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Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL).

Kwon SY, Shin JJ, Lee JH, Cho WH - J Orthop Surg Res (2015)

Bottom Line: Among the variables tested, age, initial ASIA motor grade, intramedullary SI grade, and SAC were significantly related to neurological outcome.The better the preoperative neurological status, the more favorable the neurological outcome after surgery.A higher SI grade on preoperative T2WI was negatively related to neurological outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye-7 dong, 761-1, Nowon-gu, Seoul, 139-707, South Korea. s3169@paik.ac.kr.

ABSTRACT

Background: Ossification of the posterior longitudinal ligament (OPLL) may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, few studies have investigated the influence of OPLL on neurological outcome after acute cord injury. We examined whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI based on intramedullary signal intensity (SI) changes on magnetic resonance imaging (MRI).

Methods: From June 2006 to July 2013, we treated 246 patients with cervical cord injury. Fifty-one (20.7%) patients had ventral cord compression due to OPLL without any bony fractures. Among them, 38 patients (34 men, mean age 62.7 years) underwent cervical laminoplasty (8) and cervical decompression and fixation (30). The neurologic assessments were performed in patients who had 1-year follow-up, and the mean follow-up period was 42.2 months. OPLL type, cause of injury, cervical sagittal angle, cervical spine stenosis, cord compression ratio (space available for the spinal cord (SAC)), and grade of intramedullary SI (grade 0, none; grade 1, light; grade 2, intense T2WI) were assessed.

Results: Mean American Spinal Injury Association (ASIA) motor score at admission was 38.4 ± 21.9 (range, 2-70) and improved to 67.7 ± 19.1 (range, 8-94) at last follow-up (p < 0.05). Mean recovery rate of the motor score was 55.8 ± 19.9%. Five patients had SI grade 0, 20 patients had SI grade 1, and 13 patients had SI grade 2. Among the variables tested, age, initial ASIA motor grade, intramedullary SI grade, and SAC were significantly related to neurological outcome. However, initial cervical alignment, canal diameter, length of SI, time interval between injury and operation, and OPLL type had no significant effect on neurological outcome.

Conclusions: Preoperative neurological status, cord compression ratio, and SI grade are related to neurological outcome in patients with SCI associated with OPLL. The better the preoperative neurological status, the more favorable the neurological outcome after surgery. A higher SI grade on preoperative T2WI was negatively related to neurological outcome. Therefore, the severity of SI change, cord compression ratio, and preoperative neurological status can be regarded as significant prognostic factors in patients with SCI associated with OPLL.

No MeSH data available.


Related in: MedlinePlus

The correlation between age, ASIA motor score, SAC, and recovery ratio. a The patients’ age showed a significant correlation with the recovery ratio. b Initial ASIA motor score was correlated with recovery ratio. c Recovery ratio was correlated with the space available for the spinal cord (SAC)
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Fig6: The correlation between age, ASIA motor score, SAC, and recovery ratio. a The patients’ age showed a significant correlation with the recovery ratio. b Initial ASIA motor score was correlated with recovery ratio. c Recovery ratio was correlated with the space available for the spinal cord (SAC)

Mentions: Univariate logistic regression analysis and multivariate logistic regression analysis were performed to identify prognostic factors. Patient age, initial ASIA motor score, severity of intramedullary signal intensity, and SAC had significant effects on the neurological outcome after surgery (Table 2). Patient age was significantly correlated with recovery ratio (coefficient = −1.0733, 95 % CI = −1.8715– − 0.2752, p = 0.0098, Fig. 6a). Initial ASIA motor score was significantly correlated with recovery ratio (coefficient = 0.7533, 95 % CI = 0.5711–0.8647, p < 0.0001, Fig. 6b). Furthermore, the change in SAC was significantly correlated with the rate of postoperative neurologic improvement (coefficient = 0.3967, 95 % CI = 0.07842–0.6416, p = 0.0166, Fig. 6c). However, there was no significant relationship between initial cervical curvature, time interval between injury and operation, OPLL type, the length of signal intensity (SI), or congenital canal stenosis (Pavlov’s ratio) and neurological outcome.Table 2


Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL).

