Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.4103/ajns.AJNS_477_20
Functional outcome of surgically treated patients of ossified posterior longitudinal ligament of cervical and dorsal spine in Indian population – A single center retrospective analysis of 40 patients
![](https://www.thieme-connect.de/media/10.1055-s-00053244/202104/lookinside/thumbnails/10-4103-ajns-ajns-477-20_332841-1.jpg)
Aims: The aim of the study was to retrospectively evaluate the neurological outcome in operated patients of ossified posterior longitudinal ligament (OPLL) of cervical and/or dorsal spine using modified Japanese orthopedic association (mJOA) score and find out the factors affecting the outcome. Settings and Design: The study design was a retrospective study. Materials and Methods: Forty operated patients of cervical and/or dorsal spine OPLL were included in the study. Neurological examination was conducted and analyzed using mJOA score pre- and postoperatively at 1, 6, and 12 months. Improvement in the mJOA score based on age, sex, type of OPLL, duration of symptoms, type of surgical procedure, and radiological parameters were calculated, analyzed, and compared with previous records of the patient. Results: Significant improvement in mJOA scores with mean preoperative being 12.27 ± 1.95 with 1-year postoperative 13.85 ± 2.02 (P < 0.0001) noted. There is a significant difference in mean mJOA scores in posterior approach with instrumentation (P < 0.0001) as compared with laminoplasty group (P < 0.005). Patients with occupancy ratio <60% had better results (P < 0.0001) as compared to those with occupancy ratio of >60% (P = 0.003). Patients with duration of symptoms >1 year had poorer results compared to those of <1 year duration. Mean ossification kyphosis angle was 19.4° ± 5.73°. Conclusion: OPLL is a progressive disease which causes severe neurological deficit if left untreated. OPLL in a young patient with short duration of symptoms, low occupancy ratio, and low ossification kyphosis had better chances of neurological recovery. Type of OPLL and sex of patient do not affect the recovery. OPLL managed early and surgically has better results irrespective of anterior or posterior approach with significant improvement in mJOA score. Decompression with fusion has better results than decompression alone.
Key-words:
Cervical and dorsal spine - modified Japanese orthopedic association score - occupancy ratio - ossification kyphosis angle - ossified posterior longitudinal ligamentFinancial support and sponsorship
Nil.
Publication History
Received: 21 October 2020
Accepted: 10 April 2021
Article published online:
16 August 2022
© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
-
1 Raykar R, Bettaswamy G, Singh R. Retrospective and prospective analysis of clinical, radiological and prognostic factors affecting surgical denouement in ossified posterior longitudinal ligament: an institutional experience. International surgery journal. 2019;6(3). DOI: http://dx.doi.org/10.18203/2349-2902.isj20190518
-
2 Matsunaga S, Sakou T. Ossification of the posterior longitudinal ligament of the cervical spine: etiology and natural history. Spine (Phila Pa 1976). 2012 Mar 1;37(5):E309-14. doi: 10.1097/BRS.0b013e318241ad33. PMID: 22146284.
-
3 Yan L, Gao R, Liu Y, He B, Lv S, Hao D. The Pathogenesis of Ossification of the Posterior Longitudinal Ligament. Aging Dis. 2017 Oct 1;8(5):570-582. doi: 10.14336/AD.2017.0201. PMID: 28966802; PMCID: PMC5614322.
-
4 Li H, Jiang LS, Dai LY. A review of prognostic factors for surgical outcome of ossification of the posterior longitudinal ligament of cervical spine. Eur Spine J. 2008 Oct;17(10):1277-88. doi: 10.1007/s00586-008-0740-8. Epub 2008 Aug 14. PMID: 18704517; PMCID: PMC2556477.
-
5 Masaki Y, Yamazaki M, Okawa A, Aramomi M, Hashimoto M, Koda M, et al. An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament: anterior decompression with spinal fusion versus laminoplasty. J Spinal Disord Tech. 2007 Feb;20(1):7-13. doi: 10.1097/01.bsd.0000211260.28497.35. PMID: 17285045.
-
6 Yudoyono F, Cho PG, Park SH, Moon BJ, Yi S, Ha Y, et al. Factors associated with surgical outcomes of cervical ossification of the posterior longitudinal ligament. Medicine (Baltimore). 2018 Jul;97(29):e11342. doi: 10.1097/MD.3328410000011342. PMID: 30024507; PMCID: PMC6086522.
-
7 Muzumdar D. Surgery for multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament. Neurol India. 2016 Jan-Feb;64(1):16-8. doi: 10.4103/0028-3886.173630. PMID: 26754984.
-
8 Hou Y, Liang L, Shi GD, Xu P, Xu GH, Shi JG, et al. Comparing effects of cervical anterior approach and laminoplasty in surgical management of cervical ossification of posterior longitudinal ligament by a prospective nonrandomized controlled study. Orthop Traumatol Surg Res. 2017 Sep;103(5):733-740. doi: 10.1016/j.otsr.2017.05.011. Epub 2017 Jun 12. PMID: 28619269.
-
9 Kommu R, Sahu BP, Purohit AK. Surgical outcome in patients with cervical ossified posterior longitudinal ligament: A single institutional experience. Asian J Neurosurg. 2014 Oct-Dec;9(4):196-202. doi: 10.4103/1793-5482.146602. PMID: 25685216; PMCID: PMC4323963.
