Yuan Hao, Lei Wei, Li Wenping, Zhou Yunlong, Jia Xufeng, Feng Daxiong, Lei Fei
Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, PR China.
Department of orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
BMC Musculoskelet Disord. 2025 Apr 8;26(1):341. doi: 10.1186/s12891-025-08577-0.
This study aims to assess the predictive value of preoperative parameters on recovery outcomes in patients with myelopathy caused by cervical ossification of the posterior longitudinal ligament (COPLL) undergoing laminoplasty (LAMP).
A retrospective analysis was performed on myelopathy patients caused by COPLL who underwent LAMP between 2017 and 2020. Preoperative variables, including basic epidemiological characteristics, comorbidities, functional scores, K-line-related parameters, Torg-Pavlov ratio, maximal SCOR and COPLL shape, were analyzed for their predictive influence on postoperative outcomes in cervical spine function, upper and lower extremity function, bladder function, and quality of life (QOL). Binary logistic regression model analyses were used to evaluate predictive accuracy.
A total of 84 patients were included in the study. Preoperative parameters were significant predictors of postoperative improvement following LAMP surgery for myelopathy caused by COPLL. K-line-related factors, including K-line (-) (AUC = 0.80) and K-line on sagittal T1WI (-) (AUC = 0.76), were important predictors of cervical spine function improvement. Preoperative QOL scores (AUC = 0.78) also played a significant role in predicting cervical spine function improvement. For upper extremity function, preoperative upper extremity scores were a key predictor (AUC = 0.79), while C4-C6 K-line (-) (AUC = 0.81) was also a relevant factor. Similarly, preoperative lower extremity scores were crucial for predicting lower extremity function improvement (AUC = 0.85), and preoperative QOL scores were significant predictors of QOL improvement (AUC = 0.78). Other parameters, such as the Torg-Pavlov ratio, maximal SCOR, and the shape of COPLL, provided supplementary predictive value, though their influence was secondary to JOACMEQ scores and K-line parameters. Bladder function showed minimal postoperative improvement, with preoperative bladder status and the Torg-Pavlov ratio at C5 being the primary predictors for bladder improvement. Overall, preoperative K-line findings, JOACMEQ scores, and spinal canal measurements provided valuable guidance for postoperative expectations and surgical planning.
Preoperative K-line parameters and JOACMEQ scores are robust predictors of functional recovery in myelopathy patients caused by COPLL undergoing LAMP. While Torg-Pavlov ratio, maximal SCOR, and the shape of COPLL offer additional predictive value for overall recovery, they remain useful for preoperative surgical planning. These findings emphasize the importance of comprehensive preoperative assessment to optimize outcomes.
本研究旨在评估术前参数对接受椎板成形术（LAMP）治疗的后纵韧带骨化症（COPLL）所致脊髓病患者恢复结局的预测价值。
对2017年至2020年间接受LAMP治疗的COPLL所致脊髓病患者进行回顾性分析。分析术前变量，包括基本流行病学特征、合并症、功能评分、K线相关参数、Torg-Pavlov比值、最大SCOR和COPLL形态，以评估其对颈椎功能、上肢和下肢功能、膀胱功能及生活质量（QOL）术后结局的预测影响。采用二元逻辑回归模型分析评估预测准确性。
本研究共纳入84例患者。术前参数是LAMP手术治疗COPLL所致脊髓病术后改善的重要预测指标。与K线相关的因素，包括K线（-）（AUC = 0.80）和矢状面T1WI上的K线（-）（AUC = 0.76），是颈椎功能改善的重要预测指标。术前QOL评分（AUC = 0.78）在预测颈椎功能改善方面也发挥了重要作用。对于上肢功能，术前上肢评分是关键预测指标（AUC = 0.79），而C4-C6 K线（-）（AUC = 0.81）也是一个相关因素。同样，术前下肢评分对于预测下肢功能改善至关重要（AUC = 0.85），术前QOL评分是QOL改善的重要预测指标（AUC = 0.78）。其他参数，如Torg-Pavlov比值、最大SCOR和COPLL形态，提供了补充预测价值，但其影响仅次于JOACMEQ评分和K线参数。膀胱功能术后改善最小，术前膀胱状态和C5水平的Torg-Pavlov比值是膀胱改善的主要预测指标。总体而言，术前K线检查结果、JOACMEQ评分和椎管测量为术后预期和手术规划提供了有价值的指导。
术前K线参数和JOACMEQ评分是接受LAMP治疗的COPLL所致脊髓病患者功能恢复的有力预测指标。虽然Torg-Pavlov比值、最大SCOR和COPLL形态为总体恢复提供了额外的预测价值，但它们仍有助于术前手术规划。这些发现强调了全面术前评估对优化结局的重要性。
