Conservatively Treated Ossification of the Posterior Longitudinal Ligament Increases the Risk of Spinal Cord Injury: A Nationwide Cohort Study

Wu, Jau Ching; Chen, Yi Chun; Liu, Laura; Huang, Wen Cheng; Chen, Tzeng Ji; Lo, Su Shun; Thien, Peck Foong; Cheng, Henrich

doi:10.1089/neu.2011.2095

Cited by 47 publications

(42 citation statements)

References 25 publications

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“…6,[30][31][32][33] The present study has the merit of using the national cohort in an area of higher prevalence of both SCI and OPLL to demonstrate risk factors of SCI in patients with CSM. The study provides a reference guide for future management of CSM.…”

Section: Discussionmentioning

confidence: 99%

“…10,[16][17][18]23 Although there remains a great controversy about the proper surgical strategy for treating patients with OPLL (e.g., anterior vs posterior), 11,12,16 it is generally agreed that surgical intervention should be provided for patients with severe presentations of OPLL as indicated radiographically or clinically, and that the strategy should be tailored to the individual. 3,5,10,[16][17][18]26,31 There are limitations to the present study. There was inherent heterogeneity of these patients with CSM, including their neurological function, techniques used for and extent of surgery, and degree of SCI.…”

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confidence: 88%

“…1,7,8,26 In a previous large data study conducted by Wu et al, cervical SCI was found to be more likely to happen in patients with OPLL, with an estimated 32.16-fold higher risk than in the age-and sex-matched group. 31 That being said, conservative treatment for patients with established OPLL should be conducted with great caution. The result of the aforementioned study was supported by other previous publications that specifically tried to identify the risk factors contributing to SCI in patients with OPLL.…”

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confidence: 99%

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Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

Chen¹,

Chen³

et al. 2016

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OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively. METHODS This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier and Cox regression analyses were performed to compare the risk of SCI between the groups. RESULTS Between January 1, 1999, and December 31, 2013, there were 17,258 patients with CSM who were followed up for 89,003.78 person-years. The overall incidence of SCI in these patients with CSM was 2.022 per 1000 person-years. Patients who had CSM with OPLL and were conservatively managed had the highest incidence of SCI, at 4.11 per 1000 person-years. Patients who had CSM with OPLL and were surgically managed had a lower incidence of SCI, at 3.69 per 1000 person-years. Patients who had CSM without OPLL and were conservatively managed had an even lower incidence of SCI, at 2.41 per 1000 person-years. Patients who had CSM without OPLL and were surgically managed had the lowest incidence of SCI, at 1.31 per 1000 person-years. The Cox regression model demonstrated that SCIs are significantly more likely to happen in male patients and in those with OPLL (HR 2.00 and 2.24, p < 0.001 and p = 0.007, respectively). Surgery could significantly lower the risk for approximately 50% of patients (HR 0.52, p < 0.001). CONCLUSIONS Patients with CSM had an overall incidence rate of SCI at approximately 0.2% per year. Male sex, the coexistence of OPLL, and conservative management are twice as likely to be associated with subsequent SCI. Surgery is therefore suggested for male patients with CSM who also have OPLL.

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Section: Discussionmentioning

confidence: 99%

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confidence: 88%

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confidence: 99%

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Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

Chen¹,

Chen³

et al. 2016

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“…Coexist ing OPLL has been reported to be associated at a rate of 6.5%-10.1% in cervical SCI in different series. 5,14,20 Mi nor trauma or a relatively small external force can cause ‡ The crude hazard ratio was statistically significant (p = 0.023). § The hazard ratio was adjusted for patients' age and sex, and the propensity scores for this adjustment were calculated by taking into account diabetes, hypertension, osteoporosis, rheumatoid arthritis, and osteoarthritis as covariates.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study

Yen

et al. 2013

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Object This study aimed to determine the age- and sex-specific incidence of cervical spondylotic myelopathy (CSM) and its associated risk of causing subsequent spinal cord injury (SCI). Methods Using the National Health Insurance Research Database (NHIRD), a 12-year nationwide database in Taiwan, this retrospective cohort study analyzed the incidence of hospitalization caused by CSM. All patients diagnosed with and admitted for CSM were identified during the study period. The CSM patients were divided into 2 groups, a control group and an operated group. An incidence density method was used to estimate age- and sex-specific incidence rates of CSM. The Kaplan-Meier method and Cox regression analyses were performed to compare the risk of SCI between the 2 groups. Results From 1998 to 2009, covering 349.5 million person-years, 14,140 patients were hospitalized for CSM. The overall incidence of CSM-related hospitalization was 4.04 per 100,000 person-years. Specifically, males and older persons had a higher incidence rate of CSM. During the follow-up of these patients for 13,461 person-years, a total of 166 patients were diagnosed with SCI. The incidence of SCI was higher in the control group than the operated group (13.9 vs 9.4 per 1000 person-years, respectively). During the follow-up, SCI was more likely to occur in CSM patients who were treated conservatively (crude HR 1.48, p = 0.023; adjusted HR 1.57, p = 0.011) than in those who underwent surgery for CSM. Conclusions In a national cohort of eastern Asia, the incidence of CSM-caused hospitalization was 4.04 per 100,000 person-years, with higher incidences observed in older and male patients. Subsequent SCI was more likely to develop in patients who received nonoperative management than in those who underwent surgery. Therefore, patients with CSM managed without surgery should be cautioned about SCI. However, further investigations are still required to clarify the risks and complications associated with surgery for CSM.

