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Liu B, Ding W, Wang H. Prevalence and Risk Factors for Modic Changes in Symptomatic Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Study of 203 Patients. Med Sci Monit 2023; 29:e941674. [PMID: 37990489 PMCID: PMC10680289 DOI: 10.12659/msm.941674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Modic changes (MC) are abnormal bone signals under the vertebral endplates on magnetic resonance imaging (MRI) of the spine. Three types of MC may be seen on MRI as abnormal bone signals of the vertebral endplate and adjacent bone marrow. This retrospective study of 203 patients with symptomatic cervical ossification of the posterior longitudinal ligament (OPLL) aimed to evaluate factors associated with MC on cervical spine MRI. MATERIAL AND METHODS We included 203 patients with symptomatic cervical ossification of the OPLL. All patients underwent MRI with T1 and T2 sequences to assess the presence and type of MC. Univariate and multivariate logistic regression analyses were used to identify the risk factors for MC. RESULTS The prevalence of MC in patients with symptomatic cervical OPLL was 21.18%. Type 2 MC accounted for 88.64% of the cases. Local type and MC share the same segment (100.00%), followed by segmental type (77.27%), mixed type (75.00%), and continuous type (75.00%). Age (OR=1.05, 95% CI: 1.01-1.09, P=0.013) and neck pain (OR=2.67, 95% CI: 1.04-6.83, P=0.041) were significantly correlated with MC. Further receiver operating characteristic (ROC) analysis displayed an area under the curve (AUC) of 0.657 (P=0.002) for age, and the optimal cutoff was 60.50 years (sensitivity 0.67, specificity 0.68). CONCLUSIONS The results of this study found that older age and neck pain were significantly associated with development of cervical spine MC. Patients ≥60.5 years with symptomatic cervical OPLL had a higher probability of developing MC.
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Affiliation(s)
- Binbin Liu
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China (mainland)
- Department of Spinal Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Wenyuan Ding
- Department of Spinal Surgery, Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China (mainland)
| | - Hui Wang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China (mainland)
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Li N, Ma S, Duan F, Wei Y, He D, Nagoshi N, Watanabe K, Nakamura M, Matsumoto M, Jeon H, Lee JJ, Kim KN, Ha Y, Kwan K, Cheung AKP, Clark A. Are clinical outcomes affected by laminoplasty method and K-line in patients with cervical ossification of posterior longitudinal ligament? A multicenter study. J Orthop Surg Res 2022; 17:513. [PMID: 36434732 PMCID: PMC9700906 DOI: 10.1186/s13018-022-03407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Open-door laminoplasty (ODL) and French-door laminoplasty (FDL) are the main laminoplasty techniques used to treat cervical ossification of the posterior longitudinal ligament (C-OPLL). However, few studies have compared the outcomes of ODL and modified FDL (mFDL) for C-OPLL. We explored the differences in outcomes between ODL and mFDL for C-OPLL and analyzed the technical efficacy of each procedure in patients with K-line (+) or (-) C-OPLL. METHODS From January 2010 to December 2015, 202 patients with K-line (+) or (-) C-OPLL were retrospectively recruited from 4 institutions. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, JOA score recovery rate, operative time, blood loss, and complications. Univariate analysis and binary logistic regression models were adjusted for confounding factors. RESULTS Two hundred patients (mFDL, n = 69; ODL, n = 131) with a median follow-up of 42 months (range 36-54 months) were included. The postoperative JOA score significantly improved in both groups (P < 0.05). After adjusting for confounding factors, there was a statistically significant difference in blood loss (≥ 300 mL) between the two groups (P = 0.005), but there was no significant difference in the postoperative JOA score (≥ 14) (P = 0.062), JOA score recovery rate (≥ 0.82) (P = 0.187), or operative time (≥ 90 min) (P = 0.925). C5 palsy tended to occur more often in the mFDL group, although the difference was not significant (P > 0.05). The stratified analysis of the K-line status showed more blood loss in K-line (+) patients who underwent mFDL, but there was no significant difference in the postoperative JOA score, JOA score recovery rate, or operative time between the ODL and mFDL groups. Additionally, there was no significant difference in blood loss, postoperative JOA score, JOA score recovery rate, or operative time among all patients with K-line (+) or (-) C-OPLL in both groups. CONCLUSIONS Both ODL and mFDL are effective for patients with C-OPLL. However, more blood loss tends to occur during mFDL. This study showed no significant difference in the operative time or incidence of complications between the two techniques. The efficacy of ODL and mFDL was not affected by the K-line status (+ or -) in patients with C-OPLL.
