Qualitative evidence from a systematic review of prognostic predictors for surgical outcomes following cervical ossification of the posterior longitudinal ligament

Ossification of the Posterior Longitudinal Ligament: Pathophysiology, Diagnosis, and Management

Ossification of the posterior longitudinal ligament (OPLL) occurs as heterotopic bone forms in the posterior longitudinal ligament, resulting in neural compression, myelopathy, and radiculopathy. OPLL is most commonly observed in East Asian populations, with prevalence rates of 1.9% to 4.3% reported in Japan. OPLL rates are lower in North American and European patients, with reported prevalence of 0.1% to 1.7%. Patients typically develop symptoms due to OPLL in their cervical spines. The etiology of OPLL is multifactorial, including genetic, metabolic, and anatomic factors. Asymptomatic or symptomatic patients with OPLL can be managed nonsurgically, whereas patients with neurologic symptoms may require surgical decompression from an anterior, posterior, or combined approach. Surgical treatment can provide notable improvement in neurologic function. Surgical decision making accounts for multiple factors, including patient comorbidities, neurologic status, disease morphology, radiographic findings, and procedure complication profiles. In this study, we review OPLL epidemiology and pathophysiology, clinical features, radiographic evaluation, management, and complications.

Factors associated with surgical outcomes of cervical ossification of the posterior longitudinal ligament

To investigate factors associated with surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL). This retrospective study included patients (662 males and 251 females; mean age 55.8 years) with symptomatic OPLL. All patients had been diagnosed with OPLL based on cervical magnetic resonance imaging and computed tomography scans. Demographic, surgical outcome was measured using visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scale scores. The results of our study indicated radicular pain was more common in segmental and circumscribe OPLL subtypes (P < 0.05). An anterior approach was favored in patients with less than 3 involved vertebral levels (P < 0.05). All surgical methods showed good outcomes (P < 0.05). Continuous and mixed OPLL subtypes showed worse surgical outcome with higher VAS and JOA scores (P < 0.05). Laminoplasty and anterior cervical discectomy and fusion were significantly associated with a higher recovery rate (P < 0.05). Among these patients, there were more complications with the anterior approach (P < 0.05). Male gender, open door laminoplasty ipsilateral, and ipsilateral-to-symptom-side opening were associated with postoperative C5 palsy (P < 0.05). Cervical OPLL may cause myelopathy, surgery is a safe and effective treatment for OPLL. There were no differences in clinical outcome according to surgical type, but complication rates varied depending on sex and surgical approach to symptom.

Correlation between preoperative physical signs and functional outcomes after laminoplasty for ossification of the posterior longitudinal ligament

BACKGROUND

Ossification of the posterior longitudinal ligament (OPLL) can cause myelopathy that is often managed surgically. Knowledge of predictors of surgical outcomes can provide decision support to surgeons. The aims of this study were to investigate the relationships between preoperative physical signs and postoperative functional outcomes in patients with OPLL and to clarify whether physical signs could predict functional outcomes.

METHODS

Fifty-five patients with OPLL who had undergone cervical laminoplasty were included in this study. Six physical signs including hyperreflexia, Babinski sign, sensory disturbance, grip strength, 10-s grip and release test, and bladder dysfunction, and four other factors including age, duration of symptoms, history of minor trauma and preoperative Japanese Orthopaedic Association (JOA) score were investigated as potential predictive prognostic factors using both univariate and multivariate analyses.

RESULTS

The mean recovery rate of JOA score was 62.5 ± 32.5%. The neurological recovery rate was negatively associated with age (P = 0.002), the duration of symptoms (P = 0.002) and Babinski sign (P = 0.007), whereas it was positively correlated with grip strength (P = 0.011). Multiple logistic regression analyses revealed that age (Odds ratio: 0.89, 95% CI: 0.81-0.99) and Babinski sign (Odds ratio: 0.18, 95% CI: 0.04-0.89) were factors associated with functional outcomes.

CONCLUSIONS

Satisfactory functional outcomes could be expected for patients who are young and do not exhibit the Babinski sign, showing that the Babinski sign could be useful as an indicator of the window of opportunity for achieving satisfactory functional outcomes.

Degenerative cervical myelopathy

Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.

Influencia pronóstica de la edad y el tiempo de evolución de los síntomas en la mielopatía cervical espondilótica

OBJETIVO: Presentamos un estudio, que trata de dilucidar la influencia de la edad y el tiempo de evolución de los síntomas, en el pronóstico tras la cirugía. MÉTODO: Estudio prospectivo de 66 pacientes, intervenidos debido a MCE, valorados (escala mJOA) pre y postoperatoriamente. Seguimiento de tres años. Se analizan las variables edad y tiempo de evolución clínica (TE), esta última se subdivide en dos grupos: larga evolución (>1 año), con 35 casos y corta evolución (≤ 1 año), con 31 casos, así como la variable de reciente agravación (RA). Esta última, si la enfermedad ha ido progresando de forma paulatina, sin grandes altibajos, se valora como NO (15 casos); si hubiese una aceleración en la progresión de la enfermedad antes de la intervención, se valora como SI (20 casos). RESULTADOS: La edad tuvo una correlación (r=-0,38) con significación P<0,01 con la situación clínica preoperatoria (r=-0,38) y posoperatoria (r=-0,30) p<0,05. No se encontró correlación entre la edad y la tasa de recuperación. El TE no presentó correlación con el estado clínico preoperatorio. Se encontró una correlación negativa entre el tiempo de evolución, estado clínico postoperatorio (r=-0,46) y el TR (r=-0,42) con una significación p<0,001. TR fue un 20% mayor en los pacientes con corta evolución clínica. Cuanto a la variable RA, se apreció una mayor afectación clínica preoperatoria, 1,45 puntos de media (mJOA) con significación p<0,05, así como peores tasas de recuperación (10%) que aquellos pacientes. En RA, aunque esta última sin significación estadística. CONCLUSIONES: La edad influye negativamente en la situación clínica preoperatoria y postoperatoria, no siendo predictiva cuanto a la capacidad de mejorar. El tiempo de evolución es un valor de pronóstico para la capacidad de mejorar, siendo su influencia negativa.