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Okubo T, Nagoshi N, Iga T, Tsuji T, Horiuchi Y, Kitamura K, Daimon K, Funao H, Takeda K, Ozaki M, Suzuki S, Tsuji O, Matsumoto M, Nakamura M, Watanabe K, Ishii K, Yamane J. Does the presence of preoperative neck pain impact clinical outcomes after posterior decompression in patients with cervical ossification of the posterior longitudinal ligament?: Retrospective multicenter cohort study. Spinal Cord 2024:10.1038/s41393-024-01027-z. [PMID: 39237712 DOI: 10.1038/s41393-024-01027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/25/2024] [Accepted: 08/30/2024] [Indexed: 09/07/2024]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVES To evaluate how preoperative neck pain influences clinical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL). SETTING Fourteen medical institutions in Japan. METHODS We enrolled 90 patients with cervical OPLL who underwent posterior decompression and were followed for a minimum of two years. We collected demographic data, medical history, and imaging findings. Patients were divided into two groups based on preoperative neck pain presence (Pre-op. neck pain (-) and (+) groups), and their outcomes were compared. RESULTS There were no significant differences in patient demographics between the Pre-op. neck pain (-) and (+) groups. Both groups showed similar distributions of ossification types and K-line positivity. Perioperative complications were comparable between the two groups. Radiographic analysis revealed no significant differences in C2-7 angles or cervical range of motion, pre- and postoperatively. Both groups demonstrated significant improvement in postoperative Japanese orthopedic association (JOA) scores, but there were no significant differences in scores or recovery rates. In the Pre-op. neck pain (-) group, factors associated with appearance of postoperative neck pain included pre- and postoperative lower JOA scores and larger C2-7 angles in neutral and extension positions. CONCLUSIONS It emerges that lower pre- and postoperative JOA scores or larger C2-7 angles in neutral and extension positions predispose to postoperative neck pain even in those patients without preoperative neck pain. Therefore, this is worth discussing at the time of consenting patients for surgical decompression and fixation.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
- Keio Spine Research Group (KSRG), Tokyo, Japan.
| | - Takahito Iga
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Sano Kosei General Hospital, Tochigi, Japan
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yosuke Horiuchi
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Saitama Medical Center, Saitama, Japan
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Kazuya Kitamura
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, Hiratsuka City Hospital, Kanagawa, Japan
- Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan
| | - Kenshi Daimon
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Saitama Medical Center, Saitama, Japan
- Department of Orthopaedic Surgery, Ogikubo Hospital, Tokyo, Japan
| | - Haruki Funao
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Spine and Spinal cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Kazuki Takeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Ken Ishii
- Keio Spine Research Group (KSRG), Tokyo, Japan
- New Spine Clinic Tokyo, Tokyo, Japan
| | - Junichi Yamane
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan
- Department of Orthopaedic Surgery, Kanagawa Prefectural Police Association Keiyu Hospital, Kanagawa, Japan
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Chikuda H. The Essence of Clinical Practice Guidelines for Ossification of Spinal Ligaments, 2019: 3. Diagnosis of OPLL. Spine Surg Relat Res 2021; 5:325-327. [PMID: 34708166 PMCID: PMC8502510 DOI: 10.22603/ssrr.2021-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gumma University, School of Medicine, Gunma, Japan
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Inoue T, Soshi S, Kubota M, Marumo K. New Method for the Quantitative Assessment of Sensory Disturbances in Cervical Myelopathy: Application for Neurological Level Diagnosis. Spine Surg Relat Res 2020; 4:216-222. [PMID: 32864487 PMCID: PMC7447351 DOI: 10.22603/ssrr.2019-0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/08/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Cervical myelopathy frequently manifests as sensory disturbances, including numbness, and their distribution pattern aids in neurological level diagnosis. However, the objective assessment of sensory disturbances is challenging. In this study, we attempted to quantitatively evaluate sensory symptoms in patients with cervical myelopathy according to lesion level using PainVisionⓇ. Methods Dermal sensations were evaluated in patients (n = 158) and healthy volunteers (n = 100) using PainVisionⓇ PS-2100, which measured the current perception threshold (CPT). The results were analyzed for their correlation with magnetic resonance imaging (MRI) data, visual analog scale (VAS) scores, and patient functional status assessed by the Japanese Orthopaedic Association (JOA) and JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores. Results Forearm and palm CPT values were significantly higher in patients with cervical myelopathy (both sites, P < 0.001) and were negatively correlated with the JOA score (forearm, r = −0.33; palm, r = −0.35; P < 0.001) and the JOACMEQ scores for upper extremity function (forearm, r = −0.37; palm, r = −0.39; P < 0.001), lower extremity function (forearm, r = −0.39; palm, r = −0.40; P < 0.001), and quality of life (forearm r = −0.27, P = 0.0025); however, no correlation was observed with the VAS score. Stratification of patients according to their lesion levels determined by MRI revealed that the C3/C4 subgroup had significantly higher forearm CPT values than the C4/C5 (P = 0.024) and C5/C6 (P = 0.0013) subgroups and higher palm CPT values than the C5/C6 subgroup (P = 0.009). Conclusions Quantitative measurements of sensory disturbances using the PainVisionⓇ device correspond to the degree of patient functional disability and the lesion level. This indicates that both the distribution and intensity of sensory abnormalities are important for neurological level diagnosis in patients with cervical myelopathy.