Kwon SY, Shin JJ, Lee JH, Cho WH - J Orthop Surg Res (2015)

The correlation between age, ASIA motor score, SAC, and recovery ratio. a The patients’ age showed a significant correlation with the recovery ratio. b Initial ASIA motor score was correlated with recovery ratio. c Recovery ratio was correlated with the space available for the spinal cord (SAC)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4465733&req=5

Fig6: The correlation between age, ASIA motor score, SAC, and recovery ratio. a The patients’ age showed a significant correlation with the recovery ratio. b Initial ASIA motor score was correlated with recovery ratio. c Recovery ratio was correlated with the space available for the spinal cord (SAC)
Mentions: Univariate logistic regression analysis and multivariate logistic regression analysis were performed to identify prognostic factors. Patient age, initial ASIA motor score, severity of intramedullary signal intensity, and SAC had significant effects on the neurological outcome after surgery (Table 2). Patient age was significantly correlated with recovery ratio (coefficient = −1.0733, 95 % CI = −1.8715– − 0.2752, p = 0.0098, Fig. 6a). Initial ASIA motor score was significantly correlated with recovery ratio (coefficient = 0.7533, 95 % CI = 0.5711–0.8647, p < 0.0001, Fig. 6b). Furthermore, the change in SAC was significantly correlated with the rate of postoperative neurologic improvement (coefficient = 0.3967, 95 % CI = 0.07842–0.6416, p = 0.0166, Fig. 6c). However, there was no significant relationship between initial cervical curvature, time interval between injury and operation, OPLL type, the length of signal intensity (SI), or congenital canal stenosis (Pavlov’s ratio) and neurological outcome.Table 2

Bottom Line: Among the variables tested, age, initial ASIA motor grade, intramedullary SI grade, and SAC were significantly related to neurological outcome.The better the preoperative neurological status, the more favorable the neurological outcome after surgery.A higher SI grade on preoperative T2WI was negatively related to neurological outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye-7 dong, 761-1, Nowon-gu, Seoul, 139-707, South Korea. s3169@paik.ac.kr.

ABSTRACT

Background: Ossification of the posterior longitudinal ligament (OPLL) may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, few studies have investigated the influence of OPLL on neurological outcome after acute cord injury. We examined whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI based on intramedullary signal intensity (SI) changes on magnetic resonance imaging (MRI).

Methods: From June 2006 to July 2013, we treated 246 patients with cervical cord injury. Fifty-one (20.7%) patients had ventral cord compression due to OPLL without any bony fractures. Among them, 38 patients (34 men, mean age 62.7 years) underwent cervical laminoplasty (8) and cervical decompression and fixation (30). The neurologic assessments were performed in patients who had 1-year follow-up, and the mean follow-up period was 42.2 months. OPLL type, cause of injury, cervical sagittal angle, cervical spine stenosis, cord compression ratio (space available for the spinal cord (SAC)), and grade of intramedullary SI (grade 0, none; grade 1, light; grade 2, intense T2WI) were assessed.

Results: Mean American Spinal Injury Association (ASIA) motor score at admission was 38.4 ± 21.9 (range, 2-70) and improved to 67.7 ± 19.1 (range, 8-94) at last follow-up (p < 0.05). Mean recovery rate of the motor score was 55.8 ± 19.9%. Five patients had SI grade 0, 20 patients had SI grade 1, and 13 patients had SI grade 2. Among the variables tested, age, initial ASIA motor grade, intramedullary SI grade, and SAC were significantly related to neurological outcome. However, initial cervical alignment, canal diameter, length of SI, time interval between injury and operation, and OPLL type had no significant effect on neurological outcome.

Conclusions: Preoperative neurological status, cord compression ratio, and SI grade are related to neurological outcome in patients with SCI associated with OPLL. The better the preoperative neurological status, the more favorable the neurological outcome after surgery. A higher SI grade on preoperative T2WI was negatively related to neurological outcome. Therefore, the severity of SI change, cord compression ratio, and preoperative neurological status can be regarded as significant prognostic factors in patients with SCI associated with OPLL.

No MeSH data available.


Related in: MedlinePlus