{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:30:39Z","timestamp":1761823839724},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2017,3]]},"abstract":"\nOBJECTIVE<\/jats:title>\nAlthough posterior decompressive surgery is widely used to treat patients with cervical myelopathy and multilevel ossification of the posterior longitudinal ligament (OPLL), a poor outcome is anticipated if the sagittal alignment is kyphotic (or K-line negative). Accordingly, it is mandatory to perform anterior decompression and fusion in patients with cervical kyphosis. However, it can be difficult to perform anterior surgery because of the high risk of complications. This present report proposes a novel \u201cgreenstick fracture technique\u201d to change the K-line from negative to positive in patients with cervical myelopathy, OPLL, and kyphotic deformity.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nFour patients with cervical myelopathy, continuous-type OPLL, and kyphotic sagittal alignment (who were K-line negative) were indicated for surgery. Posterior laminectomy and lateral mass screw insertions using a posterior approach were performed, followed by anterior surgery. Multilevel discectomy and thinning of the OPLL mass by bur drilling was performed, then an intentional greenstick fracture at each disc level was made to convert the cervical K-line from negative to positive. Finally, posterior instrumentation using a rod was carried out to maintain cervical lordosis.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nMRI showed complete decompression of the cord by posterior migration in all cases, which had been caused by cervical lordosis. Restoration of neurological defects was confirmed at the 1-year follow-up assessment. No specific complications were identified that were associated with this technique.<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nA greenstick fracture technique may be effective and safe when applied to patients with cervical myelopathy, continuous-type OPLL, and kyphotic deformity (K-line negative). However, further studies with more cases will be required to reveal its generalizability and safety.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.8.spine16542","type":"journal-article","created":{"date-parts":[[2016,10,28]],"date-time":"2016-10-28T14:01:31Z","timestamp":1477663291000},"page":"325-330","source":"Crossref","is-referenced-by-count":22,"title":["A novel technique to correct kyphosis in cervical myelopathy due to continuous-type ossification of the posterior longitudinal ligament"],"prefix":"10.3171","volume":"26","author":[{"given":"Dong-Ho","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youn-Suk","family":"Joo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang Ju","family":"Hwang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Choon Sung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae Hwan","family":"Cho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-spine16542","series-title":"J Am Acad Orthop Surg","doi-asserted-by":"publisher","first-page":"420","DOI":"10.5435\/JAAOS-22-07-420","article-title":"Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine","volume":"22","author":"An HS,","year":"2014","unstructured":"An HS, Al-Shihabi L, Kurd M: Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine. J Am Acad Orthop Surg 22:420\u2013429, 201410.5435\/JAAOS-22-07-42024966248"},{"issue":"3","key":"b2-spine16542","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E12","DOI":"10.3171\/2011.1.FOCUS10278","article-title":"Approach-related complications after decompression for cervical ossification of the posterior longitudinal ligament","volume":"30","author":"Cardoso MJ,","year":"2011","unstructured":"Cardoso MJ, Koski TR, Ganju A, Liu JC: Approach-related complications after decompression for cervical ossification of the posterior longitudinal ligament. Neurosurg Focus 30:3E12, 201110.3171\/2011.1.FOCUS1027821361750"},{"key":"b3-spine16542","series-title":"Asian Spine J","doi-asserted-by":"publisher","first-page":"267","DOI":"10.4184\/asj.2011.5.4.267","article-title":"Ossification of the posterior longitudinal ligament: a review of literature","volume":"5","author":"Choi BW,","year":"2011","unstructured":"Choi BW, Song KJ, Chang H: Ossification of the posterior longitudinal ligament: a review of literature. Asian Spine J 5:267\u2013276, 201110.4184\/asj.2011.5.4.26722164324"},{"issue":"Suppl 7","key":"b4-spine16542","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1007\/s00586-015-4298-y","article-title":"Favourable outcome of posterior decompression and stabilization in lordosis for cervical spondylotic myelopathy: the spinal cord \u201cback shift\u201d concept","volume":"24","author":"Denaro