title: Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine.
abstract: OBJECTIVE
  Numerous surgical procedures have been developed for treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, and these can be performed via three approaches: anterior, posterior, or combined anterior-posterior. The optimal approach in cases involving OPLL-induced cervical myelopathy, however, remains controversial. To address this issue, the authors assessed the benefits and limitations of expansive open-door laminoplasty for OPLL-related myelopathy by evaluating mid- and long-term clinical results.
  
  
  METHODS
  Clinical results obtained in 72 patients who underwent expansive open-door laminoplasty between 1983 and 1997 and who were followed for at least 5 years were assessed using the Japanese Orthopaedic Association (JOA) scoring system. The mean preoperative JOA score was 9.2 +/- 0.4; at 3 years postoperatively, the JOA score was 14.2 +/- 0.3 and the recovery rate (calculated using the Hirabayashi method) was 63.1 +/- 4.5%, both having reached their highest level. These favorable results were maintained up to 5 years after surgery. An increase in cervical myelopathy due to progression of the ossified ligament was observed in only two of 30 patients who could be followed for more than 10 years. Severe surgery-related complications were not observed. Preoperative JOA score, age at the time of surgery, and duration between onset of initial symptoms and surgery affected clinical results.
  
  
  CONCLUSIONS
  Mid-term and long-term results of expansive open-door laminoplasty were satisfactory. Considering factors that affected surgical results, early surgery is recommended for OPLL of the cervical spine.
authors.affiliation: Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors.forename: Yuto
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Chiba
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.forename: Hironari
authors.initials: H
authors.lastname: Takaishi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Hirabayashi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hirabayashi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000601:surgery; D008137:Longitudinal Studies; D008141:Lordosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000601:surgery; D017887:Ossification of Posterior Longitudinal Ligament / Q000601:surgery*; D011183:Postoperative Complications; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome