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

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

World Neurosurg. 2017 Dec 27;:

Authors: Du YQ, Duan WR, Chen Z, Wu H, Jian FZ

Abstract
OBJECTIVE: 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).
METHODS: Ninety OPLL patients underwent anterior cervical decompression between January 2014 and December 2016 were reviewed. DDs occurred in 12 patients. Demographic, clinical and radiological data; intra- and postoperative management; and complications were analyzed. Risk factors for DDs were assessed using multivariate analysis. A treatment algorithm was identified based on these findings and our experience.
RESULTS: The prevalence of DDs is 13.3% (12/90). Univariate and multivariate analyses showed that the ratio of OPLL base to spinal canal (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 using 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 developed complications associated with DDs and CSF leaks at the final follow-up.
CONCLUSIONS: Patients with broad-based OPLL, kyphotic cervical alignment with thick OPLL masses, and lateral, curved and irregular OPLL masses are associated with higher risks of DDs in anterior surgery for OPLL. Intraoperative primary repair using onlay grafts combined with early lumbar drains are simple, safe and effective strategies for DDs. The long-term sequelae of DDs are optimistic if they are managed adequately.

PMID: 29288856 [PubMed - as supplied by publisher]

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