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Affiliation(s)
- Takeshi Inoue
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shigeru Soshi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Kubota
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Keishi Marumo
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Clinical characteristics in patients with ossification of the posterior longitudinal ligament: A prospective multi-institutional cross-sectional study. Sci Rep 2020; 10:5532. [PMID: 32218490 PMCID: PMC7099083 DOI: 10.1038/s41598-020-62278-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/05/2020] [Indexed: 11/16/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) can occur throughout the entire spine and can sometimes lead to spinal disorder. Although patients with OPLL sometimes develop physical limitations because of pain, the characteristics of pain and effects on activities of daily living (ADL) have not been precisely evaluated in OPLL patients. Therefore, we conducted a multi-center prospective study to assess whether the symptoms of cervical OPLL are different from those of cervical spondylosis (CS). A total of 263 patients with a diagnosis of cervical OPLL and 50 patients with a diagnosis of CS were enrolled and provided self-reported outcomes, including responses to the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), JOA Back Pain Evaluation Questionnaire (JOABPEQ), visual analog scale (VAS), and SF-36 scores. The severity of myelopathy was significantly correlated with each domain of the JOACMEQ and JOABPEQ. There was a negative correlation between the VAS score for each domain and the JOA score. There were significantly positive correlations between the JOA score and the Mental Health, Bodily Pain, Physical Functioning, Role Emotional, and Role Physical domains of the SF-36. One-to-one matching resulted in 50 pairs of patients with OPLL and CS. Although there was no significant between-group difference in scores in any of the domains of the JOACMEQ or JOABPEQ, the VAS scores for pain or numbness in the buttocks or limbs were significantly higher in the CS group; however, there was no marked difference in low back pain, chest tightness, or numbness below the chest between the two study groups. The scores for the Role Physical and Body Pain domains of the SF-36 were significantly higher in the OPLL group than in the CS group, and the mean scores for the other domains was similar between the two groups. The results of this study revealed that patients with OPLL were likely to have neck and low back pain and restriction in ADL. No specific type of pain was found in patients with OPLL when compared with those who had CS.
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Multicenter cross-sectional study of the clinical features and types of treatment of spinal cord-related pain syndrome. J Orthop Sci 2019; 24:798-804. [PMID: 30777363 DOI: 10.1016/j.jos.2019.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/11/2019] [Accepted: 01/28/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND We termed chronic neuropathic pain (NeP) in patients with diseases associated with spinal cord damage as "spinal cord-related pain syndrome". We conducted a survey of patients with the syndrome to assess the type and severity of NeP and its effect on QOL, and treatment modalities. METHODS This cross-sectional study was conducted in 185 patients recruited from 15 medical institutions. We analyzed the questionnaires sent to clinicians (basic information, magnetic resonance imaging (MRI) findings, type and effectiveness of medications) and patients [modified Neuropathic Pain Symptom Inventory (NPSI) and short form (SF)-36 healthy survey]. RESULTS The incidence of spinal cord-related pain syndrome was highest in patients with cervical spondylotic myelopathy, ossification of posterior longitudinal ligament (OPLL) and spinal cord injury. The number of patients with at-level pain was higher than those with below-level pain; dysesthesia/paresthesia, spontaneous and evoked pain types were mainly seen in patients with at-level pain and dysesthesia/paresthesia was common among those with below-level pain. NPSI score was higher than 10 in the majority of patients, and the subscore for dysesthesia/paresthesia was significantly the highest. The NPSI score was the highest in patients with severe hyperintense signal increase on MRI. The scores of all SF-36 sub-items were significantly lower than the national average. The majority of patients used non-steroid anti-inflammatory drugs and gabapentin/pregabalin; the latter was significantly effective for allodynia, compared with other medications, regardless of the pain level. CONCLUSIONS The majority of patients with spinal cord-related pain syndrome suffered from severe NeP, which affected physical activity. The pain phenotype varied according to the level of the lesion and dysesthesia/paresthesia was the most intense. Compared with other medications, gabapentin/pregabalin was significantly effective especially for dysesthesia/paresthesia and evoked pain regardless of the pain level.
