Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study

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Object. Ossification of the posterior longitudinal ligament (OPLL) may produce quadriplegia. The course of future neurological deterioration in patients with radiographic evidence of OPLL, however, is not known. The authors conducted a long-term follow-up cohort study of more than 10 years to clarify the clinical course of this disease progression.

Methods. A total of 450 patients, including 304 managed conservatively and 146 treated by surgery, were enrolled in the study. All patients underwent neurological and radiographical follow-up examinations for a mean of 17.6 years. Myelopathy was graded using Nurick classification and the Japanese Orthopaedic Association scale.

Fifty-five (17%) of 323 patients without myelopathy evident at the first examination developed myelopathy during the follow-up period. Risk factors associated with the evolution of myelopathy included greater than 60% OPLL-induced stenotic compromise of the cervical canal, and increased range of motion of the cervical spine. Using Kaplan—Meier analysis, the myelopathy-free rate in patients without first-visit myelopathy was 71% after 30 years. A significant difference in final functional outcome was not observed between nonsurgical and surgical cases in which preoperative Nurick grades were 1 or 2. In patients with Nurick Grade 3 or 4 myelopathy, however, only 12% who underwent surgery eventually became wheelchair bound or bedridden compared with 89% of those managed conservatively. Surgery proved ineffective in the management of patients with Grade 5 disease.

Conclusions. Results of this long-term cohort study elucidated the clinical course of OPLL following conservative or surgical management. Surgery proved effective for the management of patients with Nurick Grades 3 and 4 myelopathy.

Article Information

Address reprint requests to:Shunji Matsunaga, M.D., Ph.D., Department of Orthopaedic Surgery, Faculty of Medicine, Kagoshima University, 8–35–1 Sakuragaoka, Kagoshima, Japan. email:shunji@m.kufm.kagoshima-u.ac.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Schematic diagram showing presentation and treatment data in 450 patients with OPLL.

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    Graph demonstrating results of Kaplan—Meier estimate regarding myelopathy-free rates in patients without myelopathy at initial examination.

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