• Hirotaka Chikuda, Atsushi Seichi, Katsushi Takeshita, Shunji Matsunaga, Masahiko Watanabe, Yukihiro Nakagawa, Kazuya Oshima, Yutaka Sasao, Yasuaki Tokuhashi, Shinnosuke Nakahara, Kenji Endo, Kenzo Uchida, Masahiko Takahata, Toru Yokoyama, Kei Yamada, Yutaka Nohara, Shiro Imagama, Hideo Hosoe, Hiroshi Ohtsu, Hiroshi Kawaguchi, Yoshiaki Toyama, and Kozo Nakamura.
• Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan. chikuda-tky@umin.ac.jp
• Spine. 2011 Aug 15;36(18):1453-8.

Study DesignRetrospective multicenter study.ObjectiveTo review the clinical characteristics of traumatic cervical spinal cord injury (SCI) associated with ossification of the posterior longitudinal ligament (OPLL).Summary Of Background DataDespite its potentially devastating consequences, there is a lack of information about acute cervical SCI complicated by OPLL.MethodsThis 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.ResultsA 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).ConclusionPrevalence 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.

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