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Liu X, Li T, Shi L, Luo Y, Chen D, Xu B, Chen Y. Extended Laminoplasty for Ossification of Posterior Longitudinal Ligament Involving the C2 Segment. World Neurosurg 2019; 130:317-323. [PMID: 31323405 DOI: 10.1016/j.wneu.2019.07.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To evaluate effectiveness and safety of extended laminoplasty for the treatment of ossification of posterior longitudinal ligament (OPLL) involving the C2 segment. METHODS A total of 132 cases who accepted laminoplasty for treating the OPLL from 2010 to 2015 were included and divided into Group A (n = 26, with C2 OPLL and C2-C7 laminoplasty), Group B (n = 29, with C2 OPLL and C3-C7 laminoplasty), and Group C (n = 77, without C2 OPLL and had C3-C7 laminoplasty). Clinical and radiologic outcomes were compared among the 3 groups. RESULTS At the final visit, significant improvements in Japanese Orthopedic Association score, Neck Disability Index, Health-Related Quality-of-Life Short Form 36 Physical Component Summary, and Visual Analog Scale score in neck were observed in all 3 groups. However, all the C2-C7 Cobb angle, C2-C3 Cobb angle, sagittal vertical axis, and number of cases with cervical or segmental kyphosis in the 3 groups were not significantly changed. Although total blood loss, operation time, maximum Visual Analog Scale score in neck, incidence of axial pain, change of C2-C7, or sagittal vertical axis in Group A were all significantly larger than that in Group B or Group C, differences in neurologic recovery rate, Neck Disability Index, Health-Related Quality-of-Life Short Form 36 Physical Component Summary, change of the C2-C3 Cobb angle, and incidence of cervical or segmental malalignment among the 3 groups were not significant at the final visit. CONCLUSIONS If decompression indication for cases with OPLL involving the C2 segment was appropriate, extended laminoplasty up to the C2 segment could provide satisfactory neurologic recovery and would not accelerate cervical or segmental malalignment progression.
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Affiliation(s)
- Xiaowei Liu
- Department of Orthopaedics, Jinling Hospital, Medicine College, Nanjing University, Nanjing, Jiangsu, China
| | - Tiefeng Li
- Department of Spine Surgery, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Lei Shi
- Department of Spine Surgery, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Yibin Luo
- Department of Spine Surgery, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Deyu Chen
- Department of Spine Surgery, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Bin Xu
- Department of Orthopaedics, Jinling Hospital, Medicine College, Nanjing University, Nanjing, Jiangsu, China
| | - Yu Chen
- Department of Spine Surgery, Changzheng Hospital, Naval Military Medical University, Shanghai, China.
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Radiological Characteristics and Clinical Outcome of Ossification of Posterior Longitudinal Ligament Involving C2 After Posterior Laminoplasty and Instrumented Fusion Surgery. Spine (Phila Pa 1976) 2019; 44:E150-E156. [PMID: 30044366 DOI: 10.1097/brs.0000000000002807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To analyze the radiological characteristics and surgical outcome of cervical ossification of posterior longitudinal ligament (OPLL) involving C2 level. SUMMARY OF BACKGROUND DATA The study and report focused on the OPLL involving C2 level are rare. Therefore, the radiological characteristics and surgical outcome remain unclear. METHODS The records of the patients with OPLL involving C2 level who underwent posterior surgery from July 2006 through October 2015 were retrospectively reviewed. The types, longitudinal and transverse extent, occupation ratio, K-line classification of OPLL, and high-intensity zone of spine cord on magnetic resonance imaging were analyzed to evaluate the radiological characteristics. All the cases received posterior open-door laminoplasty and instrumented fusion surgery. The Japanese Orthopedic Association (JOA) score and recovery rate (RR) were used to evaluate neurological function after surgery. RESULTS A total of 45 patients with OPLL involving C2 level were enrolled in the study. Their radiological data were carefully analyzed. The mixed (73.3%) and continuous type (24.5%) were observed. The mean number of involved segments was 5.1. The narrowest spinal canal mostly located in the level of C3-C4 and mean occupying ratio was 65.3%. Thirty-two patients were followed up for at least 2 years and the mean follow-up time was 46.2 months. The mean JOA score was 10.3 preoperatively and 15.2 at the final follow-up and the mean RR was 70.7%. The K-line (+) and (-) subgroups showed similar preoperative JOA score and RR. The high-intensity zone (+) subgroup showed lower preoperative JOA score but equal RR with (-) subgroup. CONCLUSION When OPLL involve C2 level, it often presented different radiological characteristics. The posterior open-door laminoplasty and instrumented fusion surgery could achieve favorable clinical outcomes. Further researches and long-term clinical follow-up are needed to better appreciate the OPLL involving C2 level. LEVEL OF EVIDENCE 4.
