Acute cervical spinal cord injury complicated by preexisting ossification of the posterior longitudinal ligament

A multicenter study

Hirotaka Chikuda, Atsushi Seichi, Katsushi Takeshita, Shunji Matsunaga, Masahiko Watanabe, Yukihiro Nakagawa, Kazuya Oshima, Yutaka Sasao, Yasuaki Tokuhashi, Shinnosuke Nakahara, Kenji Endo, Kenzo Uchida, Masahiko Takahata, Toru Yokoyama, Kei Yamada, Yutaka Nohara, Shiro Imagama, Hideo Hosoe, Hiroshi Ohtsu, Hiroshi Kawaguchi & 2 others Yoshiaki Toyama, Kozo Nakamura

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Study Design.: Retrospective multicenter study. Objective.: To review the clinical characteristics of traumatic cervical spinal cord injury (SCI) associated with ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data.: Despite its potentially devastating consequences, there is a lack of information about acute cervical SCI complicated by OPLL. Methods.: This study included consecutive patients with acute traumatic cervical SCI (Frankel A, B, and C) who were admitted within 48 hours of injury to 34 spine institutions across Japan. For analysis of neurologic outcome, patients who had completed at least a 6-month follow-up were included. Neurologic improvement was defined as at least one grade conversion in Frankel grade. Results.: A total of 453 patients were identified (367 men, 86 women; mean age, 59 years). OPLL was found in 106 (23%) patients (87 men, 19 women; mean age, 66 years). Most of the patients with OPLL (94 of 106) were without bone injury, presenting with incomplete SCI. The prevalence of OPLL reached 34% in SCI without bone injury. The cause of SCI was predominantly falls (74%). Only 25% of the patients were aware of OPLL. Half of the OPLL patients reported gait disturbance before injury. Forty-eight (52%) OPLL patients without bone injury underwent surgery (median, 13.5 days after injury), mostly laminoplasty. Overall, no significant difference was noted in neurologic improvement between surgery group and conservative group. However, further stratification showed that surgery was associated with greater neurologic recovery in patients who had gait disturbance before injury (P = 0.04). Conclusion.: Prevalence of OPLL among cervical SCI was alarmingly high, especially in those without bone injury. Most of cervical SCI associated with OPLL were incomplete, without bone injury, and caused predominantly by low-energy trauma. The majority of the patients were unaware of OPLL. Surgery produced better neurologic recovery in patients who had gait disturbance before injury.

Original languageEnglish
Pages (from-to)1453-1458
Number of pages6
JournalSpine
Volume36
Issue number18
DOIs
Publication statusPublished - 2011 Aug 15

Fingerprint

Ossification of Posterior Longitudinal Ligament
Spinal Cord Injuries
Multicenter Studies
Wounds and Injuries
Nervous System
Bone and Bones
Gait
Cervical Cord
Japan

Keywords

  • canal stenosis
  • myelopathy
  • ossification of the posterior longitudinal ligament
  • patient awareness
  • spinal cord injury
  • surgery
  • trauma
  • treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Chikuda, H., Seichi, A., Takeshita, K., Matsunaga, S., Watanabe, M., Nakagawa, Y., ... Nakamura, K. (2011). Acute cervical spinal cord injury complicated by preexisting ossification of the posterior longitudinal ligament: A multicenter study. Spine, 36(18), 1453-1458. https://doi.org/10.1097/BRS.0b013e3181f49718

Acute cervical spinal cord injury complicated by preexisting ossification of the posterior longitudinal ligament : A multicenter study. / Chikuda, Hirotaka; Seichi, Atsushi; Takeshita, Katsushi; Matsunaga, Shunji; Watanabe, Masahiko; Nakagawa, Yukihiro; Oshima, Kazuya; Sasao, Yutaka; Tokuhashi, Yasuaki; Nakahara, Shinnosuke; Endo, Kenji; Uchida, Kenzo; Takahata, Masahiko; Yokoyama, Toru; Yamada, Kei; Nohara, Yutaka; Imagama, Shiro; Hosoe, Hideo; Ohtsu, Hiroshi; Kawaguchi, Hiroshi; Toyama, Yoshiaki; Nakamura, Kozo.