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“…Reports have demonstrated higher incidences of OPLL in Eastern Asian countries including, Japan and Taiwan. 39,43 The patients with OPLL were excluded from the current study by preoperative CT scans even if the OPLL was of the segmental type. Patients with malignancy, infection, metabolic bone disease, severe systemic disease, or traumatic ligamentous injury were also excluded.…”

Section: Management Protocolmentioning

confidence: 99%

Postoperative nonsteroidal antiinflammatory drugs and the prevention of heterotopic ossification after cervical arthroplasty: analysis using CT and a minimum 2-year follow-up

Huang

et al. 2015

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OBJECT Heterotopic ossification (HO) after cervical arthroplasty is not uncommon and may cause immobility of the disc. To prevent HO formation, study protocols of clinical trials for cervical arthroplasty undertaken by the US FDA included perioperative use of nonsteroidal antiinflammatory drugs (NSAIDs). However, there are few data supporting the use of NSAIDs to prevent HO after cervical arthroplasty. Therefore, this study aimed to evaluate the efficacy of NSAIDs in HO formation and clinical outcomes. METHODS Consecutive patients who underwent 1- or 2-level cervical arthroplasty with a minimum follow-up of 24 months were retrospectively reviewed. All patients were grouped into 1 of 2 groups, an NSAID group (those patients who had used NSAIDs postoperatively) and a non-NSAID group (those patients who had not used NSAIDs postoperatively). The formation of HO was detected and classified using CT in every patient. The incidence of HO formation, disc mobility, and clinical outcomes, including visual analog scale (VAS) scores of neck and arm pain, neck disability index (NDI) scores, and complications were compared between the two groups. Furthermore, a subgroup analysis of the patients in the NSAID group, comparing the selective cyclooxygenase (COX)-2 to nonselective COX-2 NSAID users, was also conducted for each of the above-mentioned parameters. RESULTS A total of 75 patients (mean age [± SD] 46.71 ± 9.94 years) with 107 operated levels were analyzed. The mean follow-up duration was 38.71 ± 9.55 months. There were no significant differences in age, sex, and levels of arthroplasty between the NSAID and non-NSAID groups. There was a nonsignificantly lower rate of HO formation in the NSAID group than the non-NSAID group (47.2% vs. 68.2%, respectively; p = 0.129). During follow-up, most of the arthroplasty levels remained mobile, with similar rates of immobile discs in the NSAID and non-NSAID groups (13.2% and 22.7%, respectively; p = 0.318). Furthermore, there was a nonsignificantly lower rate of HO formation in the selective COX-2 group than the nonselective COX-2 group (30.8% vs 52.5%, respectively; p = 0.213). The clinical outcomes, including VAS neck, VAS arm, and NDI scores at 24 months postoperatively, were all similar in the NSAID and non-NSAID groups, as well as the selective and nonselective COX-2 groups (all p > 0.05). CONCLUSIONS In this study there was a trend toward less HO formation and fewer immobile discs in patients who used postoperative NSAIDs after cervical arthroplasty than those who did not, but this trend did not reach statistical significance. Patients who used selective COX-2 NSAIDs had nonsignificantly less HO than those who used nonselective COX-2 NSAIDs. The clinical outcomes were not affected by the use of NSAIDs or the kinds of NSAIDs used (selective vs nonselective COX-2). However, the study was limited by the number of patients included, and the efficacy of NSAIDs in the prevention of HO after cervical arthroplasty may need further investigation to confirm these results.

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Conservatively Treated Ossification of the Posterior Longitudinal Ligament Increases the Risk of Spinal Cord Injury: A Nationwide Cohort Study

Cited by 47 publications

References 25 publications

Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study

Postoperative nonsteroidal antiinflammatory drugs and the prevention of heterotopic ossification after cervical arthroplasty: analysis using CT and a minimum 2-year follow-up

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