Comparative study of preoperative sagittal alignment between patients with multisegment cervical ossification of the posterior longitudinal ligament and cervical spondylotic myelopathy

Hao Li; Zhihao Ma; Xia Wang; Suomao Yuan; Yonghao Tian; Lianlei Wang; Xinyu Liu

doi:10.1016/j.spinee.2023.06.390

Comparative study of preoperative sagittal alignment between patients with multisegment cervical ossification of the posterior longitudinal ligament and cervical spondylotic myelopathy

Spine J. 2023 Nov;23(11):1667-1673. doi: 10.1016/j.spinee.2023.06.390. Epub 2023 Jun 23.

Authors

Hao Li¹, Zhihao Ma¹, Xia Wang¹, Suomao Yuan¹, Yonghao Tian¹, Lianlei Wang¹, Xinyu Liu²

Affiliations

¹ Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China.
² Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China. Electronic address: newyuliu@163.com.

PMID: 37355047
DOI: 10.1016/j.spinee.2023.06.390

Abstract

Background context: Preoperative sagittal alignment is of great significance in the development of spinal deformities, degenerative diseases, preoperative planning, postoperative clinical evaluation, and functional recovery. However, few reports have focused on the difference in preoperative sagittal alignment between patients with ossification of the posterior longitudinal ligament (OPLL) and patients with cervical spondylotic myelopathy (CSM).

Purpose: To compare preoperative sagittal alignment between patients with multisegment cervical OPLL and multilevel CSM.

Study design: Retrospective study.

Patient sample: A total of 243 patients were included in this study.

Outcome measures: The outcome measures were the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, number of hand actions in 10 seconds, hand-grip strength, C2 to C7 Cobb angle, C2 to C5 Cobb angle, C5 to C7 Cobb angle, C2 to C7 sagittal vertical axis, C7 slope, T1 slope, K-line, K-line tilt, and range of motion (ROM).

Methods: The outcome measures were calculated in the OPLL group and CSM group and the data were analyzed using the unpaired t-test, χ² test, and one-way analysis of variance.

Results: A total of 243 patients (136 men, 107 women; mean age, 59.1±10.6 years) underwent surgical treatment from September 2013 to December 2021. In total, 123 patients were diagnosed with multisegment cervical OPLL, including continuous type (n=39), segmental type (n=38), and mixed type (n=46). The remaining 120 patients had multisegment CSM. The disease course in the OPLL group was significantly shorter than that in the CSM group (p<.05). Among the above preoperative measurements, the JOA score, number of hand actions in 10 seconds, hand-grip strength, and VAS score were not significantly different between the two groups (p>.05). The C2 to C7 Cobb angle was significantly larger in the OPLL than CSM group (17.7°±9.2° and 14.9°±9.3°, respectively; p< .05), as was the C5 to C7 Cobb angle (10.0°±6.3° and 7.5°±6.1°, respectively; p<.05). The ROM was significantly smaller in the OPLL than CSM group (33.1°±8.1° and 40.1°±10.9°, respectively; p<.001). Within the OPLL group, the ROM was significantly smaller in the continuous type than in the segmental type (p<.05).

Conclusion: Patients with multisegment cervical OPLL have greater lordotic preoperative sagittal alignment and smaller preoperative ROM than patients with CSM.

Keywords: CSM; Cervical; OPLL; ROM; Radiographic comparison; Sagittal alignment.