K-Line Tilt is a Predictor of Postoperative Kyphotic Deformity After Laminoplasty for Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament

Study Design: Retrospective single-center study. Objectives: K-line is a decision-making tool to determine the appropriate surgical procedures for patients with cervical ossification of the posterior longitudinal ligament (C-OPLL). Laminoplasty (LAMP) is one of the standard surgical procedures indicated on the basis of K-line measurements (+: OPLL does not cross the K-line). We investigated the impact of K-line tilt, a radiographic parameter of cervical sagittal balance measured using the K-line, on surgical outcomes after LAMP. Methods: The study included 62 consecutive patients with K-line (+) C-OPLL who underwent LAMP. The following preoperative and postoperative radiographic measurements were evaluated: (1) the K-line, (2) K-line tilt (an angle between the K-line and vertical line), (3) center of gravity of the head –C7 sagittal vertical axis, (4) C2–C7 lordotic angle, (5) C7 slope, and (6) C2–C7 range of motion. Clinical results were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score). Results: All the patients had non-kyphotic cervical alignment (CL ≥ 0°) preoperatively; however, kyphotic deformity (CL < 0°) was observed in 6 patients (9.7%) postoperatively. The recovery rate of the C-JOA scores was poor in the kyphotic deformity (+) group (7.8%) than in the kyphotic deformity (−) group (47.5%). The K-line tilt was identified to be a preoperative risk factor in the multivariate analysis, and the cutoff K-line tilt for predicting the postoperative kyphotic deformity was 20°. Conclusions: LAMP is not suitable for K-line (+) C-OPLL patients with K-line tilts >20°.

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A novel technique to correct kyphosis in cervical myelopathy due to continuous-type ossification of the posterior longitudinal ligament

Journal of Neurosurgery Spine ◽

10.3171/2016.8.spine16542 ◽

2017 ◽

Vol 26 (3) ◽

pp. 325-330 ◽

Cited By ~ 11

Author(s):

Dong-Ho Lee ◽

Youn-Suk Joo ◽

Chang Ju Hwang ◽

Choon Sung Lee ◽

Jae Hwan Cho

Keyword(s):

Cervical Myelopathy ◽

Sagittal Alignment ◽

Present Report ◽

Posterior Instrumentation ◽

Posterior Longitudinal Ligament ◽

Kyphotic Deformity ◽

Cervical Lordosis ◽

Anterior Surgery ◽

Continuous Type ◽

Greenstick Fracture

OBJECTIVE Although posterior decompressive surgery is widely used to treat patients with cervical myelopathy and multilevel ossification of the posterior longitudinal ligament (OPLL), a poor outcome is anticipated if the sagittal alignment is kyphotic (or K-line negative). Accordingly, it is mandatory to perform anterior decompression and fusion in patients with cervical kyphosis. However, it can be difficult to perform anterior surgery because of the high risk of complications. This present report proposes a novel “greenstick fracture technique” to change the K-line from negative to positive in patients with cervical myelopathy, OPLL, and kyphotic deformity. METHODS Four patients with cervical myelopathy, continuous-type OPLL, and kyphotic sagittal alignment (who were K-line negative) were indicated for surgery. Posterior laminectomy and lateral mass screw insertions using a posterior approach were performed, followed by anterior surgery. Multilevel discectomy and thinning of the OPLL mass by bur drilling was performed, then an intentional greenstick fracture at each disc level was made to convert the cervical K-line from negative to positive. Finally, posterior instrumentation using a rod was carried out to maintain cervical lordosis. RESULTS MRI showed complete decompression of the cord by posterior migration in all cases, which had been caused by cervical lordosis. Restoration of neurological defects was confirmed at the 1-year follow-up assessment. No specific complications were identified that were associated with this technique. CONCLUSIONS A greenstick fracture technique may be effective and safe when applied to patients with cervical myelopathy, continuous-type OPLL, and kyphotic deformity (K-line negative). However, further studies with more cases will be required to reveal its generalizability and safety.

