TY - JOUR
T1 - Acute cervical spinal cord injury complicated by preexisting ossification of the posterior longitudinal ligament
T2 - A multicenter study
AU - Chikuda, Hirotaka
AU - Seichi, Atsushi
AU - Takeshita, Katsushi
AU - Matsunaga, Shunji
AU - Watanabe, Masahiko
AU - Nakagawa, Yukihiro
AU - Oshima, Kazuya
AU - Sasao, Yutaka
AU - Tokuhashi, Yasuaki
AU - Nakahara, Shinnosuke
AU - Endo, Kenji
AU - Uchida, Kenzo
AU - Takahata, Masahiko
AU - Yokoyama, Toru
AU - Yamada, Kei
AU - Nohara, Yutaka
AU - Imagama, Shiro
AU - Hosoe, Hideo
AU - Ohtsu, Hiroshi
AU - Kawaguchi, Hiroshi
AU - Toyama, Yoshiaki
AU - Nakamura, Kozo
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2011/8/15
Y1 - 2011/8/15
N2 - Study Design.: Retrospective multicenter study. Objective.: To review the clinical characteristics of traumatic cervical spinal cord injury (SCI) associated with ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data.: Despite its potentially devastating consequences, there is a lack of information about acute cervical SCI complicated by OPLL. Methods.: This study included consecutive patients with acute traumatic cervical SCI (Frankel A, B, and C) who were admitted within 48 hours of injury to 34 spine institutions across Japan. For analysis of neurologic outcome, patients who had completed at least a 6-month follow-up were included. Neurologic improvement was defined as at least one grade conversion in Frankel grade. Results.: A total of 453 patients were identified (367 men, 86 women; mean age, 59 years). OPLL was found in 106 (23%) patients (87 men, 19 women; mean age, 66 years). Most of the patients with OPLL (94 of 106) were without bone injury, presenting with incomplete SCI. The prevalence of OPLL reached 34% in SCI without bone injury. The cause of SCI was predominantly falls (74%). Only 25% of the patients were aware of OPLL. Half of the OPLL patients reported gait disturbance before injury. Forty-eight (52%) OPLL patients without bone injury underwent surgery (median, 13.5 days after injury), mostly laminoplasty. Overall, no significant difference was noted in neurologic improvement between surgery group and conservative group. However, further stratification showed that surgery was associated with greater neurologic recovery in patients who had gait disturbance before injury (P = 0.04). Conclusion.: Prevalence of OPLL among cervical SCI was alarmingly high, especially in those without bone injury. Most of cervical SCI associated with OPLL were incomplete, without bone injury, and caused predominantly by low-energy trauma. The majority of the patients were unaware of OPLL. Surgery produced better neurologic recovery in patients who had gait disturbance before injury.
AB - Study Design.: Retrospective multicenter study. Objective.: To review the clinical characteristics of traumatic cervical spinal cord injury (SCI) associated with ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data.: Despite its potentially devastating consequences, there is a lack of information about acute cervical SCI complicated by OPLL. Methods.: This study included consecutive patients with acute traumatic cervical SCI (Frankel A, B, and C) who were admitted within 48 hours of injury to 34 spine institutions across Japan. For analysis of neurologic outcome, patients who had completed at least a 6-month follow-up were included. Neurologic improvement was defined as at least one grade conversion in Frankel grade. Results.: A total of 453 patients were identified (367 men, 86 women; mean age, 59 years). OPLL was found in 106 (23%) patients (87 men, 19 women; mean age, 66 years). Most of the patients with OPLL (94 of 106) were without bone injury, presenting with incomplete SCI. The prevalence of OPLL reached 34% in SCI without bone injury. The cause of SCI was predominantly falls (74%). Only 25% of the patients were aware of OPLL. Half of the OPLL patients reported gait disturbance before injury. Forty-eight (52%) OPLL patients without bone injury underwent surgery (median, 13.5 days after injury), mostly laminoplasty. Overall, no significant difference was noted in neurologic improvement between surgery group and conservative group. However, further stratification showed that surgery was associated with greater neurologic recovery in patients who had gait disturbance before injury (P = 0.04). Conclusion.: Prevalence of OPLL among cervical SCI was alarmingly high, especially in those without bone injury. Most of cervical SCI associated with OPLL were incomplete, without bone injury, and caused predominantly by low-energy trauma. The majority of the patients were unaware of OPLL. Surgery produced better neurologic recovery in patients who had gait disturbance before injury.
KW - canal stenosis
KW - myelopathy
KW - ossification of the posterior longitudinal ligament
KW - patient awareness
KW - spinal cord injury
KW - surgery
KW - trauma
KW - treatment
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U2 - 10.1097/BRS.0b013e3181f49718
DO - 10.1097/BRS.0b013e3181f49718
M3 - Review article
C2 - 21240049
AN - SCOPUS:80051787887
SN - 0362-2436
VL - 36
SP - 1453
EP - 1458
JO - Spine
JF - Spine
IS - 18
ER -