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Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)

BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, few studies have investigated the influence of OPLL on neurological outcome after acute cord injury. We examined wh...

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Autores principales: Kwon, Soon Young, Shin, Jun Jae, Lee, Ji Hae, Cho, Woo Ho
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465733/
https://www.ncbi.nlm.nih.gov/pubmed/26065682
http://dx.doi.org/10.1186/s13018-015-0235-3
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author Kwon, Soon Young
Shin, Jun Jae
Lee, Ji Hae
Cho, Woo Ho
author_facet Kwon, Soon Young
Shin, Jun Jae
Lee, Ji Hae
Cho, Woo Ho
author_sort Kwon, Soon Young
collection PubMed
description BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, few studies have investigated the influence of OPLL on neurological outcome after acute cord injury. We examined whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI based on intramedullary signal intensity (SI) changes on magnetic resonance imaging (MRI). METHODS: From June 2006 to July 2013, we treated 246 patients with cervical cord injury. Fifty-one (20.7 %) patients had ventral cord compression due to OPLL without any bony fractures. Among them, 38 patients (34 men, mean age 62.7 years) underwent cervical laminoplasty (8) and cervical decompression and fixation (30). The neurologic assessments were performed in patients who had 1-year follow-up, and the mean follow-up period was 42.2 months. OPLL type, cause of injury, cervical sagittal angle, cervical spine stenosis, cord compression ratio (space available for the spinal cord (SAC)), and grade of intramedullary SI (grade 0, none; grade 1, light; grade 2, intense T2WI) were assessed. RESULTS: Mean American Spinal Injury Association (ASIA) motor score at admission was 38.4 ± 21.9 (range, 2–70) and improved to 67.7 ± 19.1 (range, 8–94) at last follow-up (p < 0.05). Mean recovery rate of the motor score was 55.8 ± 19.9 %. Five patients had SI grade 0, 20 patients had SI grade 1, and 13 patients had SI grade 2. Among the variables tested, age, initial ASIA motor grade, intramedullary SI grade, and SAC were significantly related to neurological outcome. However, initial cervical alignment, canal diameter, length of SI, time interval between injury and operation, and OPLL type had no significant effect on neurological outcome. CONCLUSIONS: Preoperative neurological status, cord compression ratio, and SI grade are related to neurological outcome in patients with SCI associated with OPLL. The better the preoperative neurological status, the more favorable the neurological outcome after surgery. A higher SI grade on preoperative T2WI was negatively related to neurological outcome. Therefore, the severity of SI change, cord compression ratio, and preoperative neurological status can be regarded as significant prognostic factors in patients with SCI associated with OPLL.
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spelling pubmed-44657332015-06-15 Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL) Kwon, Soon Young Shin, Jun Jae Lee, Ji Hae Cho, Woo Ho J Orthop Surg Res Research Article BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, few studies have investigated the influence of OPLL on neurological outcome after acute cord injury. We examined whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI based on intramedullary signal intensity (SI) changes on magnetic resonance imaging (MRI). METHODS: From June 2006 to July 2013, we treated 246 patients with cervical cord injury. Fifty-one (20.7 %) patients had ventral cord compression due to OPLL without any bony fractures. Among them, 38 patients (34 men, mean age 62.7 years) underwent cervical laminoplasty (8) and cervical decompression and fixation (30). The neurologic assessments were performed in patients who had 1-year follow-up, and the mean follow-up period was 42.2 months. OPLL type, cause of injury, cervical sagittal angle, cervical spine stenosis, cord compression ratio (space available for the spinal cord (SAC)), and grade of intramedullary SI (grade 0, none; grade 1, light; grade 2, intense T2WI) were assessed. RESULTS: Mean American Spinal Injury Association (ASIA) motor score at admission was 38.4 ± 21.9 (range, 2–70) and improved to 67.7 ± 19.1 (range, 8–94) at last follow-up (p < 0.05). Mean recovery rate of the motor score was 55.8 ± 19.9 %. Five patients had SI grade 0, 20 patients had SI grade 1, and 13 patients had SI grade 2. Among the variables tested, age, initial ASIA motor grade, intramedullary SI grade, and SAC were significantly related to neurological outcome. However, initial cervical alignment, canal diameter, length of SI, time interval between injury and operation, and OPLL type had no significant effect on neurological outcome. CONCLUSIONS: Preoperative neurological status, cord compression ratio, and SI grade are related to neurological outcome in patients with SCI associated with OPLL. The better the preoperative neurological status, the more favorable the neurological outcome after surgery. A higher SI grade on preoperative T2WI was negatively related to neurological outcome. Therefore, the severity of SI change, cord compression ratio, and preoperative neurological status can be regarded as significant prognostic factors in patients with SCI associated with OPLL. BioMed Central 2015-06-12 /pmc/articles/PMC4465733/ /pubmed/26065682 http://dx.doi.org/10.1186/s13018-015-0235-3 Text en © Kwon et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kwon, Soon Young
Shin, Jun Jae
Lee, Ji Hae
Cho, Woo Ho
Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)
title Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)
title_full Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)
title_fullStr Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)
title_full_unstemmed Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)
title_short Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)
title_sort prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (opll)
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465733/
https://www.ncbi.nlm.nih.gov/pubmed/26065682
http://dx.doi.org/10.1186/s13018-015-0235-3
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