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Association between diffuse idiopathic skeletal hyperostosis and thoracic kyphosis in patients with cervical myelopathy: a retrospective observational study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04851-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Motoyoshi Takayuki ◽

Hirai Takashi ◽

Yoshii Toshitaka ◽

Inose Hiroyuki ◽

Matsukura Yu ◽

...

Keyword(s):

Thoracic Spine ◽

Cervical Myelopathy ◽

Thoracic Kyphosis ◽

Sagittal Alignment ◽

Diffuse Idiopathic Skeletal Hyperostosis ◽

Vertical Axis ◽

Structural Abnormality ◽

Sagittal Vertical Axis ◽

C7 Slope ◽

Whole Spine

Abstract Background Diffuse idiopathic skeletal hyperostosis (DISH) is a structural abnormality of the thoracic spine that is known to impair posture. However, the relationship between DISH and sagittal balance in the whole spine is unclear. The aims of this study were to investigate the prevalence of DISH in patients with cervical myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) or cervical spondylosis and to compare sagittal alignment of the spine between patients with and without DISH. Methods A total of 103 consecutive patients with a diagnosis of cervical myelopathy due to cervical OPLL or spondylosis were retrospectively enrolled in this single-center study. DISH was defined as an ossified lesion that was seen to be completely bridging at least four contiguous adjacent vertebral bodies in the thoracic spine on computed tomography scans. Cervical and spinopelvic sagittal parameters were measured in whole spine radiographs. Results The study population included 28 cases with DISH [DISH (+) group] and 75 without DISH [DISH (−) group]. OPLL was more prevalent in the DISH (+) group than in the DISH (−) group; however, there were no significant differences in other clinical findings. Propensity score matching produced 26 pairs. C7 slope, C2-7 sagittal vertical axis (C-SVA), whole thoracic kyphotic angles, upper thoracic kyphosis, and T5-T12 thoracic kyphosis values were significant higher in the DISH (+) group than in the DISH (−) group. There was no significant between-group difference in the other sagittal spinopelvic parameters. Conclusions This study is the first to compare sagittal alignment in patients with cervical myelopathy according to whether or not they have DISH. Patients with DISH are more likely to have excessive kyphosis in the thoracic spine, a high C7 slope, and a high C2-7 SVA.

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Clinical outcomes of laminoplasty for patients with lysosomal storage disease including mucopolysaccharidosis and mucolipidoses: a retrospective cohort study

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-02031-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hidetomi Terai ◽

Koji Tamai ◽

Masatoshi Hoshino ◽

Hiromitsu Toyoda ◽

Akinobu Suzuki ◽

...

Keyword(s):

Cervical Myelopathy ◽

Posterior Longitudinal Ligament ◽

Atlantoaxial Instability ◽

Symptom Improvement ◽

Posterior Arch ◽

Type I ◽

Lysosomal Storage ◽

Japanese Orthopedic Association ◽

The Mean

Abstract Background Although the clinical efficacy of laminoplasty in adult cervical spondylotic myelopathy or ossification of posterior longitudinal ligament has been frequently reported, there are only few reports of laminoplasty for patients with lysosome storage diseases (LSDs). Therefore, this study aimed to report the midterm clinical and radiological outcomes of patients with LSDs after cervical laminoplasty. Methods Six patients with LSD who underwent laminoplasty with/without C1 laminectomy for cervical myelopathy were enrolled. Clinical evaluations, including the cervical Japanese Orthopedic Association (cJOA) score and visual analog scale (VAS) scores for upper extremity numbness, and radiographic parameters, including C2–C7 lordotic angle, atlanto-dens interval (ADI), and ⊿ADI, were evaluated preoperatively, at 2 years postoperatively, and at the final follow-up. Results Five patients had mucopolysaccharidoses (type I: n = 1, II: n = 3, VII: n = 1) and one patient had mucolipidoses type III. The mean age of patients at surgery was 27.5 years, and the mean postoperative follow-up period was 61 months. All mucopolysaccharidoses cases required C1 posterior arch resection with C2–C7 laminoplasty. No critical complications were observed postoperatively. There were no significant differences in C2–C7 angle (p = 0.724) and ⊿ADI (p = 0.592) between the preoperative and final follow-ups. The cJOA score and VAS for numbness significantly improved at the final follow-up (p = 0.004 and p = 0.007, respectively). Conclusions The cervical myelopathy in patients with LSD could be safely and effectively treated with laminoplasty with/without C1 posterior arch resection after excluding patients with atlantoaxial instability. Atlantoaxial stability and symptom improvement could be maintained at an average of 5 years postoperatively.

