What Are the Important Predictors of Postoperative Functional Recovery in Patients With Cervical OPLL? Results of a Multivariate Analysis

Abstract

Study Design: A retrospective cohort study. Objective: The objective of this study was to identify important predictors of poor functional recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL). Methods: This was a retrospective cohort study of 142 OPLL patients with laminoplasty; 135 had complete radiographical data and were followed up for ≥2 years. The following OPLL characteristics were compared between patients with “good” and “poor” outcomes (Japanese Orthopedic Association [JOA] recovery rate ≥50% and <50%, respectively): number of ossified levels, OPLL classification, ossification shape, K-line, canal-occupying ratio, and increased magnetic resonance imaging (MRI) signal intensity. Predictors of functional recovery were identified. Results: Pre- and postoperative (2 years following surgery) JOA scores were 10.6 ± 2.9 and 14.1 ± 2.2, respectively, indicating significant improvement following laminoplasty ( P < .001). The average JOA recovery rate was 53.4% ± 34.7%, with 81 (60.0%) and 54 (40.0%) patients in the better and poorer neurological outcome groups, respectively. The canal occupation ratio of OPLL ≤60%/>60% were 117 (86.7%) and 18 (13.3%) patients, respectively. In the stepwise logistic regression analysis, an occupation ratio greater than 60% was identified as a significant factor for poor postoperative neurological outcome (relative risk, 4.82; 95% confidential interval, 1.61-14.46, P = .005). Conclusions: This multivariate analysis demonstrated a large size OPLL (occupying ratio >60%) was associated with a risk of poor neurological recovery roughly 5 times greater, and therefore other types of surgery are recommended in cases with such a ratio.

Surgical outcomes of posterior cervical laminectomy with instrumented fusion managing regional kyphotic cervical spondylotic myelopathy and k-line negative ossification of the posterior longitudinal ligament: Is the decompression sufficient?

“…In present study, the operative time of PLF were 171.36 ± 39.69min for KSM group and 184.25 ± 85.26min for NKO group, as the intraoperative blood loss were 179.09 ± 134.20 ml for KSM group and 272.50 ± 265.80 ml for NKO group. For the risk of postoperative instability for CSM patients, we didn't consider to perform laminoplasty which was reported had lower JOA recovery rate than laminectomy by previous studies[6, 14,15].…”

Factors Negatively Influencing Postoperative Improvement After Laminoplasty in Degenerative Cervical Myelopathy

“…As in previous studies, we defined poor recovery as a recovery rate of < 50% and a good recovery as a recovery rate of ≥ 50%. 5,22,23 Outcome and risk factor analyses were performed by comparing the good recovery and poor recovery groups. We analyzed continuous variables using the Mann-Whitney U test.…”

Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire as an outcome measure for ossification of posterior longitudinal ligament patients in East Asia: an investigation of reliability, validity, and responsiveness

“…During a long-term follow-up study of OPLL patients in Japan, Matsunaga et of patients (36/137) who had presented with symptoms of myelopathy at the first examination opted for conservative treatment (35). Patients in Japan usually receive surgical management in their 60s (11,12,36,37) and often seek surgical treatment after a long disease progression course. Consequently, their pathology and symptoms at the time of surgical intervention are more severe, resulting in a lower improvements of postoperative scores in QOL domian.…”