Intramedullary Signal Intensity and Other Prognostic Factors for Surgical Outcome in Spinal Cord Injury Associated With Ossification of the Posterior Longitudinal Ligament (OPLL)

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Purpose

Ossification of the posterior longitudinal ligament (OPLL) might cause stenotic changes in the spinal canal and lead to cervical myelopathy. Also, it may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, there are only a few reports that discuss the influence of OPLL on the neurological outcome after acute cord injury. We have tried to find out whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI

Methods

From June 2006 to July 2013, we treated 194 patients with cervical cord injury. 51 (26.3%) patients had ventral cord compression due to OPLL without any bony fracture. 13 patients who underwent anterior cervical decompression were excluded because of the bias or differences in surgical factors. In this study, Thirty-eight patients (34 men and 4 women, mean age 62.7 years) underwent cervical laminoplasty (8 cases) and cervical decompression and fixation (30). Patient neurologic status on

Results

The cause of SCI was predominantly falling (73.7%). Radiological findings revealed continuous or mixed type OPLL in 18 patients and segmental type OPLL in 20 patients. 34 patients showed improvement in ASIA grade. Five patients with SI Grade 0, 20 patients with SI Grade 1, and 13 patients with Grade 2 showed intramedullary SI changes in MRI findings. The mean ASIA motor score at admission was 38.4±21.9 (range, 2-70) and at last follow up it became 67.7±19.1 (range, 8-94) (p<0.05). The mean

Conclusions

We found that preoperative neurological status, maximal cord compression ratio and intramedullary signal intensity are related to the neurological outcome in the patients with spinal cord injury associated with OPLL. The better the preoperative neurological status was, the more improving the neurological outcome became after surgical operation. The SI severity on the preoperative T2WI was negatively related to neurological outcome. Therefore, the severity of SI change, maximal cord compression

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.

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