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Clinical Outcomes of Laminoplasty for Patients With Lysosomal Storage Disease Including Mucopolysaccharidosis and Mucolipidoses: a Retrospective Cohort Study

10.21203/rs.3.rs-651514/v1 ◽

2021 ◽

Author(s):

Hidetomi Terai ◽

Koji Tamai ◽

Masatoshi Hoshino ◽

Hiromitsu Toyoda ◽

Akinobu Suzuki ◽

...

Keyword(s):

Cervical Myelopathy ◽

Posterior Longitudinal Ligament ◽

Atlantoaxial Instability ◽

Symptom Improvement ◽

Posterior Arch ◽

Type I ◽

Lysosomal Storage ◽

Japanese Orthopedic Association ◽

Atlantoaxial Stability

Abstract Background:Although the clinical efficacy of laminoplasty in adult cervical spondylotic myelopathy or ossification of posterior longitudinal ligament has been frequently reported, there are only a few reports of laminoplasty for patients with lysosome storage diseases (LSDs). Thus, this study aimed to report the midterm clinical and radiological outcomes of patients with LSDs after cervical laminoplasty.Methods: Six LSD patients who underwent laminoplasty with/without C1 laminectomy for cervical myelopathy were enrolled. Clinical evaluations, including the cervical Japanese Orthopedic Association (cJOA) score and visual analog scale (VAS) for upper extremity numbness and radiographic parameters, including C2-7 lordotic angle, atlanto-dens interval (ADI), and ⊿ADI, were evaluated preoperatively, at 2 years postoperatively, and at the final follow-up. Results: Five patients had mucopolysaccharidoses (type I: n=1, II: n=3, VII: n=1) and one patient had mucolipidoses type III. Mean age at surgery was 27.5 years. Mean postoperative follow-up period was 61 months. All mucopolysaccharidoses cases required C1 posterior arch resection with C2-C7 laminoplasty. No critical complications were observed postoperatively. There were no significant differences between preoperative and final follow-up in C2-7 angle (p=0.724) and ⊿ADI (p=0.592). The cJOA score and VAS for numbness significantly improved at the final follow-up (p=0.004 and p=0.007, respectively).Conclusion: The cervical myelopathy of LSD patients could be safely and effectively treated with laminoplasty with/without C1 posterior arch resection after eliminating patients with atlantoaxial instability. The atlantoaxial stability and symptom improvement could be maintained at an average of 5 years postoperatively.

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Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

10.21203/rs.3.rs-41622/v1 ◽

2020 ◽

Author(s):

Hiroyuki Inose ◽

Takashi Hirai ◽

Toshitaka Yoshii ◽

Atsushi Kimura ◽

Katsushi Takeshita ◽

...

