title: Perioperative complications of anterior cervical decompression with fusion in patients with ossification of the posterior longitudinal ligament: a retrospective, multi-institutional study.
abstract: BACKGROUND
  Anterior decompression with fusion (ADF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL) is reportedly associated with a higher incidence of complications than is laminoplasty. However, the frequency of perioperative complications associated with ADF for cervical OPLL has not been fully established. The purpose of this study was to investigate the incidence of perioperative complications, especially neurological complications, following ADF performed to relieve compressive cervical myelopathy due to cervical OPLL.
  
  
  METHODS
  Study participants comprised 150 patients who had undergone ADF for cervical OPLL at 27 institutions between 2005 and 2008. Perioperative--especially neurological--complications occurring within 2 weeks after ADF were analyzed. Preoperative imaging findings, including Cobb angle, between C2 and C7 and occupying ratio of OPLL were investigated. Multivariate analysis with logistic regression was performed to identify independent risk factors for neurological complications.
  
  
  RESULTS
  Three patients (2.0 %) showed deterioration of lower-extremity function after ADF. One of the three patients had not regained their preoperative level of function 6 months after surgery. Upper-extremity paresis occurred in 20 patients (13.3 %), five of whom had not returned to preoperative levels 6 months after surgery. Patients with upper-extremity paresis showed significantly higher occupying ratios of OPLL, greater blood loss, longer operation times, fusion of more segments, and higher rates of cerebrospinal fluid leakage than those without paresis. Independent risk factors for upper-extremity paresis were a high occupying ratio of OPLL and large blood loss during surgery.
  
  
  CONCLUSIONS
  The incidences of deterioration in upper- and lower-extremity functions were 13.3 % and 2.0 %, respectively. Patients with a high occupying ratio of OPLL are at higher risk of developing neurological deterioration.
authors.affiliation: Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kimura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seichi
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hoshino
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Macondo
authors.initials: M
authors.lastname: Mochizuki
authors.forename: Atsuomi
authors.initials: A
authors.lastname: Aiba
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kato
authors.forename: Kenzo
authors.initials: K
authors.lastname: Uchida
authors.forename: Kei
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Shinnosuke
authors.initials: S
authors.lastname: Nakahara
authors.forename: Shinichirou
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Masashi
authors.initials: M
authors.lastname: Neo
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Taguchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Endo
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
authors.forename: Masahito
authors.initials: M
authors.lastname: Takahashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kaito
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Chikuda
authors.forename: Takahito
authors.initials: T
authors.lastname: Fujimori
authors.forename: Takui
authors.initials: T
authors.lastname: Ito
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ono
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Abumi
authors.forename: Kei
authors.initials: K
authors.lastname: Yamada
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010291:Paresis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome