Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Japanese Multicenter Research Organization for Ossification of the Spinal Ligament.
Spine (Phila Pa 1976). 2023 Sep 15;48(18):1259-1265. doi: 10.1097/BRS.0000000000004762. Epub 2023 Jun 27.
A prospective multicenter study.
To investigate the effect of preoperative symptom duration on neurological recovery for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL).
The optimal timing to perform surgery in the setting of cervical OPLL remains unknown. It is important to know the influence of symptom duration on postoperative outcomes to facilitate discussions regarding the timing of surgery.
The study included 395 patients (291 men and 104 women; mean age, 63.7 ± 11.4 yr): 204 were treated with laminoplasty, 90 with posterior decompression and fusion, 85 with anterior decompression and fusion, and 16 with other procedures. The Japanese Orthopedic Association (JOA) score and patient-reported outcomes of the JOA Cervical Myelopathy Evaluation Questionnaire were used to assess clinical outcomes preoperatively and 2 years after surgery. Logistic regression analysis was used to identify factors associated with the achievement of minimum clinically important difference (MCID) after surgery.
The recovery rate was significantly lower in the group with symptom duration of ≥5 years compared with the groups with durations of <0.5 years, 0.5 to 1 year, and 1 to 2 years. Improvement of JOA Cervical Myelopathy Evaluation Questionnaire in the upper extremity function score ( P < 0.001), lower extremity function ( P = 0.039), quality of life ( P = 0.053), and bladder function ( P = 0.034) were all decreased when the symptom duration exceeded 2 years. Duration of symptoms ( P = 0.001), age ( P < 0.001), and body mass index ( P < 0.001) were significantly associated with the achievement of MCID. The cutoff value we established for symptom duration was 23 months (area under the curve, 0.616; sensitivity, 67.4%; specificity, 53.5%).
Symptom duration had a significant impact on neurological recovery and patient-reported outcome measures in this series of patients undergoing surgery for cervical OPLL. Patients with symptom duration exceeding 23 months may be at greater risk of failing to achieve MCID after surgery.
一项前瞻性多中心研究。
探讨术前症状持续时间对颈椎后纵韧带骨化症（OPLL）治疗的神经恢复的影响。
颈椎 OPLL 手术的最佳时机仍不清楚。了解症状持续时间对术后结果的影响对于讨论手术时机很重要。
本研究纳入 395 例患者（291 例男性和 104 例女性；平均年龄 63.7±11.4 岁）：204 例行椎板成形术，90 例行后路减压融合术，85 例行前路减压融合术，16 例行其他手术。使用日本骨科协会（JOA）评分和 JOA 颈椎脊髓病评价问卷的患者报告结果来评估术前和术后 2 年的临床结果。使用逻辑回归分析确定与术后达到最小临床重要差异（MCID）相关的因素。
与症状持续时间<0.5 年、0.5-1 年和 1-2 年相比，症状持续时间≥5 年的患者的恢复率显著降低。上肢功能评分（ P<0.001）、下肢功能（ P=0.039）、生活质量（ P=0.053）和膀胱功能（ P=0.034）的 JOA 颈椎脊髓病评价问卷改善均随着症状持续时间超过 2 年而降低。症状持续时间（ P=0.001）、年龄（ P<0.001）和体重指数（ P<0.001）与达到 MCID 显著相关。我们为症状持续时间建立的截止值为 23 个月（曲线下面积为 0.616；敏感性为 67.4%；特异性为 53.5%）。
在接受颈椎 OPLL 手术的这一系列患者中，症状持续时间对神经恢复和患者报告的结果测量有显著影响。症状持续时间超过 23 个月的患者术后可能更难以达到 MCID。
3 级。