Keyword(s):

Cervical Myelopathy ◽

Recovery Rate ◽

Neck Disability Index ◽

Multiple Linear Regression Model ◽

Vertical Axis ◽

Neurological Recovery ◽

Anterior Decompression ◽

Sagittal Vertical Axis ◽

Japanese Orthopedic Association ◽

Degenerative Cervical Myelopathy

Abstract Background Anterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. However, it is difficult to preoperatively predict the extent to which patients will experience postoperative neurological improvement. We aimed to identify predictors associated with neurological recovery after ADF in a retrospective study of prospectively collected data. Methods We prospectively enrolled patients who were scheduled for ADF for DCM. The associations of baseline variables with recovery rate were investigated using a multiple linear regression model. Results In total, 36 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy, European Quality of Life Five Dimensions Scale, Neck Disability Index, and Physical Component Summary of the SF-36 (PCS) scores improved postoperatively. The recovery rate was significantly correlated with the sagittal vertical axis (SVA) and T1 pelvic angle. Univariate regression analyses showed that the SVA and PCS score were significantly associated with recovery rate. Lastly, multiple regression analysis identified the independent predictors of recovery rate after ADF as thoracic kyphosis (TK), PCS, and SVA. According to this prediction model, the following equation was obtained: recovery rate = − 8.26 + 1.17 × (TK) – 0.45 × (SVA) + 0.85 × (PCS). Conclusion Patients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, DCM patients with these predictors who undergo ADF might be cautioned about poor recovery and be required to provide adequate informed consent.

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Quantitative Assessment of Gait Characteristics in Degenerative Cervical Myelopathy: A Prospective Clinical Study

Journal of Clinical Medicine ◽

10.3390/jcm9030752 ◽

2020 ◽

Vol 9 (3) ◽

pp. 752 ◽

Cited By ~ 1

Author(s):

Sukhvinder Kalsi-Ryan ◽

Anna C. Rienmueller ◽

Lauren Riehm ◽

Colin Chan ◽

Daniel Jin ◽

...

Keyword(s):

Cervical Myelopathy ◽

Rank Correlation ◽

Neurological Status ◽

Therapeutic Interventions ◽

Prospective Clinical Study ◽

Early Presentation ◽

Japanese Orthopedic Association ◽

Gait Parameters ◽

Degenerative Cervical Myelopathy ◽

The Impact

It is challenging to discriminate the early presentation of Degenerative Cervical Myelopathy (DCM) as well as sensitively and accurately distinguishing between mild, moderate, and severe levels of impairment. As gait dysfunction is one of the cardinal symptoms of DCM, we hypothesized that spatiotemporal gait parameters, including the enhanced gait variability index (eGVI), could be used to sensitively discriminate between different severities of DCM. A total of 153 patients recently diagnosed with DCM were recruited and stratified on the basis of DCM severity grades, as measured using the modified Japanese Orthopedic Association (mJOA) scale. Demographic information and neurological status were collected. Gait assessments were performed using an 8 m walkway. Spearman rank correlation was used to identify relationships between gait parameters and mJOA values as well as the mJOA lower extremity (LE) subscore. Kruskal–Wallis H test was performed to evaluate differences between severity groups, as defined by mJOA classification. A significant and relatively strong correlation was found between the mJOA score and eGVI, as well as between the LE subscore of the mJOA and eGVI. Significant differences in the eGVI (X2(2, N = 153) = 55.04, p < 0.0001, ε2 = 0.36) were found between all groups of DCM severity, with a significant increase in the eGVI as DCM progressed from mild to moderate. The eGVI was the most discriminative gait parameter, which facilitated objective differentiation between varying severities of DCM. Quantitative gait assessments show promise as an accurate and objective tool to diagnose and classify DCM, as well as to potentially evaluate the impact of therapeutic interventions.

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The impact of dynamic factors on surgical outcomes after double-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine

Journal of Neurosurgery Spine ◽

10.3171/2014.8.spine131197 ◽

2014 ◽

Vol 21 (6) ◽

pp. 938-943 ◽

Cited By ~ 25

Author(s):

Keishi Maruo ◽

Tokuhide Moriyama ◽

Toshiya Tachibana ◽

Shinichi Inoue ◽

Fumihiro Arizumi ◽

...

