• Satoru Egawa, Toshitaka Yoshii, Kenichiro Sakai, Kazuo Kusano, Yukihiro Nakagawa, Takashi Hirai, Atsushi Kimura, Takeo Furuya, Tsukasa Kanchiku, Yukitaka Nagamoto, Masahiko Takahata, Kanji Mori, Hiroyuki Katoh, Narihito Nagoshi, Shiro Imagama, Masao Koda, Yoshiharu Kawaguchi, Katsushi Takeshita, Morio Matsumoto, Masashi Yamazaki, and Atsushi Okawa.
• Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
• Spine. 2021 Dec 1; 46 (23): 1621-1629.

Study DesignA prospective multicenter study.ObjectiveThis study aims to investigate the postoperative complications of anterior decompression with fusion (ADF) for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL).Summary Of Background DataSurgical treatment for cervical OPLL has a high risk of various complications. ADF is reported to be effective for cervical OPLL, especially for massive OPLL. However, few studies have focused on the surgical complications of ADF.MethodsWe prospectively included 102 patients undergoing ADF for severe cervical OPLL with average canal occupying ratio of 49.8%. We evaluated systemic and local complications, neurological complications, and risk factors related to the postoperative complications.ResultsFrequently observed complications included graft/ implant complications (18.6%), neurological complications (11.8%), and cerebrospinal fluid leak (11.8%). Motor palsy involving only the upper extremity was found in nine patients (8.8%), and other motor palsies involving the lower extremities were found in three patients (2.9%). None of the preoperative factors were significantly associated with the occurrence of neurological palsies, whereas the number of operated levels was a significant factor related to the postoperative graft/implant complications (P = 0.003; odds ratio, 2.112). The incidence of graft/implant complications and related reoperation increased as the number of operated levels increased (especially four levels or more). Most motor palsies were observed immediately after surgery. Of the motor palsies in the bilateral upper extremities and palsies involving the lower extremities, 85.7% showed good recovery, whereas only 40% of unilateral upper extremity motor palsies showed good recovery during the follow-up period.ConclusionIn ADF for cervical OPLL, the number of operated levels was a significant factor related to the postoperative complication. Specifically, the incidence of graft/implant complications and reoperation rate increased in ADF with four or more levels.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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