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Du YQ, Duan WR, Chen Z, Wu H, Jian FZ. Predictors for Development of Symptomatic Myelopathy in Patients with Radiculopathy Caused by Cervical Ossification of Posterior Longitudinal Ligament. World Neurosurg 2019; 124:e710-e714. [PMID: 30660887 DOI: 10.1016/j.wneu.2018.12.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify clinical factors predicting the development of myelopathy in cervical ossification of the posterior longitudinal ligament (OPLL) patients with radiculopathy. METHODS We retrospectively reviewed 83 cervical OPLL patients who presented with radiculopathy. On the basis of the symptoms and physical findings, we divided patients into 2 groups: myelopathy group and nonmyelopathy group. Demographic, clinical, and radiologic characteristics were reviewed and analyzed among the 2 groups. Predictors for the development of myelopathy were assessed via univariate and multivariate analysis. RESULTS Univariate analysis demonstrated that a high occupying ratio and the presence of an intramedullary high signal were risk factors for development of myelopathy from radiculopathy in OPLL patients. Multivariate analysis further identified that a high occupying ratio was the only independent predictor (odds ratio 1.05, 95% confidence interval 1.003-1.091, P = 0.035). The cervical range of motion and minor trauma were not related to the development of myelopathy in our study. CONCLUSIONS Nonmyelopathic OPLL patients with radiculopathy and a high occupying ratio were at higher risk of developing myelopathy, and surgical intervention should be recommended in these cases. However, for elderly patients with significant comorbid conditions, the risks and benefits of surgery should be carefully considered.
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Affiliation(s)
- Yue-Qi Du
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wan-Ru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng-Zeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Abstract
Surgical management of patients with mild degenerative cervical myelopathy (DCM) is controversial. This article reviews 84 subjects with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) who underwent surgical treatment. Nine had mild myelopathy: 6 CSM and 3 OPLL. Seven presented with pain or numbness of upper extremities. MRI revealed intramedullary hyperintensity in 55.6%. Five underwent anterior decompression and fusion, whereas 4 were operated posteriorly. Pain and intramedullary signal change on MRI are important. Management of patients with mild DCM should be determined individually, considering benefits and risks in long-term conservative treatment and surgery.
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Affiliation(s)
- Izumi Koyanagi
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, 1-20, Hachiken 9-jo, Higashi 5-chome, Nishi-ku, Sapporo 063-0869, Japan.
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Yoon SY, Park TH, Eun NL, Park YG. The cutoff value of ossification of posterior longitudinal ligament (OPLL) for early diagnosis of myelopathy using somatosensory evoked potential in cervical OPLL patients. Spinal Cord 2017; 55:606-611. [PMID: 28220819 DOI: 10.1038/sc.2017.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES The objective of this study was to find out whether ossification of posterior longitudinal ligament (OPLL) characteristics, including size, shape and subtype, can be used to diagnose myelopathy using somatosensory evoked potential (SEP) in cervical OPLL patients. SETTING Yonsei University College of Medicine, Seoul, Korea. METHODS We retrospectively reviewed the medical records of 153 cervical OPLL patients who underwent SEP study. OPLL anterior-posterior (AP) diameter, area and involved longitudinal vertebral level were measured. OPLL was classified into subtypes according to longitudinal continuity and shape. Correlation analysis and receiver operating curve were used. RESULTS Tibial SEP latency was significantly correlated with OPLL AP diameter (P=0.001), diameter occupying ratio (P=0.019), area (P=0.007), area occupying ratio (P=0.008), involved longitudinal vertebral level (P=0.028) and space available for the spinal cord (P=0.019). The cutoff values that were diagnostic for SEP prolongation suggesting myelopathy were 4.91 mm for OPLL AP diameter, 6.02 mm for space available for the spinal cord, 44.5% for diameter occupying ratio, 63.4 mm2 for area, 36.1% for area occupying ratio and level 2 for the involved longitudinal vertebral level. CONCLUSIONS Our results revealed that tibial SEP latency was significantly correlated with OPLL size and suggested cutoff values of OPLL diameter (4.91 mm, 44.5%) and area (63.4 mm2, 36.1%) for early diagnosis of myelopathy. These results can help to establish treatment plans.
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Affiliation(s)
- S Y Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - T H Park
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - N L Eun
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y G Park
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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