Keyword(s):

Cervical Spine ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Cervical Myelopathy ◽

Recovery Rate ◽

Posterior Longitudinal Ligament ◽

Dynamic Factors ◽

The Mean ◽

The Impact

Object Laminoplasty is the preferred operation for most patients with cervical myelopathy due to multilevel ossification of the posterior longitudinal ligament (OPLL). Recent studies have demonstrated several significant risk factors for poor clinical outcomes after laminoplasty, including older age, lower preoperative Japanese Orthopaedic Association (JOA) score, postoperative change in cervical alignment, cervical kyphosis, and high occupying ratio of the OPLL (that is, the ratio of the greatest anteroposterior thickness of the OPLL to the anteroposterior diameter of the spinal canal at the same level on a lateral image). However, the impact of dynamic factors on clinical outcomes is unclear. The purpose of this study is to assess the impact of dynamic factors on the clinical outcome after laminoplasty for cervical myelopathy due to OPLL. Methods A consecutive series of patients who underwent laminoplasty for cervical myelopathy due to OPLL between 2003 and 2009 was retrospectively reviewed. The indication for laminoplasty at the authors' hospital included preoperative straight or lordotic alignment of the cervical spine and an occupying ratio of OPLL less than 60%. The JOA score and recovery rate were used to evaluate clinical outcomes. A poor clinical outcome was defined as a recovery rate of less than 50%. Patient factors examined along with outcome included age, preoperative JOA score, preoperative somatosensory evoked potentials, preoperative motor evoked potentials, body mass index, and presence of high intensity on MRI. Radiographic measures included the preoperative C2–7 lordotic angle, preoperative C2–7 range of motion (ROM), preoperative segmental ROM at the level of myelopathy, and the occupying ratio of OPLL. Results There were 45 patients (33 males and 12 females). The mean follow-up period was 4 years (range 2–6.8 years). The mean patient age was 66.9 years (range 50–85 years). The mean JOA score significantly increased from 9.1 before surgery to 13.1 at the final follow-up. The mean recovery rate was 51.2%. Nineteen patients (42%) had a recovery rate of less than 50%. Patient factors were not associated with surgical outcomes. Only the preoperative C2–7 ROM was significantly greater in the poor surgical outcome group (23.1° vs 14.1°). Receiver operating characteristic curve analysis showed that the optimal preoperative C2–7 ROM cutoff was 20°. Logistic regression analysis revealed that patients with a preoperative C2–7 ROM of greater than 20° had a 4.6 times higher risk (p = 0.021) of a poor clinical outcome, indicating that dynamic factors may have an impact on the surgical outcome of laminoplasty. Conclusions Fusion surgery may be a useful strategy in patients with preoperative hypermobility of the cervical spine.

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Differences in radiological and functional outcomes between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament after multi-level laminoplasty

10.21203/rs.3.rs-24947/v1 ◽

2020 ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Sagittal Balance ◽

Recovery Rate ◽

Cervical Spondylotic Myelopathy ◽

Functional Outcomes ◽

Vertical Axis ◽

Posterior Longitudinal Ligament ◽

Sagittal Vertical Axis ◽

Japanese Orthopedic Association ◽

Significant Difference ◽

Multi Level

Abstract Objective The purpose of this study was to compare the radiological and functional outcomes between patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) after multi-level laminoplasty. Methods This study included 75 patients (32 with CSM and 43 with OPLL) with preserved cervical sagittal balance who underwent multi-level laminoplasty for cervical myelopathy. The radiological outcomes were analyzed using the following parameters: C2–C7 Cobb angle in neutral (C27AN), flexed (C27AF), and extended (C27AE) neck postures; C2–C7 range of motion (C27ROM); T1 slope (T1S); and C2–C7 sagittal vertical axis (C27SVA). The functional outcomes were analyzed using the modified Japanese Orthopedic Association (mJOA) score, Nurick grade, and recovery rate. The radiological and functional outcomes between the two groups were evaluated 12-months postoperatively. Results C27AF, C27ROM, and C27SVA in the CSM group and C27ROM in the OPLL group decreased significantly (p < 0.05). There was a significant difference in ΔC27SVA between the two groups (9.41 ± 17.06 mm vs. 1.10 ± 17.15 mm, p < 0.05). However, there were no significant intra- or intergroup changes and differences in C27AN (p > 0.05). The functional outcomes including mJOA score (p = 0.251), Nurick grade (p = 0.316), and recovery rate (p = 0.435) showed no significant intergroup differences. Conclusions Although there were no significant differences in functional outcomes between the two groups, the CSM group showed a greater deterioration in sagittal balance with an increase of C27SVA than the OPLL group after multi-level laminoplasty.

