ArticleJournal of orthopaedic surgery and research2025
Long-term loss of intervertebral disc height after posterior cervical surgery for ossification of the posterior longitudinal ligament: a retrospective study with more than 3 years of follow-up.
Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPosterior decompression is a common treatment for cervical OPLL but may accelerate intervertebral disc degeneration by disrupting posterior tension-band structures. The long-term behavior of intervertebral disc height (IDH) after surgery remains poorly understood. PURPOSE: To evaluate the prevalence and radiographic predictors of long-term IDH loss following posterior cervical surgery for OPLL.
methodsThis single-center retrospective study included 108 patients who underwent posterior decompression for cervical OPLL between 2007 and 2020, with ≥ 3 years of follow-up. Total C3-C7 IDH was measured on midsagittal CT preoperatively and at final follow-up. Patients were grouped by IDH loss (> 1 mm vs. ≤ 1 mm). Radiographic and clinical parameters were compared. Multivariate logistic regression with AIC-based stepwise selection identified independent predictors. Model performance was assessed by AUC and F1 score.
resultsAt a median follow-up of 61 months, 24.1% of patients exhibited IDH loss > 1 mm. The IDH group had a larger preoperative C0-2 Cobb angle (27.4° vs. 22.9°, P = 0.008), higher C2 slope (17.9° vs. 13.2°, P = 0.014), and greater total disc height (11.8 mm vs. 10.7 mm, P = 0.040). Multivariate analysis identified preoperative OALL at C5/6 (OR = 3.02, 95% CI 1.08-8.49, P = 0.036) and larger C0-2 Cobb angle (OR = 1.10, 95% CI 1.02-1.17, P = 0.009) as independent risk factors, whereas OPLL at C6 was protective (OR = 0.26, 95% CI 0.09-0.77, P = 0.015). The final model yielded an AUC of 0.74 and F1 score of 0.52.
conclusionsApproximately one-quarter of patients developed significant IDH loss after posterior cervical surgery for OPLL. Larger cranio-cervical extension (C0-2 Cobb), OALL at C5/6, and absence of OPLL at C6 were associated with greater risk. Preoperative sagittal alignment and ossification patterns may help identify patients at risk for postoperative disc degeneration.
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