V,","year":"2015","unstructured":"Denaro V, Longo UG, Berton A, Salvatore G, Denaro L: Favourable outcome of posterior decompression and stabilization in lordosis for cervical spondylotic myelopathy: the spinal cord \u201cback shift\u201d concept. Eur Spine J 24:Suppl 7826\u2013831, 201510.1007\/s00586-015-4298-y26538154"},{"issue":"Suppl 2","key":"b5-spine16542","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1007\/s00586-015-3784-6","article-title":"Anterior approaches for cervical spondylotic myelopathy: which? when? how?","volume":"24","author":"Emery SE:","year":"2015","unstructured":"Emery SE: Anterior approaches for cervical spondylotic myelopathy: which? when? how?. Eur Spine J 24:Suppl 2150\u2013159, 201510.1007\/s00586-015-3784-625652554"},{"key":"b6-spine16542","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"941","DOI":"10.2106\/00004623-199807000-00002","article-title":"Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up","volume":"80","author":"Emery SE,","year":"1998","unstructured":"Emery SE, Bohlman HH, Bolesta MJ, Jones PK: Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up. J Bone Joint Surg Am 80:941\u2013951, 1998969799810.2106\/00004623-199807000-00002"},{"key":"b7-spine16542","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E990","DOI":"10.1097\/BRS.0b013e3182a7f4ff","article-title":"A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line","volume":"33","author":"Fujiyoshi T,","year":"2008","unstructured":"Fujiyoshi T, Yamazaki M, Kawabe J, Endo T, Furuya T, Koda M, : A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line. Spine (Phila Pa 1976) 33:E990\u2013E993, 200810.1097\/BRS.0b013e3182a7f4ff"},{"key":"b8-spine16542","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.2106\/JBJS.F.01114","article-title":"Cerebrospinal fluid leaks following cervical spine surgery","volume":"90","author":"Hannallah D,","year":"2008","unstructured":"Hannallah D, Lee J, Khan M, Donaldson WF, Kang JD: Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg Am 90:1101\u20131105, 20081845140310.2106\/JBJS.F.01114"},{"key":"b9-spine16542","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1097\/01.brs.0000257566.91177.cb","article-title":"Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 2: Advantages of anterior decompression and fusion over laminoplasty","volume":"32","author":"Iwasaki M,","year":"2007","unstructured":"Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K, : Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 2: Advantages of anterior decompression and fusion over laminoplasty. Spine (Phila Pa 1976) 32:654\u2013660, 200710.1097\/01.brs.0000257566.91177.cb17413470"},{"key":"b10-spine16542","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/j.jocn.2008.05.011","article-title":"Acute graft extrusion following central corpectomy in patients with cervical spondylotic myelopathy and ossified posterior longitudinal ligament","volume":"16","author":"Kumar GS,","year":"2009","unstructured":"Kumar GS, Rajshekhar V: Acute graft extrusion following central corpectomy in patients with cervical spondylotic myelopathy and ossified posterior longitudinal ligament. J Clin Neurosci 16:373\u2013377, 200910.1016\/j.jocn.2008.05.01119138851"},{"issue":"22 Suppl 1","key":"b11-spine16542","series-title":"Spine (Phila Pa 1976)","first-page":"S171","article-title":"Surgical management of degenerative cervical myelopathy: a consensus statement","volume":"38","author":"Lawrence BD,","year":"2013","unstructured":"Lawrence BD, Shamji MF, Traynelis VC, Yoon ST, Rhee JM, Chapman JR, : Surgical management of degenerative cervical myelopathy: a consensus statement. Spine (Phila Pa 1976) 38:22 Suppl 1S171\u2013S172, 2013"},{"key":"b12-spine16542","series-title":"Orthopedics","first-page":"e117","article-title":"Anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive myelopathy","volume":"37","author":"Liu X,","year":"2014","unstructured":"Liu X, Wang H, Zhou Z, Jin A: Anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive myelopathy. Orthopedics 37:e117\u2013e122, 2014"},{"issue":"3","key":"b13-spine16542","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E13","DOI":"10.3171\/2010.12.FOCUS10255","article-title":"Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature","volume":"30","author":"Mazur M,","year":"2011","unstructured":"Mazur M, Jost GF, Schmidt MH, Bisson EF: Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature. Neurosurg Focus 30:3E13, 20112136175110.3171\/2010.12.FOCUS10255"},{"issue":"22 Suppl 1","key":"b14-spine16542","series-title":"Spine (Phila Pa 1976)","first-page":"S55","article-title":"Nonoperative management of cervical myelopathy: a systematic review","volume":"38","author":"Rhee