Associations between Clinical Symptoms and Degree of Ossification in Patients with Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multi-Institutional Cross-Sectional Study

Abstract

This study aimed to clarify whether ossification predisposition influences clinical symptoms including pain, restriction of activities of daily living, and quality of life in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Cervical ossification predisposition potentially causes neurologic dysfunction, but the relationship between clinical symptoms and radiologic severity of OPLL has not yet been investigated. Data were prospectively collected from 16 institutions across Japan. We enrolled 239 patients with cervical OPLL. The primary outcomes were patient-reported outcomes, including visual analog scale (VAS) pain scores and other questionnaires. Whole-spine computed tomography images were obtained, and correlations were investigated between clinical symptoms and radiologic findings, including the distribution of OPLL, the sum of the levels where OPLL was present (OP-index), and the canal narrowing ratio (CNR) grade. The cervical OP-index was Grade 1 in 113 patients, Grade 2 in 90, and Grade 3 in 36. No significant correlations were found between radiologic outcomes and VAS pain scores. The cervical OP-index was associated with lower extremity function, social dysfunction, and locomotive function. The CNR grade was not correlated with clinical symptoms, but Grade 4 was associated with lower extremity dysfunction. Thickness and extension of ossified lesions may be associated with lower extremity dysfunction in cervical OPLL.

Associations between Clinical Findings and Severity of Diffuse Idiopathic Skeletal Hyperostosis in Patients with Ossification of the Posterior Longitudinal Ligament

“…These findings are consistent with the opinion of some clinicians that DISH should be considered a state rather than a disease [26]. DISH may be present not only by itself but can also accompany ossification of other spinal ligaments that often lead to spinal cord disorders [13,27]. Therefore, in the present study, to reduce selection bias in this regard, we enrolled only patients with cervical OPLL.…”

“…Basic demographic and clinical data of patients were collected, including age, sex, diabetes mellitus (DM) status, body mass index (BMI), and presence of neck pain, back pain, and/or low back pain (LBP). Clinical status was evaluated using the following measures: cervical Japanese Orthopaedic Association (JOA) score [11], which is used for functional assessment of patients with cervical myelopathy, JOA Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ) [12], which assesses the function of the cervical spine, upper and lower extremities, and bladder as well as quality of life; and the JOA Back Pain Evaluation Questionnaire (JOA-BPEQ) [13], which assesses lumbar spine function, social dysfunction, mentality, locomotive function, and body pain. The degree of pain or stiffness in the neck or shoulders, pain or numbness in the arms or hands, and LBP was evaluated using a visual analog scale (VAS).…”

“…Blinded to clinical outcomes, six senior spine surgeons (S.U., K.M., S.M., K.K., N.N., and K.T.) independently evaluated the images, as described previously [13]. OPLL was assessed as DISH if it completely bridged at least four contiguous adjacent vertebral bodies anywhere in the spine based on the criteria established by Resnick and Niwayama [5].…”

Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

“…Ossification of the posterior longitudinal ligament (OPLL) is a multifactorial disease that develops under complex genetic and environmental conditions [ 1 , 2 ]. The ectopic ossification causes chronic compression of the spinal cord, which leads to neurological dysfunction below the level of compression [ 3 ]. Although the prevalence of OPLL in the general population is relatively low, ranging from 0.1 to 2.5% in the United States and 1.9 to 4.3% in Japan [ 1 , 4 , 5 ], OPLL accounts for 18 to 35% as an etiology of degenerative cervical myelopathy (DCM), which requires surgical treatment [ 6 ].…”

Hsa-circ-0007292 promotes the osteogenic differentiation of posterior longitudinal ligament cells via regulating SATB2 by sponging miR-508-3p

“…Ossification of the posterior longitudinal ligament (OPLL) is a common orthopedic disease, which is characterized by the progressive heterotopic ossification of the posterior longitudinal ligament (PLL) and frequently involves the cervical spinal cord [ 1 ]. OPLL can cause neurological pain and dysfunction by narrowing the vertebral canal and compressing the nerve roots or spinal cord [ 2 ]. Once the onset of myelopathic symptoms has started, neurologic function gradually deteriorates, at which point patients require decompressive surgery [ 3 ].…”