-
10 Koda M, Mochizuki M, Konishi H, Aiba A, Kadota R, Inada T, et al, Furuya T. Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (-) cervical ossification of the posterior longitudinal ligament. Eur Spine J. 2016 Jul;25(7):2294-301. doi: 10.1007/s00586-016-4555-8. Epub 2016 Apr 13. PMID: 27072553.
-
11 Mizuno J, Nakagawa H. Outcome analysis of anterior decompressive surgery and fusion for cervical ossification of the posterior longitudinal ligament: report of 107 cases and review of the literature. Neurosurg Focus. 2001 Apr 15;10(4):E6. doi: 10.3171/foc.2001.10.4.7. PMID: 16732633.
-
12 Chen Y, Yang L, Liu Y, Yang H, Wang X, Chen D. Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament. PLoS One. 2014 Jul 7;9(7):e102008. doi: 10.1371/journal.pone.0102008. PMID: 25000183; PMCID: PMC4084983.
-
13 Meyer SA, Wu JC, Mummaneni PV. Laminoplasty outcomes: is there a difference between patients with degenerative stenosis and those with ossification of the posterior longitudinal ligament? Neurosurg Focus. 2011 Mar;30(3):E9. doi: 10.3171/2011.1.FOCUS10279. PMID: 21361755.
-
14 Maruo K, Moriyama T, Tachibana T, Inoue S, Arizumi F, Daimon T, et al. The impact of dynamic factors on surgical outcomes after double-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg Spine. 2014 Dec;21(6):938-43. doi: 10.3171/2014.8.SPINE131197. Epub 2014 Oct 3. PMID: 25279653.
-
15 Choi BW, Song KJ, Chang H. Ossification of the posterior longitudinal ligament: a review of literature. Asian Spine J. 2011 Dec;5(4):267-76. doi: 10.4184/asj.2011.5.4.267. Epub 2011 Nov 28. PMID: 22164324; PMCID: PMC3230657.
-
16 Hirai T, Yoshii T, Iwanami A, Takeuchi K, Mori K, Yamada T, et al. Prevalence and Distribution of Ossified Lesions in the Whole Spine of Patients with Cervical Ossification of the Posterior Longitudinal Ligament A Multicenter Study (JOSL CT study). PLoS One. 2016 Aug 22;11(8):e0160117. doi: 10.1371/journal.pone.0160117. PMID: 27548354; PMCID: PMC4993375.
-
17 Mehdi SK, Alentado VJ, Lee BS, Mroz TE, Benzel EC, Steinmetz MP. Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis. Neurosurg Focus. 2016 Jun;40(6):E9. doi: 10.3171/2016.3.FOCUS1630. PMID: 27246492.
-
18 Abiola R, Rubery P, Mesfin A. Ossification of the Posterior Longitudinal Ligament: Etiology, Diagnosis, and Outcomes of Nonoperative and Operative Management. Global Spine J. 2016 Mar;6(2):195-204. doi: 10.1055/s-0035-1556580. Epub 2015 Jun 30. PMID: 26933622; PMCID: PMC4771496.
-
19 Li S, Zhang P, Gao X, Miao D, Gao Y, Shen Y. Potential risk factors for poor outcome after anterior sur gery for patients with cervical ossification of the posterior longitudinal ligament. Ther Clin Risk Manag. 2018 Feb 20;14:341-347. doi: 10.2147/TCRM.S152416. PMID: 29503553; PMCID: PMC5824755.
-
20 Baaj AA, Smith DA, Vale FL, Uribe JS. Surgical approaches to thoracic ossification of the posterior longitudinal ligament. J Clin Neurosci. 2012 Mar;19(3):349-51. doi: 10.1016/j.jocn.2011.05.025. Epub 2012 Jan 16. PMID: 22249019.
-
21 Feng F, Ruan W, Liu Z, Li Y, Cai L. Anterior versus posterior approach for the treatment of cervical compressive myelopathy due to ossification of the posterior longitudinal ligament: A systematic review and meta-analysis. Int J Surg. 2016 Mar;27:26-33. doi: 10.1016/j.ijsu.2016.01.038. Epub 2016 Jan 19. PMID: 26804354.
-
22 Uei H, Tokuhashi Y, Oshima M, Maseda M, Nakahashi M, Nakayama E. Efficacy of posterior decompression and fixation based on ossification-kyphosis angle criteria for multilevel ossification of the posterior longitudinal ligament in the thoracic spine. J Neurosurg Spine. 2018 Aug;29(2):150-156. doi: 10.3171/2017.12.SPINE17549. Epub 2018 May 4. PMID: 29726802.
-
23 Matsuyama Y, Yoshihara H, Tsuji T, Sakai Y, Yukawa Y, Nakamura H, et al. Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options. J Spinal Disord Tech. 2005 Dec;18(6):492-7; discussion 498. doi: 10.1097/01.bsd.0000155033.63557.9c. PMID: 16306836.
-
24 McClendon J Jr, Sugrue PA, Ganju A, Koski TR, Liu JC. Management of ossification of the posterior longitudinal ligament of the thoracic spine. Neurosurg Focus. 2011 Mar;30(3):E16. doi: 10.3171/2010.12.FOCUS10282. PMID: 21361754.
-
25 Kalb S, Martirosyan NL, Perez-Orribo L, Kalani MY, Theodore N. Anal ysis of demographics, risk factors, clinical presentation, and surgical treatment modalities for the ossified posterior longitudinal ligament. Neurosurg Focus. 2011 Mar;30(3):E11. doi: 10.3171/2010.12.FOCUS10265. PMID: 21361749.