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

Jun Jae Shin, Hyeongseok Jeon, Jong Joo Lee, Hyung Cheol Kim, Tae Woo Kim, Sung Bae An, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Do Heum Yoon, Narihito Nagoshi, Kota Watanabe, Masaya Nakamura, Morio Matsumoto, Nan Li, Sai Ma, Da He, Wei Tian, Kenny Yat Hong Kwan, Kenneth Man Chee CheungK. Daniel Riew, Daniel J. Hoh, Yoon Ha

Research output: Contribution to journalArticlepeer-review

Abstract

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 predomiworse baseline function. Therefore, myelopathy-specific preoperative counseling regarding prognosis for postoperative long-term neurological improvement should include consideration of these individual and surgical factors.

Original languageEnglish
Pages (from-to)749-758
Number of pages10
JournalJournal of Neurosurgery: Spine
Volume34
Issue number5
DOIs
Publication statusPublished - 2021 May

Keywords

  • Anterior decompression
  • Cervical myelopathy
  • Increased signal intensity
  • Ossification of the posterior longitudinal ligament
  • Posterior decompression
  • Surgical technique

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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