Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Does the presence of preoperative neck pain impact clinical outcomes after posterior decompression in patients with cervical ossification of the posterior longitudinal ligament?: Retrospective multicenter cohort study

Spinal Cord volume 62, pages 619–624 (2024)Cite this article

Subjects

Abstract

Study design

Retrospective multicenter study.

Objectives

To evaluate how preoperative neck pain influences clinical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL).

Setting

Fourteen medical institutions in Japan.

Methods

We enrolled 90 patients with cervical OPLL who underwent posterior decompression and were followed for a minimum of two years. We collected demographic data, medical history, and imaging findings. Patients were divided into two groups based on preoperative neck pain presence (Pre-op. neck pain (−) and (+) groups), and their outcomes were compared.

Results

There were no significant differences in patient demographics between the Pre-op. neck pain (−) and (+) groups. Both groups showed similar distributions of ossification types and K-line positivity. Perioperative complications were comparable between the two groups. Radiographic analysis revealed no significant differences in C2–7 angles or cervical range of motion, pre- and postoperatively. Both groups demonstrated significant improvement in postoperative Japanese orthopedic association (JOA) scores, but there were no significant differences in scores or recovery rates. In the Pre-op. neck pain (−) group, factors associated with appearance of postoperative neck pain included pre- and postoperative lower JOA scores and larger C2–7 angles in neutral and extension positions.

Conclusions

It emerges that lower pre- and postoperative JOA scores or larger C2–7 angles in neutral and extension positions predispose to postoperative neck pain even in those patients without preoperative neck pain. Therefore, this is worth discussing at the time of consenting patients for surgical decompression and fixation.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

The datasets generated and/or analyzed in this study are available from the corresponding author on request.

References

  1. Matsunaga S, Sakou T. Ossification of the posterior longitudinal ligament of the cervical spine: etiology and natural history. Spine. 2012;37:E309–314.

    Article  PubMed  Google Scholar 

  2. Abiola R, Rubery P, Mesfin A. Ossification of the posterior longitudinal ligament: etiology, diagnosis, and outcomes of nonoperative and operative management. Glob Spine J. 2016;6:195–204.

    Article  Google Scholar 

  3. Nagoshi N, Tetreault LA, Nakashima H, Nouri A, Arnold P, Zileli M, et al. Do caucasians and east asians have different outcomes following surgery for the treatment of degenerative cervical myelopathy?: Results from the prospective multicenter AOSpine International Study. Spine. 2016;41:1428–35.

    Article  PubMed  Google Scholar 

  4. Matsumoto M, Chiba K, Toyama Y. Surgical treatment of ossification of the posterior longitudinal ligament and its outcomes. Spine. 2012;37:E303–308.

    Article  PubMed  Google Scholar 

  5. Nakashima H, Tetreault L, Nagoshi N, Nouri A, Arnold P, Yukawa Y, et al. Comparison of outcomes of surgical treatment for ossification of the posterior longitudinal ligament versus other forms of degenerative cervical myelopathy:Results from the prospective, multicenter AOSpine CSM-International Study of 479 patients. J Bone Joint Surg Am. 2016;98:370–8.

    Article  PubMed  Google Scholar 

  6. An HS, Al-Shihabi L, Kurd M. Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine. J Am Acad Orthop Surg. 2014;22:420–9.

    Article  PubMed  Google Scholar 

  7. Hirai T, Yoshii T, Iwanami A, Takeuchi K, Mori K, Yamada T, et al. Prevalence and distribution of ossified lesions in the whole spine of patients with cervical ossification of the posterior longitudinal ligament a multicenter study (JOSL CT study). PLoS One. 2016;11:e0160117.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yoshii T, Hirai T, Iwanami A, Nagoshi N, Yakeuchi K, Mori K, et al. Co-existence of ossification of the nuchal ligament is associated with severity of ossification in the whole spine in patients with cervical ossification of the posterior longitudinal ligament -A multi-center CT study. J Orthop Sci. 2019;24:35–41.

    Article  PubMed  Google Scholar 

  9. Sakai K, Okawa A, Takahashi M, Arai Y, Kawabata S, Enomoto M, et al. Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty. Spine. 2012;37:367–76.

    Article  PubMed  Google Scholar 

  10. Hirai T, Yoshii T, Ushio S, Mori K, Maki S, Katsumi K, et al. Clinical characteristics in patients with ossification of the posterior longitudinal ligament: A prospective multi-institutional cross-sectional study. Sci Rep. 2020;10:5532.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kumagai G, Ono A, Numasawa T, Wada K, Inoue R, Iwasaki H, et al. Association between roentgenographic findings of the cervical spine and neck symptoms in a Japanese community population. J Orthop Sci. 2014;19:390–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Nakajima H, Uchida K, Taguchi T, Yamashita T, Tominaga T, Tanaka M, et al. Multicenter cross-sectional study of the clinical features and types of treatment of spinal cord-related pain syndrome. J Orthop Sci. 2019;24:798–804.

