Risk Factors and Management of Dural Defects in Anterior Surgery for Cervical Ossification of the Posterior Longitudinal Ligament

• Published in: World neurosurgery Vol. 111; pp. e527 - e538
• Main Authors: Du, Yue-Qi, Duan, Wan-Ru, Chen, Zan, Wu, Hao, Jian, Feng-Zeng
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2018
• Subjects: Aged; Aged, 80 and over; Algorithms; Anterior surgery; Cervical spine; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Decompression, Surgical; Dura Mater - abnormalities; Dura Mater - diagnostic imaging; Dura Mater - surgery; Dural defects; Female; Humans; Intraoperative Care; Kyphosis - diagnostic imaging; Kyphosis - etiology; Male; Management strategies; Middle Aged; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Ossification of Posterior Longitudinal Ligament - diagnostic imaging; Ossification of Posterior Longitudinal Ligament - surgery; Ossification, Heterotopic - diagnostic imaging; Ossification, Heterotopic - surgery; Posterior longitudinal ligament ossification; Postoperative Care; Prevalence; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome; DD; Anterior surgery; OR; OPLL; MRI; CI; CSFL; IR; Dural defects; Risk factors; CT; PLL; Posterior longitudinal ligament ossification; Management strategies; ACDF; ACCF; JOA; Cervical spine
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.12.113

To investigate risk factors and outcomes and to develop a cogent perioperative management algorithm for dural defects (DDs) in anterior surgery for cervical ossification of the posterior longitudinal ligament (OPLL). Ninety OPLL patients who had undergone anterior cervical decompression between January 2014 and December 2016 were reviewed. DDs occurred in 12 patients. Demographic, clinical, and radiologic data; intraoperative and postoperative management; and complications were analyzed. Risk factors for DDs were assessed with multivariate analysis. A treatment algorithm was identified based on these findings and our experience. The prevalence of DDs was 13.3% (12/90). Univariate and multivariate analyses showed that the ratio of OPLL base to spinal canal (odds ratio [OR] 1.09, P = 0.012), kyphotic cervical alignment with thick OPLL masses (OR 9.44, P = 0.026), and lateral, curved, and irregular OPLL masses (OR 8.28, P = 0.037) could be risk factors for DDs. DDs were repaired intraoperatively with onlay grafts, and lumbar drains were placed in all DD patients. The treatment was successful in all DD patients, and outcome measures did not differ between the DD and no DD groups. No patient had experienced complications associated with DDs and CSF leaks at the final follow-up visit. Patients with broad-based OPLL, kyphotic cervical alignment with thick OPLL masses, and lateral, curved, and irregular OPLL masses have a higher risk of DD in anterior surgery for OPLL. Intraoperative primary repair with onlay grafts combined with early lumbar drains is a simple, safe, and effective strategy for DDs. The outlook for the long-term sequelae of DDs is optimistic if they are managed adequately. •OPLL patients are more prone to experience dural defects, especially in anterior surgery. However, the literature regarding risk factors for dural defects in anterior surgery for OPLL is limited. In this study, we examined the risk factors for dural defects in anterior surgery for OPLL using multivariate analysis.•We found that the ratio of OPLL base to spinal canal (base ratio), kyphotic cervical alignment with thick OPLL masses (modified K-line negative OPLL), and lateral, curved, and irregular OPLL masses (OPLL with C sign) are significant risk factors for dural defects in anterior surgery for OPLL. Knowledge of these risk factors is essential for making a surgical plan, guiding postoperative management, and improving patient recovery.•The combination of intraoperative primary repair for dural defects using onlay grafts with early placement of lumbar drains is a simple, safe, and effective strategy, and no impact on clinical outcomes was observed.•Based on our study and clinical experience, we provided a stepwise management strategy for dural defects in anterior surgery for OPLL.