously without neurological sequelae.
Kyphotic change was observed in all but one patient who underwent TL for the treatment of cervical OPLL. However, we did not find any contributing factors to kyphosis or evidence of postoperative neurological deterioration.
Key Words: Total laminectomy (TL); Cervical; Ossification of posterior longitudinal ligament (OPLL); Kyphotic change; Neurological status
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