• Clin Neurol Neurosurg · Nov 2018

    Relationship of preoperative intramedullary MRI signal intensity and dynamic factors with surgical outcomes of laminoplasty for cervical ossification of the posterior longitudinal ligament.

    • Masashi Miyazaki, Toshinobu Ishihara, Naoki Notani, Shozo Kanezaki, Tetsutaro Abe, and Hiroshi Tsumura.
    • Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan. Electronic address: masashim@oita-u.ac.jp.
    • Clin Neurol Neurosurg. 2018 Nov 1; 174: 117-122.

    ObjectiveWe aimed to analyze the relationship of preoperative signal intensity on magnetic resonance imaging (MRI) and dynamic factor with surgical outcomes of laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL).Patients And MethodsWe retrospectively reviewed the records of 29 patients (20 males and 9 females) who underwent double-door laminoplasty for cervical OPLL. T2-weighted MRI was performed preoperatively. To assess the high-signal changes of the spinal cord, signal intensity was classified as grade 0 (low signal, no changes), grade 1 (medium signal, mild changes), and grade 2 (bright signal, pronounced changes). The following factors were analyzed for their relationship with surgical outcome, expressed as the Japanese Orthopedic Association (JOA) score recovery rate: pre- and postoperative C2-C7 range of motion (ROM), segmental ROM, C2-C7 lordotic angle, and spinal cord occupying ratio, as well as disease duration.ResultsDisease duration was significantly longer in patients with pronounced high-signal changes on preoperative MRI (P < 0.05 for grade 2 vs. grade 1 or 0). The mean preoperative JOA score and JOA score recovery rate were significantly lower in patients with pronounced high-signal changes on preoperative MRI (P < 0.05 for grade 2 vs. grade 1 or 0). Preoperatively, segmental ROM was significantly smaller in patients with no MRI signal intensity changes (P < 0.05 for grade 0 vs. grade 1 or 2). Additionally, preoperative segmental ROM was negatively correlated with JOA score recovery rate (R=-0.470, P = 0.01) and positively correlated with high-signal changes on preoperative MRI (R = 0.460, P = 0.012). On multivariate analysis, preoperative segmental ROM was negatively associated with JOA score recovery rate (odds ratio, - 0.407; P = 0.046).ConclusionGiven its negative correlation with JOA score recovery rate and positive correlation with high-signal changes on preoperative MRI, higher preoperative segmental ROM may be associated with spinal cord damage due to repeated minor trauma, predicting poor surgical outcome of laminoplasty in cervical OPLL.Copyright © 2018 Elsevier B.V. All rights reserved.

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