Radiological risk factors for progression of ossification of posterior longitudinal ligament following laminoplasty

Publication date: Available online 7 November 2017
Source:The Spine Journal
Author(s): Dong-Ho Lee, Jae Hwan Cho, Nam-Heun Kim, Sunghoo Kim, Jeonghyun Choi, Chang Ju Hwang, Choon Sung Lee
Background ContextResearch shows the progression of OPLL following decompressive surgery for cervical myelopathy, particularly in cases presenting with continuous or mixed radiographic types. To date, no study has investigated OPLL progression within each motion segment.PurposeTo evaluate progression of cervical ossification of the posterior longitudinal ligament (OPLL) in each motion segment using a novel system of classification, and to identify risk factors for OPLL progression following laminoplasty.Study Design/SettingRetrospective case seriesPatient SampleThis study included 34 patients (86 segments) with cervical myelopathy secondary to OPLL.Outcome MeasuresClinical and radiological data (plain radiographs and CT) were obtained.MethodsClinical data from 34 patients (86 segments) with cervical myelopathy secondary to OPLL were evaluated retrospectively. All subjects had undergone laminoplasty at a single center. Sagittal reconstructive CT images were used to measure OPLL thickness in each segment. Ossified masses were classified into four types according to the degree of disc space involvement: type 1 (no involvement); type 2 (involving disc space but not crossing); type 3 (crossing disc space but not fused); and type 4 (complete bridging). Range of motion (ROM) for each segment was measured using dynamic radiographs. Statistical analyses were performed to determine the degree of OPLL progression according to the four disc space involvement types and ROM.ResultsMean OPLL progression was significantly higher in types 2 (1.3mm) and 3 (1.5mm) than in type 1 (0.5mm) (P<0.001). Severe progression (change in thickness >2mm) was more frequent in types 2 (8/29) and 3 (7/16) than in types 1 (1/35) or 4 (0/6) (P=0.002). In types 2 or 3, ROM >5° was correlated with severe OPLL progression (52% vs. 8%; P=0.035).ConclusionsType 2 or 3 disc involvement and segmental ROM >5° were risk factors for OPLL progression. Classification of cervical OPLL according to disc involvement may help predict OPLL progression following laminoplasty. Close follow-up is warranted in cases of type 2 or 3 with greater segmental motion.



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