    Article  PubMed  Google Scholar 

  13. Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine. 1981;6:354–64.

    Article  CAS  PubMed  Google Scholar 

  14. Seichi A, Takeshita K, Ohishi I, Kawaguchi H, Akune T, Anamizu Y, et al. Long-term results of double-door laminoplasty for cervical stenotic myelopathy. Spine. 2001;26:479–87.

    Article  CAS  PubMed  Google Scholar 

  15. Shiraishi T, Kato M, Yato Y, Ueda S, Aoyama R, Yamane J, et al. New techniques for exposure of posterior cervical spine through intermuscular planes and their surgical application. Spine. 2012;37:E286–E296.

    Article  PubMed  Google Scholar 

  16. Koda M, Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, et al. Factors significantly associated with postoperative neck pain deterioration after surgery for cervical ossification of the posterior longitudinal ligament: Study of a cohort using a prospective registry. J Clin Med. 2021;10:5026.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Katsumi K, Hirai T, Yoshii T, Maki S, Mori K, Nagoshi N, et al. The impact of ossification spread on cervical spine function in patients with ossification of the posterior longitudinal ligament. Sci Rep. 2021;11:14337.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Choi BW, Hum TW. Significance of intramedullary high signal intensity on magnetic resonance imaging in patients with cervical ossification of the posterior longitudinal ligament. Clin Orthop Surg. 2015;7:465–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mori K, Yoshii T, Egawa S, Sakai K, Kusano K, Tsutsui S, et al. Impact of obesity on cervical ossification of the posterior longitudinal ligament: a nationwide prospective study. Sci Rep. 2022;12:8884.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Nagoshi N, Watanabe K, Nakamura M, Matsumoto M, Lin N, Ma S, et al. 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;13:353–9.

    Article  PubMed  Google Scholar 

  21. Li C, Zha G, Yang Z, Pang Y, Qiu S, Fan W, et al. K-line in patients with cervical ossification of the posterior longitudinal ligament: relationship with change in sagittal cervical curvature and laminoplasty outcomes. Arch Orthop Trauma Surg. 2022;142:1743–51.

    Article  PubMed  Google Scholar 

  22. Shi H, Chen L, Zhu L, Jiang ZL, Wu XT. Instrumented fusion versus instrumented non-fusion following expansive open-door laminoplasty for multilevel cervical ossification of the posterior longitudinal ligament. Arch Orthop Trauma Surg. 2023;143:2919–27.

    Article  PubMed  Google Scholar 

  23. Fujiwara H, Oda T, Makino T, Moriguchi Y, Yonenobu K, Kaito T. Impact of cervical sagittal alignment on axial neck pain and health-related quality of life after cervical laminoplasty in patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament: A prospective comparative study. Clin Spine Surg. 2018;31:E245–E251.

    Article  PubMed  Google Scholar 

  24. Nakashima H, Imagama S, Yoshii T, Egawa S, Sakai K, Kusano K, et al. Factors associated with loss of cervical lordosis after laminoplasty for patients with cervical ossification of the posterior longitudinal ligament: Data from a prospective multicenter study. Spine. 2023;48:1047–56.

    Article  PubMed  Google Scholar 

  25. Xu C, Zhang Y, Dong M, Wu H, Yu W, Tian Y, et al. The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients. Spine J. 2020;20:1422–9.

    Article  PubMed  Google Scholar 

  26. Lee CK, Shin DA, Yi S, Kim KN, Shin HC, Yoon DH, et al. Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament. J Neurosurg Spine. 2016;24:100–7.

    Article  PubMed  Google Scholar 

  27. Ogawa Y, Chiba K, Matsumoto M, Nakamura M, Takaishi H, Hirabayashi H, et al. Long-term results after expansive open-door laminoplasty for the segmental-type of ossification of the posterior longitudinal ligament of the cervical spine: a comparison with nonsegmental-type lesions. J Neurosurg Spine. 2005;3:198–204.

    Article  PubMed  Google Scholar 

  28. Martin AR, Jentzsch T, Wilson JRF, Moghaddamjou A, Jiang F, Rienmueller A, et al. Inter-rater Reliability of the Modified Japanese Orthopedic Association Score in Degenerative Cervical Myelopathy: A Cross-sectional Study. Spine. 2021;46:1063–9.

    Article  PubMed  Google Scholar 

  29. Joshi S, Balthillaya G, Neelapala YV. Thoracic posture and mobility in mechanical neck pain population: A review of the literature. Asian Spine J. 2019;13:849–60.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Zaed I, Bossi B, Ganau M, Tinterri B, Giordano M, Chibbaro S. Current state of benefits of Enhanced Recovery After Surgery (ERAS) in spinal surgeries: A systematic review of the literature. Neurochirurgie. 2022;68:61–68.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan

    Toshiki Okubo, Narihito Nagoshi, Takashi Tsuji, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Osahiko Tsuji, Morio Matsumoto, Masaya Nakamura & Kota Watanabe

  2. Keio Spine Research Group (KSRG), Tokyo, Japan

    Toshiki Okubo, Narihito Nagoshi, Takahito Iga, Takashi Tsuji, Yosuke Horiuchi, Kazuya Kitamura, Kenshi Daimon, Haruki Funao, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Osahiko Tsuji, Morio Matsumoto, Masaya Nakamura, Kota Watanabe, Ken Ishii & Junichi Yamane

  3. Department of Orthopaedic Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan

    Takahito Iga

  4. Department of Orthopaedic Surgery, Sano Kosei General Hospital, Tochigi, Japan

    Takahito Iga

  5. Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

    Takashi Tsuji

  6. Department of Orthopaedic Surgery, Japan Community Health Care Organization Saitama Medical Center, Saitama, Japan

    Yosuke Horiuchi & Kenshi Daimon

  7. Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan

    Yosuke Horiuchi

  8. Department of Orthopaedic Surgery, Hiratsuka City Hospital, Kanagawa, Japan

    Kazuya Kitamura

  9. Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan

    Kazuya Kitamura

  10. Department of Orthopaedic Surgery, Ogikubo Hospital, Tokyo, Japan

    Kenshi Daimon

  11. Spine and Spinal cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan

    Haruki Funao

  12. Department of Orthopaedic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan

    Haruki Funao

  13. New Spine Clinic Tokyo, Tokyo, Japan

    Ken Ishii

  14. Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan

    Junichi Yamane

  15. Department of Orthopaedic Surgery, Kanagawa Prefectural Police Association Keiyu Hospital, Kanagawa, Japan

    Junichi Yamane

Authors
  1. Toshiki Okubo
    View author publications

    Search author on:PubMed Google Scholar

  2. Narihito Nagoshi
    View author publications

    Search author on:PubMed Google Scholar

  3. Takahito Iga
    View author publications

    Search author on:PubMed Google Scholar

  4. Takashi Tsuji
    View author publications

    Search author on:PubMed Google Scholar

  5. Yosuke Horiuchi
    View author publications

    Search author on:PubMed Google Scholar

  6. Kazuya Kitamura
    View author publications

    Search author on:PubMed Google Scholar

  7. Kenshi Daimon
    View author publications

    Search author on:PubMed Google Scholar

  8. Haruki Funao
    View author publications

    Search author on:PubMed Google Scholar

  9. Kazuki Takeda
    View author publications

    Search author on:PubMed Google Scholar

  10. Masahiro Ozaki
    View author publications

    Search author on:PubMed Google Scholar

  11. Satoshi Suzuki
    View author publications

    Search author on:PubMed Google Scholar

  12. Osahiko Tsuji
    View author publications

    Search author on:PubMed Google Scholar

  13. Morio Matsumoto
    View author publications

    Search author on:PubMed Google Scholar

  14. Masaya Nakamura
    View author publications

    Search author on:PubMed Google Scholar

  15. Kota Watanabe
    View author publications

    Search author on:PubMed Google Scholar

  16. Ken Ishii
    View author publications

    Search author on:PubMed Google Scholar

  17. Junichi Yamane
    View author publications

    Search author on:PubMed Google Scholar

Contributions

TO collected and interpreted the data, and wrote the initial draft of this manuscript. NN, KT, MO, and SS assisted in the preparation of the manuscript. TO designed the study, and TI, TT, YH, KK, KD, HF, OT, MM, MN, KW, KI, and JY critically reviewed the manuscript. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work to ensure that questions associated with the accuracy or integrity of any part of the work were appropriately evaluated and resolved.

Corresponding author

Correspondence to Narihito Nagoshi.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics and Institutional Review Board of Keio University School of Medicine (approval number: #20110142). Informed consent was obtained from all participants prior to undergoing surgery. We certify that all applicable governmental and institutional regulations concerning the ethical use of human volunteers were followed during the course of this study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okubo, T., Nagoshi, N., Iga, T. et al. Does the presence of preoperative neck pain impact clinical outcomes after posterior decompression in patients with cervical ossification of the posterior longitudinal ligament?: Retrospective multicenter cohort study. Spinal Cord 62, 619–624 (2024). https://doi.org/10.1038/s41393-024-01027-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41393-024-01027-z

Search

Advanced search

Quick links