JM,","year":"2013","unstructured":"Rhee JM, Shamji MF, Erwin WM, Bransford RJ, Yoon ST, Smith JS, : Nonoperative management of cervical myelopathy: a systematic review. Spine (Phila Pa 1976) 38:22 Suppl 1S55\u2013S67, 2013"},{"key":"b15-spine16542","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1097\/BRS.0b013e31821f4a51","article-title":"Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty","volume":"37","author":"Sakai K,","year":"2012","unstructured":"Sakai K, Okawa A, Takahashi M, Arai Y, Kawabata S, Enomoto M, : Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty. Spine (Phila Pa 1976) 37:367\u2013376, 201210.1097\/BRS.0b013e31821f4a5121540774"},{"key":"b16-spine16542","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1097\/00007632-200003150-00004","article-title":"Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review","volume":"25","author":"Sampath P,","year":"2000","unstructured":"Sampath P, Bendebba M, Davis JD, Ducker TB: Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine (Phila Pa 1976) 25:670\u2013676, 200010.1097\/00007632-200003150-0000410752097"},{"issue":"22 Suppl 1","key":"b17-spine16542","series-title":"Spine (Phila Pa 1976)","first-page":"S147","article-title":"Myelopathy and spinal deformity: relevance of spinal alignment in planning surgical intervention for degenerative cervical myelopathy","volume":"38","author":"Shamji MF,","year":"2013","unstructured":"Shamji MF, Ames CP, Smith JS, Rhee JM, Chapman JR, Fehlings MG: Myelopathy and spinal deformity: relevance of spinal alignment in planning surgical intervention for degenerative cervical myelopathy. Spine (Phila Pa 1976) 38:22 Suppl 1S147\u2013S148, 2013"},{"key":"b18-spine16542","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2474","DOI":"10.1097\/BRS.0b013e3181573aee","article-title":"Prognostic factors for deterioration of patients with cervical spondylotic myelopathy after nonsurgical treatment","volume":"32","author":"Shimomura T,","year":"2007","unstructured":"Shimomura T, Sumi M, Nishida K, Maeno K, Tadokoro K, Miyamoto H, : Prognostic factors for deterioration of patients with cervical spondylotic myelopathy after nonsurgical treatment. Spine (Phila Pa 1976) 32:2474\u20132479, 20071809008810.1097\/BRS.0b013e3181573aee"},{"key":"b19-spine16542","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1097\/01.BRS.0000065487.82469.D9","article-title":"Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy","volume":"28","author":"Suda K,","year":"2003","unstructured":"Suda K, Abumi K, Ito M, Shono Y, Kaneda K, Fujiya M: Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 28:1258\u20131262, 20031281126810.1097\/01.BRS.0000065487.82469.D9"},{"key":"b20-spine16542","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"521","DOI":"10.3171\/2009.2.SPINE08385","article-title":"Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression","volume":"11","author":"Uchida K,","year":"2009","unstructured":"Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi S, : Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. J Neurosurg Spine 11:521\u2013528, 200910.3171\/2009.2.SPINE0838519929353"},{"key":"b21-spine16542","series-title":"Clin Orthop Relat Res","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1007\/s11999-010-1653-5","article-title":"Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy","volume":"469","author":"Woods BI,","year":"2011","unstructured":"Woods BI, Hohl J, Lee J, Donaldson W III, Kang J: Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res 469:688\u2013695, 20112108900210.1007\/s11999-010-1653-5"},{"key":"b22-spine16542","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1007\/s00586-015-3914-1","article-title":"Implications of different patterns of \u201cdouble-layer sign\u201d in cervical ossification of the posterior longitudinal ligament","volume":"24","author":"Yang H,","year":"2015","unstructured":"Yang H, Yang L, Chen D, Wang X, Lu X, Yuan W: Implications of different patterns of \u201cdouble-layer sign\u201d in cervical ossification of the posterior longitudinal ligament. Eur Spine J 24:1631\u20131639, 201510.1007\/s00586-015-3914-125840783"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/26\/3\/article-p325.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/26\/3\/article-p325.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/26\/3\/article-p325.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T22:25:31Z","timestamp":1681597531000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/26\/3\/article-p325.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3]]},"references-count":22,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2016.8.spine16542","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2017,3]]}}}