Characterizing the Management of Inpatients With Ossified Posterior Longitudinal Ligament (OPLL): A 10-year Tertiary Center UK Study.

Abstract

Study design: Retrospective cohort study.

Objective: To characterise patients admitted to a UK tertiary centre with OPLL over a 10-year period.

Summary of background data: OPLL is a progressive degenerative condition that can lead to myelopathy. Incidence of OPLL is increasing in Caucasian populations due to increased alcohol consumption, smoking, increased body mass, reduced exercise, and glucose intolerance. This questions the traditional belief that Ossification of the Posterior Longitudinal Ligament (OPLL) is primarily a disease of East and South-East Asians.

Methods: A retrospective review was performed for all OPLL cases admitted to one of the UK's largest spinal neurosurgery units between 2011 and 2021. Imaging, operation notes, clinic letters, and inpatient records were interrogated. The data for conservatively and surgically managed patients were collected. Demographics, surgical methods, complications, and recovery data are presented and analysed using univariate analysis.

Results: One hundred eighty-three patients were included, of whom 66% were male with a median age of 60 years. The majority of OPLL affected C2-5, with 2-level involvement being the most common. Eighty-six patients (47%) underwent surgical intervention, of which posterior decompression alone (35%) was the most common procedure. Fourteen (16.2%) patients developed complications, of which 4 were suspected reperfusion injuries, 6 with wound issues and 1 death. Eighty-seven percent of patients identified as White Caucasian. Importantly, data on smoking status were retrieved in only 18% of patients, precluding risk factor analysis for OPLL.

Conclusions: OPLL is a heterogeneous disease that is treated based on patient and disease-specific parameters in the inpatient population. High degrees of social deprivation in our catchment area may be more prominent risk factors than the known ethnic risk group factors. Dedicated research on risk factor identification and human tissue is needed to identify aetiology and novel therapeutic targets.