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Affiliation(s)
- Nan Li
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Sai Ma
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Fangfang Duan
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Yi Wei
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Da He
- grid.11135.370000 0001 2256 9319Department of Spine Surgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, 31 Xinjiekou Dongjie, Xicheng District, Beijing, 100035 China
| | - Narihito Nagoshi
- grid.26091.3c0000 0004 1936 9959Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- grid.26091.3c0000 0004 1936 9959Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- grid.26091.3c0000 0004 1936 9959Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- grid.26091.3c0000 0004 1936 9959Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hyeongseok Jeon
- grid.15444.300000 0004 0470 5454Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J. J. Lee
- grid.15444.300000 0004 0470 5454Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Keung-Nyun Kim
- grid.15444.300000 0004 0470 5454Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ha
- grid.15444.300000 0004 0470 5454Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea ,grid.49100.3c0000 0001 0742 4007POSTECH Biotech Center, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk 37673 Republic of Korea
| | - Kenny Kwan
- grid.194645.b0000000121742757Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - A. K. P. Cheung
- grid.194645.b0000000121742757Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Aaron Clark
- grid.266102.10000 0001 2297 6811Department of Neurological Surgery, University of California, San Francisco, CA USA
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Won YI, Lee CH, Yuh WT, Kwon SW, Kim CH, Chung CK. Genetic Odyssey to Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Systematic Review. Neurospine 2022; 19:299-306. [PMID: 35793933 PMCID: PMC9260552 DOI: 10.14245/ns.2244038.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Despite numerous studies, the pathogenesis of ossification of the posterior longitudinal ligament (OPLL) is still unclear. Previous genetic studies proposed variations in genes related to bone and collagen as a cause of OPLL. It is unclear whether the upregulations of those genes are the cause of OPLL or an intermediate result of endochondral ossification process. Causal variations may be in the inflammation-related genes supported by clinical and updated genomic studies. OPLL demonstrates features of genetic diseases but can also be induced by mechanical stress by itself. OPLL may be a combination of various diseases that share ossification as a common pathway and can be divided into genetic and idiopathic. The phenotype of OPLL can be divided into continuous (including mixed) and segmental (including localized) based on the histopathology, prognosis, and appearance. Continuous OPLL shows substantial overexpression of osteoblast-specific genes, frequent upper cervical involvement, common progression, and need for surgery, whereas segmental OPLL shows moderate-to-high expression of these genes and is often clinically silent. Genetic OPLL seems to share clinical features with the continuous type, while idiopathic OPLL shares features with the segmental type. Further genomic studies are needed to elucidate the relationship between genetic OPLL and phenotype of OPLL.
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Affiliation(s)
- Young Il Won
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Corresponding Author Chang-Hyun Lee Department of Neurosurgery, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul 03080, Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Shin Won Kwon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
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Namgoong J, Lee YH, Ju AR, Chai J, Choi D, Choi HJ, Seo JY, Park KS, Lee YJ, Lee J, Ha IH. Long-Term Follow-Up of Patients with Neck Pain Associated with Ossification of the Posterior Longitudinal Ligament Treated with Integrative Complementary and Alternative Medicine: A Retrospective Analysis and Questionnaire Survey. J Pain Res 2022; 15:1527-1541. [PMID: 35637765 PMCID: PMC9148200 DOI: 10.2147/jpr.s356280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Integrative Korean medicine treatment (KMT) is a conservative treatment approach for the ossification of the posterior longitudinal ligament (OPLL) in Korea; nonetheless, relevant studies focusing on KMT for OPLL are lacking. A multicenter retrospective analysis of patient medical records and a questionnaire survey were conducted to investigate the effectiveness of integrative KMT in patients with OPLL treated for neck pain. Patients and Methods A total of 78 inpatients radiologically diagnosed with OPLL and treated for neck pain at four Korean medicine hospitals from April 1, 2016, to December 31, 2019, were enrolled. The primary index was an improvement in the numeric rating scale (NRS) score for neck pain, whereas the secondary outcome indices were improvements in the NRS score for arm pain, neck disability index (NDI) score, and EuroQol 5-dimension 5-level (EQ-5D-5L) score. Results At discharge, the NRS score for neck pain, NRS score for arm pain, and NDI score decreased by 2.47 (95% confidence interval [CI], −2.81 to −2.14), 1.32 (95% CI, −1.73 to −0.91), and 16.02 (95% CI, −18.89 to −13.15), respectively, as compared with the scores at admission (p < 0.001). The EQ-5D-5L score increased by 0.12 (95% CI, 0.09 to 0.16) as compared with the score at admission (p < 0.001). This trend was also evident during follow-up. With respect to Patient Global Impression of Change evaluation, 33 (61.1%) patients claimed to have very much improved, whereas 17 (31.5%) patients reported to have much improved. Conclusion Inpatients with OPLL who received integrative KMT showed improvements in neck pain, arm pain, the NDI, and quality of life, which were retained throughout the follow-up period.
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Affiliation(s)
- Jin Namgoong
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Yun-Ha Lee
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Ah Ra Ju
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Jiwon Chai
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - DongJoo Choi
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Hyo Jung Choi
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Ji-Yeon Seo
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Kyoung Sun Park
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea.,Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jinho Lee
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Bucheon Jaseng Hospital of Korean Medicine, 414 KR in Sangdong, Bucheon-si, Gyeonggi-do, Republic of Korea.,Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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