Circumferential Cervical Surgery for Ossification of the Posterior Longitudinal Ligament: A Multianalytic Outcome Study

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Abstract

Study Design.

Three outcome measures, Nurick grades, Odom’s criteria, and the Short Form (SF-36) were analyzed following circumferential cervical surgery in 47 patients.

Objectives.

To analyze three outcome measures following circumferential surgery.

Summary of Background Data.

Few studies use multiple outcome criteria to assess circumferential surgery.

Methods.

Patients averaged 54 years of age and exhibited severe myelopathy (Nurick grade 3.6). Corpectomies of 2.6 vertebrae (on average) were followed by posterior fusions (C2–T1) with halo stabilization. Initial fixed-plates (n = 28) and subsequent dynamic ABC plates (Aesculap, Tuttlingen, Germany) (n = 19) were applied, Fusion was confirmed on dynamic radiographs and two-dimensional CT studies 3, 6, and up to 12 months after surgery. Nurick grades and Odom’s criteria were evaluated 1 and 2 years after surgery. Results of SF-36 questionnaires, obtained before surgery, 6 weeks, 3 months, 6 months, 1 year, 2 years after surgery, were calculated.

Results.

Neurodiagnostic studies confirmed fusion on average 5.0 months after surgery. One and 2 years after surgery, mean Nurick grades were 0.8 (+2.8 points) and 0.4 (+3.2 points), respectively. One year (2 years) postoperative Odom’s criteria revealed excellent 26 (30), good 14 (11), fair 6 (5), and poor 1 (1) patient outcomes. Comparing preoperative with 1-year postoperative SF-36 questionnaires revealed moderate improvement on 5 health scales: Social Function (+19.9), Bodily Pain (+19.6), Role–Physical (+18.8), Physical Function (+12.5), and Role–Emotional (+11.1). Minimal additional improvement occurred over the second year: Role–Physical (+21.6), Social Function (+16.4), Bodily Pain (+13.4), Physical Function (+12.8), and Role Emotional (+9.5).

Conclusion.

Based on three outcome measures, the greatest improvement occurs 1 year following circumferential surgery.

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