Does Diabetes Affect the Surgical Outcomes in Cases With Cervical Ossification of the Posterior Longitudinal Ligament? A Multicenter Study From Asia Pacific Spine Study Group

Narihito Nagoshi; Kota Watanabe; Masaya Nakamura; Morio Matsumoto; Nan Li; Sai Ma; Da He; Wei Tian; Hyeongseok Jeon; Jong Joo Lee; Keung Nyun Kim; Yoon Ha; Kenny Yat Hong Kwan; Amy Ka Po Cheung

doi:10.1177/2192568221996300

Does Diabetes Affect the Surgical Outcomes in Cases With Cervical Ossification of the Posterior Longitudinal Ligament? A Multicenter Study From Asia Pacific Spine Study Group

Global Spine J. 2023 Mar;13(2):353-359. doi: 10.1177/2192568221996300. Epub 2021 Mar 10.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
² Department of Spine Surgery, Beijing Jishuitan Hospital, the 4th Teaching Hospital of Peking University, Beijing, China.
³ Department of Neurosurgery, Yonsei University, Seoul, Korea.
⁴ Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.

Abstract

Study design: Retrospective multicenter study.

Objectives: To evaluate the surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL) in diabetes mellitus (DM) patients.

Methods: Approximately 253 cervical OPLL patients who underwent surgical decompression with or without fixation were registered at 4 institutions in 3 Asian countries. They were followed up for at least 2 years. Demographics, imaging, and surgical information were collected, and cervical Japanese Orthopaedic Association (JOA) scores and the visual analog scale (VAS) for the neck were used for evaluation.

Results: Forty-seven patients had DM, showing higher hypertension and cardiovascular disease prevalence. Although they presented worse preoperative JOA scores than non-DM patients (10.5 ± 3.1 vs. 11.8 ± 3.2; P = 0.01), the former showed comparable neurologic recovery at the final follow-up (13.9 ± 2.9 vs. 14.2 ± 2.6; P = 0.41). No correlation was noted between the hemoglobin A1c level in the DM group and the pre- and postoperative JOA scores. No significant difference was noted in VAS scores between the groups at pre- and postsurgery. Regarding perioperative complications, DM patients presented a higher C5 palsy frequency (14.9% vs. 5.8%; P = 0.04). A similar trend was observed when surgical procedure was limited to laminoplasty.

Conclusions: This is the first multicenter Asian study to evaluate the impact of DM on cervical OPLL patients. Surgical results were favorable even in DM cases, regardless of preoperative hemoglobin A1c levels or operative procedures. However, caution is warranted for the occurrence of C5 palsy after surgery.

Keywords: Asian multicenter study; cervical ossification of the posterior longitudinal ligament; diabetes mellitus; perioperative adverse events; surgical outcomes.