In: Spine, Vol. 36, No. 18, 15.08.2011, p. 1453-1458.

Research output: Contribution to journalArticle

Chikuda, H, Seichi, A, Takeshita, K, Matsunaga, S, Watanabe, M, Nakagawa, Y, Oshima, K, Sasao, Y, Tokuhashi, Y, Nakahara, S, Endo, K, Uchida, K, Takahata, M, Yokoyama, T, Yamada, K, Nohara, Y, Imagama, S, Hosoe, H, Ohtsu, H, Kawaguchi, H, Toyama, Y & Nakamura, K 2011, 'Acute cervical spinal cord injury complicated by preexisting ossification of the posterior longitudinal ligament: A multicenter study', Spine, vol. 36, no. 18, pp. 1453-1458. https://doi.org/10.1097/BRS.0b013e3181f49718
Chikuda, Hirotaka ; Seichi, Atsushi ; Takeshita, Katsushi ; Matsunaga, Shunji ; Watanabe, Masahiko ; Nakagawa, Yukihiro ; Oshima, Kazuya ; Sasao, Yutaka ; Tokuhashi, Yasuaki ; Nakahara, Shinnosuke ; Endo, Kenji ; Uchida, Kenzo ; Takahata, Masahiko ; Yokoyama, Toru ; Yamada, Kei ; Nohara, Yutaka ; Imagama, Shiro ; Hosoe, Hideo ; Ohtsu, Hiroshi ; Kawaguchi, Hiroshi ; Toyama, Yoshiaki ; Nakamura, Kozo. / Acute cervical spinal cord injury complicated by preexisting ossification of the posterior longitudinal ligament : A multicenter study. In: Spine. 2011 ; Vol. 36, No. 18. pp. 1453-1458.
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AU - Oshima, Kazuya

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AU - Endo, Kenji

AU - Uchida, Kenzo

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AU - Yokoyama, Toru

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AU - Nohara, Yutaka

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N2 - Study Design.: Retrospective multicenter study. Objective.: To review the clinical characteristics of traumatic cervical spinal cord injury (SCI) associated with ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data.: Despite its potentially devastating consequences, there is a lack of information about acute cervical SCI complicated by OPLL. Methods.: This study included consecutive patients with acute traumatic cervical SCI (Frankel A, B, and C) who were admitted within 48 hours of injury to 34 spine institutions across Japan. For analysis of neurologic outcome, patients who had completed at least a 6-month follow-up were included. Neurologic improvement was defined as at least one grade conversion in Frankel grade. Results.: A total of 453 patients were identified (367 men, 86 women; mean age, 59 years). OPLL was found in 106 (23%) patients (87 men, 19 women; mean age, 66 years). Most of the patients with OPLL (94 of 106) were without bone injury, presenting with incomplete SCI. The prevalence of OPLL reached 34% in SCI without bone injury. The cause of SCI was predominantly falls (74%). Only 25% of the patients were aware of OPLL. Half of the OPLL patients reported gait disturbance before injury. Forty-eight (52%) OPLL patients without bone injury underwent surgery (median, 13.5 days after injury), mostly laminoplasty. Overall, no significant difference was noted in neurologic improvement between surgery group and conservative group. However, further stratification showed that surgery was associated with greater neurologic recovery in patients who had gait disturbance before injury (P = 0.04). Conclusion.: Prevalence of OPLL among cervical SCI was alarmingly high, especially in those without bone injury. Most of cervical SCI associated with OPLL were incomplete, without bone injury, and caused predominantly by low-energy trauma. The majority of the patients were unaware of OPLL. Surgery produced better neurologic recovery in patients who had gait disturbance before injury.

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