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

Abstract

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.

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

“…This is reflected in a study by Morishita et al [30], which found that, prior to propensity matching in over 8,000 patients treated surgically for OPLL as identified by the national Japanese Diagnosis Procedure Combination database, those patients undergoing posterior LAMP were significantly older and had significantly higher rates of comorbidities, including malignancy, cardiovascular disease, diabetes, renal failure, and cardiac failure. Additionally, some authors have posited that posterior approaches are generally associated with fewer complications and preserved ROM (e.g., LAMP), while also allowing the decompression of a larger number of segments in multilevel OPLL [18]. It is worth pointing out though that this may depend heavily on the surgeon and institution, other studies have found either equivocal or higher rates of complications associated with posterior approaches compared to anterior approaches [27,28,31].…”

“…The most frequently reported type of OPLL varies, with many studies reporting a higher incidence of the segmental type (type 2) [3,17,18] and others reporting a nearly equal distribution of segmental, continuous, and mixed types [3,19].…”

Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases on the basis of more than 60 months of follow-up: a systematic review and meta-analysis

“…In the past several decades, anterior cervical discectomy and fusion (ACDF) has been applied to multiple cervical disorders, including cervical spondylotic myelopathy, cervical spondylotic radiculopathy, and cervical ossification of posterior longitudinal ligament, for its satisfactory clinical efficacy [1]. In the ACDF procedure, directed decompression of the nucleus pulposus and osteophyte can be performed under clear vision during operation [2].…”

Comparison of the surgeries for the ossification of the posterior longitudinal ligament-related cervical spondylosis

“…The comparison of anterior vsersus posterior has been discussed in many studies. [ 38 – 40 ] Anterior procedures, such as ACCF and ACAF, have better efficacy (vs posterior procedures) in the postoperative function. ACCF solves the problem by directly removing the vertebral body and the ossified mass, whereas ACAF moves the vertebral body and the ossified mass forward.…”