Multilevel ossification of the posterior longitudinal ligament causing cervical myelopathy: An observational series of North American patients
Background: Few studies regarding ossification of the posterior longitudinal ligament (OPLL) outside of Asia currently exist in the literature. A set of patients with multilevel cervical OPLL causing symptomatic myelopathy or radiculopathy from a North American sample is analyzed. Objective: The obj...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2023;volume=14;issue=3;spage=292;epage=298;aulast=Ledesma |
| _version_ | 1797645739828969472 |
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| author | Jonathan A Ledesma Tariq Z Issa Mark J Lambrechts Cannon Greco Hiranaka Khoa Tran Patrick O'Connor Jose A Canseco Alan S Hilibrand Christopher K Kepler Todd J Albert Alexander R Vaccaro Gregory D Schroeder David Greg Anderson |
| author_facet | Jonathan A Ledesma Tariq Z Issa Mark J Lambrechts Cannon Greco Hiranaka Khoa Tran Patrick O'Connor Jose A Canseco Alan S Hilibrand Christopher K Kepler Todd J Albert Alexander R Vaccaro Gregory D Schroeder David Greg Anderson |
| author_sort | Jonathan A Ledesma |
| collection | DOAJ |
| description | Background: Few studies regarding ossification of the posterior longitudinal ligament (OPLL) outside of Asia currently exist in the literature. A set of patients with multilevel cervical OPLL causing symptomatic myelopathy or radiculopathy from a North American sample is analyzed.
Objective: The objective of this study was to describe the demographics, radiographic findings, and surgical outcomes of a cohort of North American patients with degenerative spondylosis presenting for operative management of multilevel (>3 segments) cervical OPLL.
Materials and Methods: Forty-three patients diagnosed with multilevel cervical OPLL and degenerative spondylosis presenting with symptomatic cervical myelopathy or radiculopathy were surgically treated over a 9-year period at a single tertiary care academic medical center. Radiographic measurements were performed on preoperative computed tomography and magnetic resonance imaging images of the cervical spine. Clinical outcomes included pre- and postoperative Nurick scores, 90-day readmission, complication, and revision surgery rates.
Results: The mean age was 66.1 ± 10.9 years with a mean latest follow-up time of 32.7 ± 16.4 months. Most patients had previous diagnoses of obesity (70.7%) and hypertension (55.8%). At least one-quarter of patients were diagnosed with type 2 diabetes (34.9%), hyperlipidemia (41.9%), cardiovascular disease (25.6%), or chronic kidney disease (25.3%). The most common OPLL subtype was segmental (39.5%) and spanned a mean of 3.54 ± 1.48 segments. Myelopathic symptoms were present in 88.4% of patients. All patients experienced significant neurologic improvement at 3-week and latest follow-up (P < 0.001 for both).
Conclusions: Obesity, diabetes, and other metabolic derangements in patients with existing cervical spondylosis may be risk factors for a particularly aggressive form of multilevel OPLL. Various operative approaches may be employed to achieve adequate neurologic recovery. Further workup for OPLL in patients with these risk factors may prove beneficial to ensure appropriate operative management. |
| first_indexed | 2024-03-11T14:52:17Z |
| format | Article |
| id | doaj.art-dc0e9c053c8146c4876ec748e7e8c034 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-03-11T14:52:17Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-dc0e9c053c8146c4876ec748e7e8c0342023-10-30T09:27:41ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372023-01-0114329229810.4103/jcvjs.jcvjs_90_23Multilevel ossification of the posterior longitudinal ligament causing cervical myelopathy: An observational series of North American patientsJonathan A LedesmaTariq Z IssaMark J LambrechtsCannon Greco HiranakaKhoa TranPatrick O'ConnorJose A CansecoAlan S HilibrandChristopher K KeplerTodd J AlbertAlexander R VaccaroGregory D SchroederDavid Greg AndersonBackground: Few studies regarding ossification of the posterior longitudinal ligament (OPLL) outside of Asia currently exist in the literature. A set of patients with multilevel cervical OPLL causing symptomatic myelopathy or radiculopathy from a North American sample is analyzed. Objective: The objective of this study was to describe the demographics, radiographic findings, and surgical outcomes of a cohort of North American patients with degenerative spondylosis presenting for operative management of multilevel (>3 segments) cervical OPLL. Materials and Methods: Forty-three patients diagnosed with multilevel cervical OPLL and degenerative spondylosis presenting with symptomatic cervical myelopathy or radiculopathy were surgically treated over a 9-year period at a single tertiary care academic medical center. Radiographic measurements were performed on preoperative computed tomography and magnetic resonance imaging images of the cervical spine. Clinical outcomes included pre- and postoperative Nurick scores, 90-day readmission, complication, and revision surgery rates. Results: The mean age was 66.1 ± 10.9 years with a mean latest follow-up time of 32.7 ± 16.4 months. Most patients had previous diagnoses of obesity (70.7%) and hypertension (55.8%). At least one-quarter of patients were diagnosed with type 2 diabetes (34.9%), hyperlipidemia (41.9%), cardiovascular disease (25.6%), or chronic kidney disease (25.3%). The most common OPLL subtype was segmental (39.5%) and spanned a mean of 3.54 ± 1.48 segments. Myelopathic symptoms were present in 88.4% of patients. All patients experienced significant neurologic improvement at 3-week and latest follow-up (P < 0.001 for both). Conclusions: Obesity, diabetes, and other metabolic derangements in patients with existing cervical spondylosis may be risk factors for a particularly aggressive form of multilevel OPLL. Various operative approaches may be employed to achieve adequate neurologic recovery. Further workup for OPLL in patients with these risk factors may prove beneficial to ensure appropriate operative management.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2023;volume=14;issue=3;spage=292;epage=298;aulast=Ledesmacervical vertebraeclinical outcomesepidemiologyossification of posterior longitudinal ligamentspine |
| spellingShingle | Jonathan A Ledesma Tariq Z Issa Mark J Lambrechts Cannon Greco Hiranaka Khoa Tran Patrick O'Connor Jose A Canseco Alan S Hilibrand Christopher K Kepler Todd J Albert Alexander R Vaccaro Gregory D Schroeder David Greg Anderson Multilevel ossification of the posterior longitudinal ligament causing cervical myelopathy: An observational series of North American patients Journal of Craniovertebral Junction and Spine cervical vertebrae clinical outcomes epidemiology ossification of posterior longitudinal ligament spine |
| title | Multilevel ossification of the posterior longitudinal ligament causing cervical myelopathy: An observational series of North American patients |
| title_full | Multilevel ossification of the posterior longitudinal ligament causing cervical myelopathy: An observational series of North American patients |
| title_fullStr | Multilevel ossification of the posterior longitudinal ligament causing cervical myelopathy: An observational series of North American patients |
| title_full_unstemmed | Multilevel ossification of the posterior longitudinal ligament causing cervical myelopathy: An observational series of North American patients |
| title_short | Multilevel ossification of the posterior longitudinal ligament causing cervical myelopathy: An observational series of North American patients |
| title_sort | multilevel ossification of the posterior longitudinal ligament causing cervical myelopathy an observational series of north american patients |
| topic | cervical vertebrae clinical outcomes epidemiology ossification of posterior longitudinal ligament spine |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2023;volume=14;issue=3;spage=292;epage=298;aulast=Ledesma |
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