Two-level Anterior Cervical Corpectomy and Fusion versus Posterior Open-door Laminoplasty for the Treatment of Cervical Ossification of Posterior Longitudinal Ligament: A Comparison of the Clinical Impact on the Occipito-Atlantoaxial Complex

Abstract

Objective: Both two-level anterior cervical corpectomy and fusion (t-ACCF) and posterior open-door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t-ACCF and ODLP on the occipito-atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito-atlantoaxial complex in OPLL patients treated with t-ACCF and ODLP.

Methods: This was a retrospective study that included 74 patients who underwent t-ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3-month, and 1-year postoperative cervical neutral, flexion-extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2-7, C0-2, C0-1, C1-2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS.

Results: In the ODLP group, the SCS (C2-7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p < 0.05), and the UCS (C0-2) Cobb angle was significantly compensated for at 1 year postoperatively compared with the t-ACCF group (3.05 ± 4.09 vs 0.79 ± 2.62; p < 0.01). The SCS and lateral flexion ROM of the ODLP group was better maintained than t-ACCF (14.51 ± 6.00 vs 10.72 ± 3.79; 6.87 ± 4.56 vs 3.81 ± 1.67; p < 0.01). The compensatory increase in C0-2, C0-1, and C1-2 ROM was pronounced in both groups, especially in the ODLP group. The results of multiple linear regression showed that only the surgical procedure was a significant factor influencing UCS.

Conclusion: The loss of the SCS Cobb angle was more pronounced in ODLP relative to t-ACCF, resulting in a significant compensatory increase in UCS and atlantoaxial Cobb angle. The ROM of the UCS, atlantooccipital, and atlantoaxial joints was significantly increased in both groups, this may accelerate degenerative changes in the occipital-atlantoaxial complex, may leading to poorer outcomes in the long-term; of these, ODLP should receive more attention. In contrast, t-ACCF better maintains normal curvature of the SCS and occipito-atlantoaxial complex but loses more ROM.

Keywords

Anterior cervical corpectomy and fusion / Axis / Cervical atlas / Open-door laminoplasty / Ossification of the posterior longitudinal ligament

References

[1] Shin JJ. Comparison of adjacent segment degeneration, cervical alignment, and clinical outcomes after one-and multilevel anterior cervical discectomy and fusion. Neurospine. 2019; 16: 589–600.

[2] Stapleton CJ, Pham MH, Attenello FJ, Hsieh PC. Ossification of the posterior longitudinal ligament: genetics and pathophysiology. Neurosurg Focus. 2011; 30: E6.

[3] Lau D, Chou D, Mummaneni PV. Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes. J Neurosurg Spine. 2015; 23: 280–289.

[4] Qin R, Chen X, Zhou P, Li M, Hao J, Zhang F. Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament: a meta-analysis. Eur Spine J. 2018; 27: 1375–1387.

[5] Kuntz C, Levin LS, Ondra SL, Shaffrey CI, Morgan CJ. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine. 2007; 6: 104–112.

[6] Kauther MD, Piotrowski M, Hussmann B, Lendemans S, Wedemeyer C. Cervical range of motion and strength in 4, 293 young male adults with chronic neck pain. Eur Spine J. 2012; 21: 1522–1527.

[7] Anderst WJ, Donaldson WF 3rd, Lee JY, Kang JD. Cervical motion segment contributions to head motion during flexion\extension, lateral bending, and axial rotation. Spine J. 2015; 15: 2538–2543.

[8] Phillips FM, Phillips CS, Wetzel FT, Gelinas C. Occipitocervical neutral position. Possible surgical implications. Spine (Phila Pa 1976). 1999; 24: 775–778.

[9] Rudolfsson T, Björklund M, Djupsjöbacka M. Range of motion in the upper and lower cervical spine in people with chronic neck pain. Man Ther. 2012; 17: 53–59.

[10] Schäfer AGM, Schöttker-Königer T, Hall TM, et al. Upper cervical range of rotation during the flexion-rotation test is age dependent: an observational study. Ther Adv Musculoskelet Dis. 2020; 12:1759720x20964139.

[11] Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T. Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: radiographic data from over 1, 200 asymptomatic subjects. Eur Spine J. 2012; 21: 1492–1498.

