Flexional distance index: A new prognostic indicator of neurological outcomes at 4 years after cervical laminoplasty for K-line (+) ossification of the posterior longitudinal ligament,Clinical Neurology and Neurosurgery

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Flexional distance index: A new prognostic indicator of neurological outcomes at 4 years after cervical laminoplasty for K-line (+) ossification of the posterior longitudinal ligament
Clinical Neurology and Neurosurgery ( IF 1.8 ) Pub Date : 2021-08-21 , DOI: 10.1016/j.clineuro.2021.106896
Kazunari Takeuchi ₁ , Toru Yokoyama ₂ , Kanichiro Wada ₃ , Gentaro Kumagai ₃ , Hitoshi Kudo ₄ , Ryo Inoue ₂ , Toru Asari ₃ , Eiji Sasaki ₃ , Kaoru Yokomori ₂ , Takaaki Nakano ₂ , Yasuyuki Ishibashi ₃

Affiliation

Objective

We aimed to investigate whether K-line in the neck flexion (FK-line), flexion angle (FA), or flexion distance index (FDI) could predict the recovery rate of the Japanese Orthopedic Association score (RR-JOA) at 4 years after cervical laminoplasty (LP) for ossification of the posterior longitudinal ligament (OPLL).

Methods

A new index, i.e., the FDI, which is based on the degree of neck flexion and the OPLL size on a lateral radiograph. “Flexional distance” is the distance from C2 to C7 in neck flexion, and “distance to OPLL” is the maximal distance from the line of the flexional distance to OPLL. FDI was defined as follows: FDI = flexional distance/distance to OPLL. Twenty-three patients with K-line (+) OPLL were evaluated at 4 years after LP (follow-up rate, 92%). We investigated the relationships between preoperative radiological factors, including FK-line, FA, and FDI, and RR-JOA at 4 years postoperatively.

Results

Preoperative FK-line and FA were significantly related with the RR-JOA at 1 year postoperatively, but not at 4 years postoperatively. Preoperative FDI was significantly positively correlated with the RR-JOA at 1 year and 4 years postoperatively (P = 0.0132, r = 0.504 and P = 0.0183, r = 0.484, respectively). Preoperative FDI < 2.5 was associated with worsening of the RR-JOA at 4 years postoperatively, with a probability of 80%

Discussions

FDI could predict the RR-JOA at 4 years after LP for OPLL. Decompression with fusion may be recommended for patients with preoperative FDI < 2.5.

Level of evidence

中文翻译：

屈曲距离指数：后纵韧带 K 线 (+) 骨化颈椎板成形术后 4 年神经学结果的新预后指标

客观的

我们旨在调查颈部屈曲 K 线 (FK-line)、屈曲角度 (FA) 或屈曲距离指数 (FDI) 是否可以预测日本骨科协会评分 (RR-JOA) 在 4 年时的恢复率颈椎板成形术 (LP) 后纵韧带 (OPLL) 骨化。

方法

一个新的指标，即 FDI，它基于颈部屈曲程度和侧位片上的 OPLL 大小。“屈曲距离”是颈部屈曲时从C2到C7的距离，“到OPLL的距离”是从屈曲距离线到OPLL的最大距离。FDI 定义如下：FDI = 屈曲距离/到 OPLL 的距离。23 名 K 线 (+) OPLL 患者在 LP 后 4 年接受了评估（随访率为 92%）。我们调查了术前放射学因素（包括 FK 线、FA 和 FDI）与术后 4 年的 RR-JOA 之间的关系。

结果

术前 FK 线和 FA 与术后 1 年的 RR-JOA 显着相关，但在术后 4 年则不相关。术前 FDI 与术后 1 年和 4 年的 RR-JOA 显着正相关（分别为P = 0.0132，r = 0.504 和P = 0.0183， r = 0.484）。术前 FDI < 2.5 与术后 4 年 RR-JOA 恶化相关，概率为 80%