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Administrative Coding Methods Impact Surgical Site Infection Rates

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.616 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s111-s112

Author(s):

Mohammed Alsuhaibani ◽

Mohammed Alzunitan ◽

Kyle Jenn ◽

Daniel Diekema ◽

Michael Edmond ◽

...

Keyword(s):

Cesarean Section ◽

Surgical Procedures ◽

Hip Prosthesis ◽

Knee Prosthesis ◽

Surgical Site Infections ◽

Fold Increase ◽

Abdominal Hysterectomy ◽

Absolute Difference ◽

Coding Method ◽

The Impact

Background: Surveillance for surgical site infections (SSI) is recommended by the CDC. Currently, colon and abdominal hysterectomy SSI rates are publicly available and impact hospital reimbursement. However, the CDC NHSN allows surgical procedures to be abstracted based on International Classification of Diseases, Tenth Revision (ICD-10) or current procedural terminology (CPT) codes. We assessed the impact of using ICD and/or CPT codes on the number of cases abstracted and SSI rates. Methods: We retrieved administrative codes (ICD and/or CPT) for procedures performed at the University of Iowa Hospitals & Clinics over 1 year: October 2018–September 2019. We included 10 procedure types: colon, hysterectomy, cesarean section, breast, cardiac, craniotomy, spinal fusion, laminectomy, hip prosthesis, and knee prosthesis surgeries. We then calculated the number of procedures that would be abstracted if we used different permutations in administration codes: (1) ICD codes only, (2) CPT codes only, (3) both ICD and CPT codes, and (4) at least 1 code from either ICD or CPT. We then calculated the impact on SSI rates based on any of the 4 coding permutations. Results: In total, 9,583 surgical procedures and 180 SSIs were detected during the study period using the fourth method (ICD or CPT codes). Denominators varied according to procedure type and coding method used. The number of procedures abstracted for breast surgery had a >10-fold difference if reported based on ICD only versus ICD or CPT codes (104 vs 1,109). Hip prosthesis had the lowest variation (638 vs 767). For SSI rates, cesarean section showed almost a 3-fold increment (2.6% when using ICD only to 7.32% with both ICD & CPT), whereas abdominal hysterectomy showed nearly a 2-fold increase (1.14% when using CPT only to 2.22% with both ICD & CPT codes). However, SSI rates remained fairly similar for craniotomy (0.14% absolute difference), hip prosthesis (0.24% absolute difference), and colon (0.09% absolute difference) despite differences in the number of abstracted procedures and coding methods. Conclusions: Denominators and SSI rates vary depending on the coding method used. Variations in the number of procedures abstracted and their subsequent impact on SSI rates were not predictable. Variations in coding methods used by hospitals could impact interhospital comparisons and benchmarking, potentially leading to disparities in public reporting and hospital penalties.Funding: NoneDisclosures: None

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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 Journal ◽

10.1177/2192568221996300 ◽

2021 ◽

pp. 219256822199630

Author(s):

Narihito Nagoshi ◽

Kota Watanabe ◽

Masaya Nakamura ◽

Morio Matsumoto ◽

Nan Li ◽

...

Keyword(s):

Multicenter Study ◽

Surgical Outcomes ◽

Hemoglobin A1c ◽

Perioperative Complications ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Asia Pacific ◽

C5 Palsy ◽

Significant Difference ◽

The Impact

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.

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