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Implications of Trauma in Patients With Cervical Ossification of the Posterior Longitudinal Ligament (OPLL)
Madhusudhan Nagesh1, Rakesh K Mishra, Abhijit Goyal-Honavar
1Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Study Design:
Retrospective cohort study.
Objective:
Cervical ossification of the posterior longitudinal ligament (OPLL) is a well-established cause of degenerative myelopathy. The objective of this study was to compare the clinical outcomes of patients with cervical OPLL who underwent surgery, with and without a history of trauma.
Summary Of Background Data:
Literature on the impact of OPLL on neurological recovery following cervical spine injury is conflicting. While some suggest an association between the presence of OPLL and neurological deterioration following trivial trauma, others have argued that OPLL does not affect neurological outcomes initially or at discharge. The correlation of clinical outcomes with preoperative radiologic features is also unclear.
Methods:
A retrospective analysis was performed of 61 patients who underwent posterior cervical approach and decompressive cervical laminectomy (without fusion) for cervical OPLL between January 2015 and December 2018 in a tertiary neurosurgical referral center. Seventeen patients had a history of antecedent trauma, while 44 did not. Patient demographics, clinical outcomes [modified Japanese Orthopedic Association score (mJOA) and Nurick grade], radiologic features, and parameters associated with recovery were analyzed and compared among the groups.
Results:
Male patients were predominant in both groups, and the mean age of presentation was slightly lower in the trauma group. The trauma group had lower pre- and postoperative mJOA scores. The length of high signal intensity (HIS) observed in T2-weighted sagittal MRI was longer in the trauma group. Significant recovery (defined as a recovery rate >50%) was significantly more frequent in the nontrauma group (35 patients, 79.5%) compared with the trauma group (2 patients, 11.76%) (P=0.007).
Conclusion:
Patients with OPLL with a history of trauma more frequently harbor radiologic changes associated with myelopathy, with lower preoperative mJOA scores, and have a lower rate of significant recovery following surgery than those without a history of trauma.