Acute cervical spinal cord injury complicated by preexisting ossification of the posterior longitudinal ligament: a multicenter study.
METHODS
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).


BACKGROUND
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).


CONCLUSIONS
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.
Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan. chikuda-tky@umin.ac.jp
Hirotaka
H
Chikuda
Atsushi
A
Seichi
Katsushi
K
Takeshita
Shunji
S
Matsunaga
Masahiko
M
Watanabe
Yukihiro
Y
Nakagawa
Kazuya
K
Oshima
Yutaka
Y
Sasao
Yasuaki
Y
Tokuhashi
Shinnosuke
S
Nakahara
Kenji
K
Endo
Kenzo
K
Uchida
Masahiko
M
Takahata
Toru
T
Yokoyama
Kei
K
Yamada
Yutaka
Y
Nohara
Shiro
S
Imagama
Hideo
H
Hosoe
Hiroshi
H
Ohtsu
Hiroshi
H
Kawaguchi
Yoshiaki
Y
Toyama
Kozo
K
Nakamura
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D016009:Chi-Square Distribution; D005260:Female; D020233:Gait Disorders, Neurologic / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome