ArticleEuropean journal of medical research2025
Anterior cervical decompression improves medial plantar pressure in OPLL with gait disturbance: a 24-month retrospective cohort study.
Article in European journal of medical 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
backgroundOssification of the posterior longitudinal ligament (OPLL) is a major cause of degenerative cervical myelopathy. Whether surgical approach differentially affects lower-limb sensorimotor function is unclear. We linked radiological markers of cord injury with gait biomechanics to compare anterior versus posterior decompression.
methodsRetrospective cohort (single tertiary center, 12/2018-12/2022). Adults with cervical OPLL, gait disturbance, and focal intramedullary T2 hyperintensity (signal change ratio [SCR] ≥ 1.20) were included. Patients underwent anterior (ACDF/ACCF/hybrid) or posterior (laminoplasty/laminectomy-fusion) decompression. The primary endpoint was the 24-month change in medial foot pressure (MFP), the percentage of total plantar load borne by a pre-defined medial mask (first-third metatarsal heads plus the medial heel). Secondary endpoints included MFP at 6 months; SCR regression at 6 and 24 months (CR1, CR2); and the Japanese Orthopaedic Association (JOA) score. STATISTICS: t-tests for group comparisons; linear regression for ΔMFP_24mo (absolute change in percentage points) with covariate adjustment.
resultsSixty-three patients were analyzed (anterior = 34; posterior = 29). Baseline demographics and imaging (SCR, CNR, C2-7 Cobb, SVA, modified K-line interval [mK-line INT]) were similar between groups. Preoperative MFP did not differ (52.6 ± 7.4% vs 52.9 ± 7.6%). At 6 months, both groups improved without between-group difference (49.4 ± 6.8% vs 49.8 ± 6.9%). At 24 months, the anterior group showed larger MFP reduction (46.1 ± 6.0% vs 50.6 ± 6.4%). JOA improvement favored anterior surgery (14.1 ± 1.0 vs 12.6 ± 2.1; p = 0.001), as did regression of T2 hyperintensity (CR2 0.22 ± 0.14 vs - 0.01 ± 0.24; p = 0.001). In multivariable analysis, anterior approach independently predicted greater ΔMFP_24mo (β = + 3.9%, 95% CI + 1.8 to + 6.0; p = 0.001), alongside preoperative SCR (β = + 1.4%, p = 0.006) and preoperative MFP (β = + 0.22% per baseline %, p = 0.012). Sensitivity analyses (complete-case; extended covariate adjustment) were consistent.
conclusionsIn OPLL myelopathy with focal T2 hyperintensity, direct ventral (anterior) decompression was associated with a more durable 24-month reduction in medialized plantar loading than posterior indirect decompression, with aligned improvements in MRI signal and JOA.
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