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Potential risk factors for poor outcome after anterior surgery for patients with cervical ossification of the posterior longitudinal ligament

Authors Li SQ, Zhang P, Gao XD, Miao DC, Gao YL, Shen Y

Received 23 September 2017

Accepted for publication 15 January 2018

Published 20 February 2018 Volume 2018:14 Pages 341—347

DOI https://doi.org/10.2147/TCRM.S152416

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Professor Deyun Wang


Shaoqing Li, Peng Zhang, Xianda Gao, Dechao Miao, Yanlong Gao, Yong Shen

Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China

Objective: Our purpose here was to identify risk factors of poor outcome after anterior operation in patients with cervical ossification of the posterior longitudinal ligament (OPLL).
Methods: This study retrospectively reviewed 98 patients who underwent anterior surgery for improving neurological symptoms. The Japanese Orthopedic Association (JOA) recovery rate <50% was defined as poor surgical outcome. We investigated the relationship between various predictors and outcome by logistic regression analysis and receiver operating characteristic curves. To explore the cause of cerebrospinal fluid (CSF) leakage, we used the Mann–Whitney U-test, χ2 test, or independent t-test.
Results: Multivariate logistic regression analysis showed that age (odds ratio [OR] =1.1, 95% confidence interval [CI] =1.03–1.18, P=0.005), occupying ratio of OPLL (OR =1.08, 95% CI =1.03–1.12, P=0.001), and residual ratio of OPLL (OR =1.07, 95% CI =1.02–1.13, P=0.008) were independently associated with poor outcome. The cutoffs of the above risk factors were set at 63.5 years, 39.65%, and 25.165%, respectively. Predictors for CSF leakage were occupying ratio of OPLL, the K-line, and shape of the ossified lesion (P<0.001, P=0.019, and P=0.003).
Conclusion: These findings suggest that advanced age, high occupying ratio of OPLL, and high residual ratio of OPLL were risk factors for postoperative poor outcome in patients with OPLL. In addition, the high occupying ratio of OPLL, the K-line (-), and hill-shape ossification were potential causes of CSF leakage.

Keywords: cervical ossification of the posterior longitudinal ligament, cerebrospinal leakage, occupying ratio, residual ratio, K-line

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