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

TitlePredictors of neurologic outcome after surgery for cervical ossification of the posterior longitudinal ligament differ based on myelopathy severity: a multicenter study
Authors
Keywordscervical myelopathy
ossification of the posterior longitudinal ligament
anterior decompression
posterior decompression
increased signal intensity
Issue Date2021
PublisherAmerican Association of Neurological Surgeons. The Journal's web site is located at http://thejns.org/loi/spi
Citation
Journal of Neurosurgery: Spine, 2021, v. 34 n. 5, p. 749-758 How to Cite?
AbstractOBJECTIVE: 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.
Persistent Identifierhttp://hdl.handle.net/10722/302464
ISSN
2023 Impact Factor: 2.9
2023 SCImago Journal Rankings: 1.286
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorShin, JJ-
dc.contributor.authorJeon, H-
dc.contributor.authorLee, JJ-
dc.contributor.authorKim, HC-
dc.contributor.authorKim, TW-
dc.contributor.authorAn, SB-
dc.contributor.authorShin, DA-
dc.contributor.authorYi, S-
dc.contributor.authorKim, KN-
dc.contributor.authorYoon, DH-
dc.contributor.authorNagoshi, N-
dc.contributor.authorWatanabe, K-
dc.contributor.authorNakamura, M-
dc.contributor.authorMatsumoto, M-
dc.contributor.authorLi, N-
dc.contributor.authorMa, S-
dc.contributor.authorHe, D-
dc.contributor.authorTian, W-
dc.contributor.authorKwan, KYH-
dc.contributor.authorCheung, KMC-
dc.contributor.authorRiew, KD-
dc.contributor.authorHoh, DJ-
dc.contributor.authorHa, Y-
dc.date.accessioned2021-09-06T03:32:40Z-
dc.date.available2021-09-06T03:32:40Z-
dc.date.issued2021-
dc.identifier.citationJournal of Neurosurgery: Spine, 2021, v. 34 n. 5, p. 749-758-
dc.identifier.issn1547-5654-
dc.identifier.urihttp://hdl.handle.net/10722/302464-
dc.description.abstractOBJECTIVE: 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.-
dc.languageeng-
dc.publisherAmerican Association of Neurological Surgeons. The Journal's web site is located at http://thejns.org/loi/spi-
dc.relation.ispartofJournal of Neurosurgery: Spine-
dc.subjectcervical myelopathy-
dc.subjectossification of the posterior longitudinal ligament-
dc.subjectanterior decompression-
dc.subjectposterior decompression-
dc.subjectincreased signal intensity-
dc.titlePredictors of neurologic outcome after surgery for cervical ossification of the posterior longitudinal ligament differ based on myelopathy severity: a multicenter study-
dc.typeArticle-
dc.identifier.emailKwan, KYH: kyhkwan@hku.hk-
dc.identifier.emailCheung, KMC: cheungmc@hku.hk-
dc.identifier.authorityKwan, KYH=rp02014-
dc.identifier.authorityCheung, KMC=rp00387-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.3171/2020.8.SPINE20504-
dc.identifier.pmid33711809-
dc.identifier.scopuseid_2-s2.0-85105299913-
dc.identifier.hkuros324730-
dc.identifier.volume34-
dc.identifier.issue5-
dc.identifier.spage749-
dc.identifier.epage758-
dc.identifier.isiWOS:000646724600008-
dc.publisher.placeUnited States-

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