6. Predictive factors for bladder function recovery following OPLL surgery: a comprehensive analysis

Abstract

BACKGROUND CONTEXT

Neurogenic bladder dysfunction poses a significant challenge in patients with ossification of posterior longitudinal ligaments (OPLL), affecting both bladder storage and voiding function. Predicting postsurgery bladder function outcomes in OPLL patients is essential for counselling, rehabilitation planning, and discharge. However, no valid prediction rule is currently available for bladder outcomes.

PURPOSE

This study aims to discover the independent factors for predicting the recovery of bowel function one year after surgery for OPLL patients.

STUDY DESIGN/SETTING

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PATIENT SAMPLE

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OUTCOME MEASURES

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METHODS

A total of 477 patients treated surgically for OPLL at various departments between 2014 and 2018 were reviewed. The treatment modalities included anterior and posterior surgical approaches and combined both, involving procedures such as corpectomy, discectomy, laminoplasty, laminectomy, and fusion. Exclusion criteria for the study were: (i) patients with a preoperative JOA score of 3 points in bladder function and (ii) patients with less than one year of follow-up after surgery. Among the remaining 192 patients analyzed, consisting of 145 men and 47 women with a mean age of 68 (standard deviation [SD]: 11.0), 2 groups were formed: the improved group (n=125) with a postoperative JOA score increase of 3 points in bladder function, and the unimproved group (n=67) with a postoperative JOA score under 2 points. JOA score consists of 6 domains: motor function in the upper extremities (MU), motor function in the lower extremities (ML), sensory function in the upper extremities (SU), sensory function in the trunk (ST), sensory function in the lower extremities (SL), and bladder function, with a minimum total score of 0 and maximum of 17. Univariable and multivariable analyses were executed using the Cox proportional hazards regression model. This study investigates factors at the initial visit, including age, sex, BMI, comorbidities, preoperative JOA score, OPLL occupation ratio, and K-line.

RESULTS

The improved group comprised 94 men and 31 women, with a mean age of 65 (standard deviation: 10.8) years. The unimproved group included 51 men and 16 women, with a mean age of 70 (standard deviation [SD]: 10.4) years. Among the improved group, 106 patients (84%) had comorbidities, and 42 patients (34%) had diabetes. The mean OPLL occupation ratio was 44.7 (SD: 16), and the mean preoperative JOA MU score was 2.41 (SD: 0.81), ML 2.05 (SD: 0.4), SU 1 (SD: 0.92), ST 1.66 (SD: 0.53), SL 1.34 (SD: 0.58), and total score of 9.98 (SD: 2.27). In the unimproved group, 56 patients (83%) had comorbidities and 23 patients (34%) had diabetes. The mean OPLL occupation ratio was 45.7 (15.7), and the mean preoperative JOA MU score was 1.93 (SD: 1.13), ML 1.3 (SD: 0.92), SU 0.88 (SD: 0.48), ST 1.35 (SD: 0.70), SL 1.12 (SD: 0.59), and total score of 7.65 (SD: 3.24). In the multivariable analyses, it was found that age (P = 0.003), preoperative JOA ML (P < 0.001), and preoperative JOA ST significantly influenced postoperative bladder function recovery. Using the receiver operating characteristic curve, a preoperative JOA ML cut-off value of 1.5 points (P < 0.001) was identified as a threshold for full bladder function recovery. The sensitivity was 0.582, and the specificity was 0.776. Conversely, a preoperative JOA SL cut-off value of 1.5 points (P < 0.001) was determined to achieve full bladder function recovery. The sensitivity was 0.478, and the specificity was 0.736.

CONCLUSIONS

Utilizing the receiver operating characteristic curve, a preoperative JOA ML and SL cut-off value of 1.5 points (P < 0.001) were determined for achieving full recovery of bladder function.

Age, preoperative JOA ML, and preoperative JOA ST are identified as relevant factors for predicting postoperative bladder function. These findings offer valuable insights for clinicians in optimizing patient care and enhancing prognostic precision in managing OPLL patients with neurogenic bladder dysfunction.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.