Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament

Abstract

Objective Factors impacting surgical options and outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) were explored. Methods A retrospective analysis was conducted of 127 eligible cervical OPLL patients (61 males, 66 females) aged 41-70 years (mean 55.2 years) selected from 152 total OPLL patients treated from 2002 to 2006, with 5-10-year (mean 6.8 years) follow-up. Patients underwent anterior subtotal corpectomy with ossification ligament resection (anterior surgery, n = 68) or posterior cervical double-door laminoplasty (posterior surgery, n = 59). Radiographic assessments of cervical curvature, T2-weighted MRI (MRIT2) signal, and OPLL occupying ratio were correlated with surgical strategy before surgery and at 1, 5 weeks, and 5 years. Results Lordosis increased following anterior surgery, though kyphosis improved by 10.3 %. The canal stenosis occupying ratio was [50 %, and short-term improvement following anterior surgery was significantly higher than posterior surgery (P [ 0.0001). Superior neurological function was observed in patients with unchanged versus high spinal MRIT2 signals (P = 0.0434). No significant differences were observed in short-term outcomes between anterior and posterior surgeries in high spinal MRIT2 signal patients, but anterior surgery produced significantly better long-term outcomes at 1 week (P = 0.7564) and 1 year (P = 0.0071). Complications occurred in five anterior and three posterior surgeries. Conclusion Preoperative assessment of cervical curvature, MRIT2 signal, and occupying ratio can be used to guide clinical surgical approach selection to potentially produce better long-term outcomes in patients with OPLL.

Comparison of anterior corpectomy and fusion versus laminoplasty for the treatment of cervical ossification of posterior longitudinal ligament: a meta-analysis

“…1). 2,3,8,16,18,19,21,22,28 The basic characteristics of included studies are shown in Table 1. No statistically significant differences were found in age, sex, occupying ratio of OPLL, and follow-up time between the 2 groups.…”

“…Quality assessment of the included studies was independently conducted by 2 investigators, and arguments were resolved by discussion. Of the 10 nonrandomized controlled studies, 9 2,3,8,16,19,21,22,27,28 received more than 7 stars on the NOS and the 1 remaining study 18 received 6 stars. These ratings meant that all included studies were of relatively high quality.…”

Spinal cord cross-sectional area during flexion and extension in the patients with cervical ossification of posterior longitudinal ligament

“…They recommended that surgical treatment should be provided before the advent of intramedullary spinal cord changes in signal intensity on MRI. Liu et al [5] also suggested that preoperative assessment of cervical curvature, MRIT2 signal, and occupying ratio can be used to guide clinical surgical approach selection to potentially produce better long-term outcomes in patients with OPLL.…”

“…However, the pathomechanism of cervical myelopathy caused by C-OPLL remains unknown. Despite spinal stenosis (6 mm \ space available for the spinal cord \14 mm), myelopathy may not develop in patients with the severe limitation of range of cervical spine [5]. This indicates that not only static factors but also dynamic factors, such as listhesis or hypermobility at the discontinuity of the ossified lesion, play important roles in the development of myelopathy, especially in mixed and segmental OPLL.…”

Review of Radiological Parameters, Imaging Characteristics, and Their Effect on Optimal Treatment Approaches and Surgical Outcomes for Cervical Ossification of the Posterior Longitudinal Ligament

“…It is thought that spinal cord cross-sectional area (SCCSA) slowly becomes narrower in patients with OPLL, but the influence of dynamic factors may be another important factor in cervical myelopathy. Liu et al 23 found that in patients with severely limited range of movement in the cervical spine, cervical myelopathy does not always develop despite spinal stenosis (6 mm < space available for the spinal cord < 14 mm). This indicates that in addition to static factors, dynamic factors such as listhesis or hypermobility at the discontinuity of the ossified part also play important roles in the development of myelopathy, especially in mixed and segmental OPLL.…”