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Predictors of neurologic outcome after surgery for cervical ossification of the posterior longitudinal ligament differ based on myelopathy severity: a multicenter study

Other Titles
 척수증 정도에 따른 경추 후종인대골화증 치료를 위한 수술 후 신경학적 예후 인자들 
 Jun Jae Shin  ;  Hyeongseok Jeon  ;  Jong Joo Lee  ;  Hyung Cheol Kim  ;  Tae Woo Kim  ;  Sung Bae An  ;  Dong Ah Shin  ;  Seong Yi  ;  Keung-Nyun Kim  ;  Do-Heum Yoon  ;  Narihito Nagoshi  ;  Kota Watanabe  ;  Masaya Nakamura  ;  Morio Matsumoto  ;  Nan Li  ;  Sai Ma  ;  Da He  ;  Wei Tian  ;  Kenny Yat Hong Kwan  ;  Kenneth Man Chee Cheung  ;  K Daniel Riew  ;  Daniel J Hoh  ;  Yoon Ha 
 JOURNAL OF NEUROSURGERY-SPINE, Vol.34(5) : 749-758, 2021-05 
Journal Title
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anterior decompression ; cervical myelopathy ; increased signal intensity ; ossification of the posterior longitudinal ligament ; posterior decompression ; surgical technique
Objective: The purpose of this retrospective multicenter study was to compare prognostic factors for neurological recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL) based on their presenting mild, moderate, or severe myelopathy.

Methods: The study included 372 consecutive patients with OPLL who underwent surgery for cervical myelopathy between 2006 and 2016 in East Asian countries with a high OPLL prevalence. Baseline and postoperative clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) myelopathy score and recovery ratio. Radiographic assessment included occupying ratio, cervical range of motion, and sagittal alignment parameters. Patient myelopathy was classified as mild, moderate, or severe based on the preoperative JOA score. Linear and multivariate regression analyses were performed to identify patient and surgical factors associated with neurological recovery stratified by baseline myelopathy severity.

Results: The mean follow-up period was 45.4 months (range 25-140 months). The mean preoperative and postoperative JOA scores and recovery ratios for the total cohort were 11.7 ± 3.0, 14.5 ± 2.7, and 55.2% ± 39.3%, respectively. In patients with mild myelopathy, only age and diabetes correlated with recovery. In patients with moderate to severe myelopathy, older age and preoperative increased signal intensity on T2-weighted imaging were significantly correlated with a lower likelihood of recovery, while female sex and anterior decompression with fusion (ADF) were associated with better recovery.

Conclusions: Various patient and surgical factors are correlated with likelihood of neurological recovery after surgical treatment for cervical OPLL, depending on the severity of presenting myelopathy. Older age, male sex, intramedullary high signal intensity, and posterior decompression are associated with less myelopathy improvement in patients with worse baseline function. Therefore, myelopathy-specific preoperative counseling regarding prognosis for postoperative long-term neurological improvement should include consideration of these individual and surgical factors.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Keung Nyun(김긍년)
Kim, Hyung Cheol(김형철)
Shin, Dong Ah(신동아) ORCID logo https://orcid.org/0000-0002-5225-4083
Shin, Jun Jae(신준재) ORCID logo https://orcid.org/0000-0002-1503-6343
Yoon, Do Heum(윤도흠) ORCID logo https://orcid.org/0000-0003-1452-5724
Yi, Seong(이성)
Lee, Jong Joo(이종주)
Jeon, Hyeong Seok(전형석)
Ha, Yoon(하윤)
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