Study design: A retrospective case-control study.
Objective: The objective of this study was to assess mid-term surgical outcomes after posterior decompression with instrumented fusion (PDF) in patients with K-line (-) type cervical ossification of the posterior longitudinal ligament (OPLL).
Summary of background data: The poor surgical outcome for K-line (-) type cervical OPLL can result from posterior decompression alone.
Materials and methods: We reviewed cases of K-line (-) type cervical OPLL in 24 patients who underwent PDF in our institute from 2002 to 2014. As a control, we used K-line (-) type cervical OPLL in 9 patients who underwent laminoplasty before 2002 (LMP group). The neurological status and radiographic findings were evaluated retrospectively.
Results: The preoperative Japanese Orthopedic Association score was 7.9±2.4 points in the PDF group and 7.4±2.3 points in the LMP group (P=0.584). The postoperative Japanese Orthopedic Association score was 11.7±2.6 points in the PDF group and 9.2±2.0 points in the LMP group at a 5-year follow-up (P=0.008). The recovery rate on average was 39.0% in the PDF group and 14.9% in the LMP group at a 5-year follow-up (P=0.037). The range of motion postoperatively at the maximal spinal cord compression level decreased significantly in the PDF group. The C2-C7 angle was 2.7 degrees of kyphosis in the PDF group, whereas 5.5 degrees of kyphosis was found in the LMP group at a 5-year follow-up (P=0.303). The center of gravity of the head-C7 sagittal vertical axis was 40 mm in the PDF group and 43 mm in the LMP group (P=0.936).
Conclusions: The relatively good surgical outcome could be obtained by PDF for patients with K-line (-)-type cervical OPLL. The addition of posterior instrumented fusion eliminated the dynamic factor at the level of maximal spinal cord compression.
Level of evidence: Level IV.