Segmental motion at the peak of the ossification foci is independent risk factor except for mal-alignment and thick ossification foci for poor outcome after laminoplasty for cervical ossification of the posterior longitudinal ligament: analyses in patients with positive K-line, lordotic alignment, and lower canal occupying ratio
JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH
Authors: Saito, Junya; Koda, Masao; Furuya, Takeo; Maki, Satoshi; Ijima, Yasushi; Kitamura, Mitsuhiro; Miyamoto, Takuya; Orita, Sumihisa; Inage, Kazuhide; Hasue, Fumio; Fujiyoshi, Takayuki; Kamiya, Koshiro; Ikeda, Yoshikazu; Nakajima, Fumitake; Hashimoto, Mitsuhiro; Noguchi, Hiroshi; Takahashi, Hiroshi; Yamazaki, Masashi; Ohtori, Seiji
Abstract
PurposeTo elucidate the independent preoperative factors that have a significant impact on poor surgical outcome after laminoplasty for K-line (+) ossification of the posterior longitudinal ligament (OPLL). Analyses in K-line (+) patient population can exclude the influence by mal-alignment and thick OPLL, both of which are well known two major factors that have significant impact on clinical outcome.MethodsThe present study included 72 patients (50 male and 22 female) who underwent laminoplasty for K-line (+) cervical OPLL and were followed-up for at least 1year. Recovery of Japanese Orthopedic Association score (JOA score) for cervical myelopathy was used as the measure of clinical outcome. For radiographic assessment, the type of OPLL, the maximum OPLL occupation ratio, the C2-C7 angle, and the segmental range of motion at the peak of OPLL (segmental ROM) were assessed. To elucidate the factors that are significantly associated with a poor clinical outcome after laminoplasty for K-line (+) OPLL, statistical analyses were conducted.ResultsThe mean preoperative JOA score was 8.9 points and improved to 12.8 points after surgery. The recovery of JOA score was 47 35%. Stepwise logistic regression following univariate analyses revealed that preoperative segmental ROM at the peak of OPLL is an independent factor associated with a poor outcome (p = 0.04, odds ratio = 1.15).Conclusions Large preoperative segmental ROM at the peak of the OPLL is an independent factor that has significant impact on poor surgical outcome after laminoplasty for K-line (+) OPLL.
Curious Case of Atypical Hangman's Fracture: C2-C3 Listhesis without Pars Fracture
JOURNAL OF NEUROSCIENCES IN RURAL PRACTICE
Authors: Jain, Surendra; Mishra, Keshav; Gandhi, Ashok; Garg, Deepak
Abstract
Traumatic spondylolisthesis of axis or hangman's fracture is the second most common C2 vertebra injury. We present a report of a young man presenting with a history of fall from height with C2 to C3 spondylolisthesis without any evidence of injury to pars interarticularis but with associated injury to capsular ligament of facet joint along with posterior spinous ligamentous injury. The patient underwent intraoperative reduction in listhesis with posterior screw fixation. The patient showed uneventful postoperative course with neurological improvement at 6-week follow-up. Hangman's fracture refers to a diverse group of injury in which the soft tissue injury has an equally important part to play as the bone fracture.