Preoperative Symptom Duration Influences Neurological Recovery and Patient Reported Outcome Measures After Surgical Treatment of Cervical Ossification of the Posterior Longitudinal Ligament.

Abstract

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±11.4y): 204 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 JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) were used to assess clinical outcomes preoperatively and two years following surgery. Logistic regression analysis was used to identify factors associated with achievement of MCID following surgery. The recovery rate was significantly lower in the group with symptom duration of ≥5 years compared to the groups with durations of <0.5 years, 0.5-1 year, and 1-2 years. Improvement of JOACMEQ 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 BMI (P<0.001) were significantly associated with the achievement of MCID. The cutoff value we established for symptom duration was 23 months (AUC 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. 3.