脊髓病严重程度与高龄及后纵韧带骨化症的信号强度变化密切相关：一项全国性前瞻性研究。

Severity of Myelopathy is Closely Associated With Advanced Age and Signal Intensity Change in Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Nationwide Investigation.

作者信息

Hirai Takashi, Yoshii Toshitaka, Egawa Satoru, Sakai Kenichiro, Kusano Kazuo, Nakagawa Yukihiro, Wada Kanichiro, Katsumi Keiichi, Fujii Kengo, Kimura Atsushi, Furuya Takeo, Nagoshi Narihito, Kanchiku Tsukasa, Nagamoto Yukitaka, Oshima Yasushi, Ando Kei, Takahata Masahiko, Mori Kanji, Nakajima Hideaki, Murata Kazuma, Matsunaga Shunji, Kaito Takashi, Yamada Kei, Kobayashi Sho, Kato Satoshi, Ohba Tetsuro, Inami Satoshi, Fujibayashi Shunsuke, Katoh Hiroyuki, Kanno Haruo, Imagama Shiro, Koda Masao, Kawaguchi Yoshiharu, Takeshita Katsushi, Matsumoto Morio, Yamazaki Masashi, Okawa Atsushi

机构信息

Department of Orthopedic Surgery, Tokyo Medical and Dental University.

Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo.

出版信息

Clin Spine Surg. 2022 Feb 1;35(1):E155-E161. doi: 10.1097/BSD.0000000000001164.

DOI:10.1097/BSD.0000000000001164

PMID:33769979

Abstract

STUDY DESIGN

Prospective, nationwide case series.

OBJECTIVE

To identify preoperative factors associated with myelopathy and neurological impairment in patients with cervical ossification of the posterior longitudinal ligament (OPLL).

SUMMARY OF BACKGROUND DATA

Various studies have reported clinical outcomes following the surgical treatment of OPLL. However, there has been no large-scale study of preoperative clinical features in patients with cervical OPLL.

MATERIALS AND METHODS

Data were prospectively collected from 28 institutions nationwide in Japan. In total, 512 patients with neurological impairment caused by cervical OPLL requiring surgery were enrolled. Basic demographic and clinical data, including age, sex, diabetes status, body mass index, smoking history, and disease duration were collected. C2-7 lordotic angle, canal narrowing ratio, range of motion in flexion-extension at C2-7, and type of OPLL were evaluated on lateral radiographs to identify factors influencing the clinical features of patients with OPLL in whom surgery was planned.

RESULTS

Complete documentation was available for 490 patients (362 male, 128 female). In total, 34 patients had the localized type, 181 had the segmental type, 64 had the continuous type, and 211 had the mixed type. Although there were no significant differences in age, body mass index, disease duration, Japanese Orthopedic Association (JOA) score, and lordotic angle at C2-7 according to the type of OPLL, significant differences were observed in a range of motion at C2-7 and the canal narrowing ratio among the 4 types. Multiple regression analysis revealed that the JOA score was significantly associated with age and signal intensity change on magnetic resonance imaging.

CONCLUSIONS

This is the first large-scale, prospective, multicenter case series study to investigate factors influencing preoperative neurological status in patients with OPLL. Age and signal intensity change on magnetic resonance images were significantly associated with JOA score in patients requiring surgery.

LEVEL OF EVIDENCE

Level II.

摘要

研究设计

前瞻性全国病例系列研究。

目的

确定颈椎后纵韧带骨化症（OPLL）患者术前与脊髓病和神经功能障碍相关的因素。

背景资料总结

多项研究报告了OPLL手术治疗后的临床结果。然而，尚未有关于颈椎OPLL患者术前临床特征的大规模研究。

材料与方法

前瞻性收集日本全国28家机构的数据。共纳入512例因颈椎OPLL导致神经功能障碍且需要手术的患者。收集基本人口统计学和临床数据，包括年龄、性别、糖尿病状况、体重指数、吸烟史和病程。通过侧位X线片评估C2-7前凸角、椎管狭窄率、C2-7屈伸活动度以及OPLL类型，以确定影响计划手术的OPLL患者临床特征的因素。

结果

490例患者（男性362例，女性128例）有完整记录。其中，局限性类型34例，节段性类型181例，连续性类型64例，混合型211例。尽管根据OPLL类型，患者在年龄、体重指数、病程、日本骨科协会（JOA）评分和C2-7前凸角方面无显著差异，但在C2-7活动度和4种类型的椎管狭窄率方面存在显著差异。多元回归分析显示，JOA评分与年龄及磁共振成像信号强度变化显著相关。