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Predictive factors for bladder function recovery following cervical OPLL surgery: a comprehensive analysis
Yusuke Setojima1, Kengo Fujii2, Toru Funayama1
1Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 Japan.
Background Context:
Neurogenic bladder dysfunction, a condition affecting both bladder storage and voiding function, remains a primary source of morbidity in patients with cervical ossification of posterior longitudinal ligaments (OPLL). Prognosticating the functional outcomes of bladder function postoperatively in patients with cervical OPLL is crucial for patient counseling, rehabilitation planning, and discharge protocols. However, a validated prediction model for bladder function outcomes is currently unavailable. The Japanese Orthopaedic Association (JOA) score, a comprehensive assessment tool for cervical compressive myelopathy, comprises 6 domains: upper extremity motor function, lower extremity motor function, upper extremity sensory function, trunk sensory function, lower extremity sensory function, and bladder function. The total score ranges from -2 to 17.
Purpose:
To determine the correlation between postoperative bladder function outcomes and preoperative parameters, including the JOA score, with an aim to identify independent prognostic factors for bladder function recovery 1 year postoperatively in patients with OPLL.
Study Design/Setting:
Retrospective review of prospectively collected data across multiple institutions.
Patient Sample:
Data were collected from 477 patients who underwent surgical intervention for cervical OPLL. After applying the exclusion criteria, data from 192 patients were included in the final analysis. The following variables were examined at the initial presentation: age, sex, body mass index (BMI), comorbidities, preoperative JOA score, OPLL occupation ratio, K-line, surgical approach, spinal fusion, and number of vertebral levels involved.
Outcome Measures:
Postoperative bladder function outcomes 1 year after surgery.
Methods:
Univariable and multivariable analyses were performed utilizing the Cox proportional hazards regression model. This study was funded by the Japan Agency for Medical Research and Development (grant number 23ek0109541h0003; total amount: $85,000). All authors have disclosed financial relationships in accordance with ICMJE guidelines.
Results:
Multivariable analyses revealed that age (p=.003), preoperative JOA lower extremity motor function score (p<.001), and preoperative JOA trunk sensory function score significantly influenced bladder function recovery. Receiver operating characteristic (ROC) curve analysis revealed that preoperative JOA scores of 1.5 points for both lower extremity motor function and trunk sensory function were the optimal thresholds for predicting complete bladder function recovery (p<.001).
Conclusion:
Age, preoperative JOA lower extremity motor function score, and JOA trunk sensory function score were identified as significant predictors of bladder function recovery following cervical OPLL surgery and may be used to develop a prediction model to guide clinical decision-making and facilitate patient counseling.
