Hiroaki Nakashima1, Lindsay Tetreault2, Narihito Nagoshi3, Aria Nouri2, Paul Arnold4, Yasutsugu Yukawa5, Tomoaki Toyone6, Masato Tanaka7, Qiang Zhou8, Michael G Fehlings9. 1. Division of Neurosurgery and Spinal Program, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 2. Division of Neurosurgery and Spinal Program, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. 3. Division of Neurosurgery and Spinal Program, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan. 4. Department of Neurosurgery, University of Kansas, Kansas City, Kansas. 5. Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan. 6. Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan. 7. Department of Orthopedic Surgery, Okayama University, Okayama, Japan. 8. Department of Orthopedics, Third Military Medical University, Chongqing, China. 9. Division of Neurosurgery and Spinal Program, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada Michael.Fehlings@uhn.on.ca.
Abstract
BACKGROUND: Degenerative cervical myelopathy (DCM) is an all-encompassing term that includes cervical spondylotic myelopathy (CSM), ossification of the posterior longitudinal ligament (OPLL), and other spinal abnormalities that cause cervical cord compression. It is unclear whether surgery is equally effective and safe for patients with OPLL as it is for those with other forms of DCM. The purpose of this study was to compare surgical outcomes of patients with OPLL and those with other forms of DCM. METHODS: Four hundred and seventy-nine patients with symptomatic DCM were prospectively enrolled in the CSM-International study at sixteen sites. Patients' functional status was evaluated using the modified Japanese Orthopaedic Association scale (mJOA) and the Nurick score. Quality of life was assessed using patient-reported outcome measures, including the Neck Disability Index (NDI) and the Short Form (SF)-36. Postoperative functional and quality-of-life outcomes were assessed at two years of follow-up, and scores were compared between patients with and without OPLL. RESULTS: Of 479 patients, 135 (28.2%) had radiographic evidence of OPLL, and 344 (71.8%) had other forms of DCM. The two groups did not differ significantly in demographics, surgical approach, or baseline myelopathy severity. Patients with OPLL achieved similar functional outcomes by two years following surgery compared with patients with other forms of DCM. With respect to quality of life, the NDI and most of the subscales of the SF-36 were not different between the two diagnostic groups. There was a higher risk of perioperative complications in the OPLL group (p = 0.054), although this relationship did not reach statistical significance. Rates of neurological complications did not differ significantly between diagnostic groups. CONCLUSIONS: Surgical decompression for the treatment of OPLL resulted in improvements in functional status and quality of life comparable to those seen in patients with other forms of DCM. Patients with OPLL were at a higher risk of perioperative complications than patients with other forms of DCM.
BACKGROUND:Degenerative cervical myelopathy (DCM) is an all-encompassing term that includes cervical spondylotic myelopathy (CSM), ossification of the posterior longitudinal ligament (OPLL), and other spinal abnormalities that cause cervical cord compression. It is unclear whether surgery is equally effective and safe for patients with OPLL as it is for those with other forms of DCM. The purpose of this study was to compare surgical outcomes of patients with OPLL and those with other forms of DCM. METHODS: Four hundred and seventy-nine patients with symptomatic DCM were prospectively enrolled in the CSM-International study at sixteen sites. Patients' functional status was evaluated using the modified Japanese Orthopaedic Association scale (mJOA) and the Nurick score. Quality of life was assessed using patient-reported outcome measures, including the Neck Disability Index (NDI) and the Short Form (SF)-36. Postoperative functional and quality-of-life outcomes were assessed at two years of follow-up, and scores were compared between patients with and without OPLL. RESULTS: Of 479 patients, 135 (28.2%) had radiographic evidence of OPLL, and 344 (71.8%) had other forms of DCM. The two groups did not differ significantly in demographics, surgical approach, or baseline myelopathy severity. Patients with OPLL achieved similar functional outcomes by two years following surgery compared with patients with other forms of DCM. With respect to quality of life, the NDI and most of the subscales of the SF-36 were not different between the two diagnostic groups. There was a higher risk of perioperative complications in the OPLL group (p = 0.054), although this relationship did not reach statistical significance. Rates of neurological complications did not differ significantly between diagnostic groups. CONCLUSIONS: Surgical decompression for the treatment of OPLL resulted in improvements in functional status and quality of life comparable to those seen in patients with other forms of DCM. Patients with OPLL were at a higher risk of perioperative complications than patients with other forms of DCM.
Authors: Aria Nouri; So Kato; Jetan H Badhiwala; Michael Robinson; Juan Mejia Munne; George Yang; William Jeong; Rani Nasser; David A Gimbel; Joseph S Cheng; Michael G Fehlings Journal: Global Spine J Date: 2019-07-09
Authors: Jeffery Head; George Rymarczuk; Geoffrey Stricsek; Lohit Velagapudi; Christopher Maulucci; Christian Hoelscher; James Harrop Journal: Neurospine Date: 2019-09-30
Authors: Jun Li; Yan Zhang; Ning Zhang; Zheng-Kuan Xv; Hao Li; Gang Chen; Fang-Cai Li; Qi-Xin Chen Journal: Medicine (Baltimore) Date: 2017-06 Impact factor: 1.889