[12] Xiao B, Wu B, Rong T, Cui W, Sang D, Liu B. Clinical impact of 3-level anterior cervical decompression and fusion (ACDF) on the occipito-atlantoaxial complex: a retrospective study of patients who received a zero-profile anchored spacer versus cage-plate construct. Eur Spine J. 2021; 30: 3656–3665.

[13] Nojiri K, Matsumoto M, Chiba K, Maruiwa H, Nakamura M, Nishizawa T, et al. Relationship between alignment of upper and lower cervical spine in asymptomatic individuals. J Neurosurg. 2003; 99: 80–83.

[14] Wang S, Passias PG, Cui L, Li G, Yan M, Zhou H, et al. Does atlantoaxial dislocation influence the subaxial cervical spine? Eur Spine J. 2013; 22: 1603–1607.

[15] Matsunaga S, Onishi T, Sakou T. Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine (Phila Pa 1976). 2001; 26: 161–165.

[16] Gong L, Ma HN, Yi P, Tan MS. Flexion dysfunction of Atlanto-occipital joint associated with cervical spondylosis. Orthop Surg. 2021; 13: 267–275.

[17] Penning L. Normal movements of the cervical spine. AJR Am J Roentgenol. 1978; 130: 317–326.

[18] Liu B, Wu B, Van Hoof T, Okito JP, Liu Z, Zeng Z. Are the standard parameters of cervical spine alignment and range of motion related to age, sex, and cervical disc degeneration? J Neurosurg Spine. 2015; 23: 274–279.

[19] Passfall L, Williamson TK, Krol O, Lebovic J, Imbo B, Joujon-Roche R, et al. Do the newly proposed realignment targets for C2 and T1 slope bridge the gap between radiographic and clinical success in corrective surgery for adult cervical deformity? J Neurosurg Spine. 2022; 37: 368–375.

[20] Matsunaga S, Kukita M, Hayashi K, Shinkura R, Koriyama C, Sakou T, et al. Pathogenesis of myelopathy in patients with ossification of the posterior longitudinal ligament. J Neurosurg. 2002; 96: 168–172.

[21] Yoshii T, Sakai K, Hirai T, Yamada T, Inose H, Kato T, et al. Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a ≥50% canal occupying ratio: a multicenter retrospective study. Spine J. 2016; 16: 1351–1357.

[22] Dohzono S, Toyoda H, Takahashi S, Suzuki A, Terai H, Nakamura H. Restrictions of cervical flexion after laminoplasty increase in the mechanical stress at the occipitocervical junction in non-rheumatoid arthritis patients. J Clin Neurosci. 2017; 45: 187–192.

[23] Kwon WK, Kim PS, Ahn SY, Song JY, Kim JH, Park YK, et al. Analysis of associating factors with C2-7 sagittal vertical axis after two-level anterior cervical fusion: comparison between plate augmentation and stand-alone cages. Spine (Phila Pa 1976). 2017; 42: 318–325.

[24] Pan Y, Ma X, Feng H, Chen C, Qin Z, Huang Y. Effect of posterior cervical expansive open-door laminoplasty on cervical sagittal balance. Eur Spine J. 2020; 29: 2831–2837.

[25] Liu J, Ebraheim NA, Sanford CG Jr, Patil V, Haman SP, Ren L, et al. Preservation of the spinous process-ligament-muscle complex to prevent kyphotic deformity following laminoplasty. Spine J. 2007; 7: 159–164.

[26] Wei W, Liao S, Shi S, Fei J, Wang Y, Chen C. Straightened cervical lordosis causes stress concentration: a finite element model study. Australas Phys Eng Sci Med. 2013; 36: 27–33.

[27] Duetzmann S, Cole T, Ratliff JK. Cervical laminoplasty developments and trends, 2003–2013: a systematic review. J Neurosurg Spine. 2015; 23: 24–34.

[28] Ratliff JK, Cooper PR. Cervical laminoplasty: a critical review. J Neurosurg. 2003; 98: 230–238.

[29] Hua W, Zhi J, Wang B, Ke W, Sun W, Yang S, et al. Biomechanical evaluation of adjacent segment degeneration after one-or two-level anterior cervical discectomy and fusion versus cervical disc arthroplasty: a finite element analysis. Comput Methods Programs Biomed. 2020; 189: 105352.

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