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Does Advanced Age Negatively Impact Treatment Outcomes of Cervical Ossification of the Posterior Longitudinal

Narihito Nagoshi^1,2, Satoru Egawa^2,3, Kenichiro Sakai^2,4

¹Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku Ward.

|June 3, 2025

Abstract

Study Design:

A multicenter prospective cohort study.

Objective:

To comprehensively evaluate the surgical impact, including patient-reported outcomes (PROs), in elderly patients with cervical ossification of the posterior longitudinal ligament (OPLL).

Background:

With the rise of aging populations worldwide, understanding the impact of age on treatment outcomes for cervical OPLL has become increasingly important. Previous studies on degenerative cervical myelopathy have highlighted inconsistent outcomes for elderly patients, with limited focus on OPLL and PROs.

Materials And Methods:

This prospective, multi-institutional study included 402 cervical OPLL patients from 2014 to 2017, categorized into elderly (≥75 yr, n = 79) and nonelderly (<75 yr, n = 323) groups. Clinical outcomes were assessed preoperatively and 2 years postoperatively using cervical Japanese Orthopedic Association (JOA) scores, Visual Analog Scale (VAS) scores, and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Multivariable regression analyses were conducted, adjusting for potential confounders, including demographic variables and imaging characteristics.

Results:

Elderly patients had worse preoperative JOA scores (9.6 vs . 11.1, P < 0.01) and lower postoperative scores at 2 years (12.3 vs . 14.0, P < 0.01). However, the improvement in JOA scores was comparable (2.7 vs . 3.0, P = 0.48), with both exceeding the minimum clinically important difference (MCID). Complication rates and VAS score improvements were also comparable. JOACMEQ outcomes demonstrated significantly poorer upper extremity function in the elderly group following surgery ( P = 0.02), whereas no significant differences were observed between the two groups in other functional domains.

Conclusion:

Despite worse baseline neurological function, elderly OPLL patients achieved similar degrees of postoperative neurological improvement as nonelderly patients. However, upper extremity function is unlikely to show significant improvement following surgery in elderly patients.

Keywords:

complications ossification of the posterior longitudinal ligament pain patient-reported outcomes prospective multicenter study surgical outcomes

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