Predictors of neurologic outcome after surgery for cervical ossification of the posterior longitudinal ligament differ based on myelopathy severity: a multicenter study

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  • 1 Department of Neurosurgery, Yongin Severance Hospital, Yonsei University School of Medicine, Yongin;
  • 2 Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul;
  • 3 Department of Neurosurgery, Bundang Jesaeng Hospital, Seoul;
  • 4 Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea;
  • 5 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan;
  • 6 Department of Spine Surgery, Beijing Jishuitan Hospital, the 4th Teaching Hospital of Peking University, Beijing;
  • 7 Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, China;
  • 8 Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York;
  • 9 Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, New York;
  • 10 Department of Neurosurgery, University of Florida, Gainesville, Florida; and
  • 11 POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
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OBJECTIVE

The purpose of this retrospective multicenter study was to compare prognostic factors for neurological recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL) based on their presenting mild, moderate, or severe myelopathy.

METHODS

The study included 372 consecutive patients with OPLL who underwent surgery for cervical myelopathy between 2006 and 2016 in East Asian countries with a high OPLL prevalence. Baseline and postoperative clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) myelopathy score and recovery ratio. Radiographic assessment included occupying ratio, cervical range of motion, and sagittal alignment parameters. Patient myelopathy was classified as mild, moderate, or severe based on the preoperative JOA score. Linear and multivariate regression analyses were performed to identify patient and surgical factors associated with neurological recovery stratified by baseline myelopathy severity.

RESULTS

The mean follow-up period was 45.4 months (range 25–140 months). The mean preoperative and postoperative JOA scores and recovery ratios for the total cohort were 11.7 ± 3.0, 14.5 ± 2.7, and 55.2% ± 39.3%, respectively. In patients with mild myelopathy, only age and diabetes correlated with recovery. In patients with moderate to severe myelopathy, older age and preoperative increased signal intensity on T2-weighted imaging were significantly correlated with a lower likelihood of recovery, while female sex and anterior decompression with fusion (ADF) were associated with better recovery.

CONCLUSIONS

Various patient and surgical factors are correlated with likelihood of neurological recovery after surgical treatment for cervical OPLL, depending on the severity of presenting myelopathy. Older age, male sex, intramedullary high signal intensity, and posterior decompression are associated with less myelopathy improvement in patients with worse baseline function. Therefore, myelopathy-specific preoperative counseling regarding prognosis for postoperative long-term neurological improvement should include consideration of these individual and surgical factors.

ABBREVIATIONS ACCF = anterior cervical corpectomy fusion; ADF = anterior decompression with fusion; BMI = body mass index; JOA = Japanese Orthopaedic Association; OPLL = ossification of the posterior longitudinal ligament; ROM = range of motion; SI = signal intensity; T2WI = T2-weighted images; VAS-neck = visual analog scale for neck pain.

Supplementary Materials

    • Supplemental Tables and Figures (PDF 1,976 KB)

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Contributor Notes

Correspondence Yoon Ha: Yonsei University College of Medicine, Seoul, Korea. hayoon@yuhs.ac.

INCLUDE WHEN CITING Published online March 12, 2021; DOI: 10.3171/2020.8.SPINE20504.

Disclosures Dr. Cheung reports receiving support from Avalon SpinCare, AO Spine, Medtronic, NuVasive, and OrthoSmart. Dr. Hoh reports receiving a stipend as a member of The Spine Journal editorial board.

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