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Article

Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study)

by
Takashi Hirai
1,*,
Toshitaka Yoshii
1,
Jun Hashimoto
1,
Shuta Ushio
1,
Kanji Mori
2,
Satoshi Maki
3,
Keiichi Katsumi
4,
Narihito Nagoshi
5,
Kazuhiro Takeuchi
6,
Takeo Furuya
3,
Kei Watanabe
4,
Norihiro Nishida
7,
Soraya Nishimura
5,
Kota Watanabe
5,
Takashi Kaito
8,
Satoshi Kato
9,
Katsuya Nagashima
10,
Masao Koda
10,
Hiroaki Nakashima
11,
Shiro Imagama
11,
Kazuma Murata
12,
Yuji Matsuoka
12,
Kanichiro Wada
13,
Atsushi Kimura
14,
Tetsuro Ohba
15,
Hiroyuki Katoh
16,
Masahiko Watanabe
16,
Yukihiro Matsuyama
17,
Hiroshi Ozawa
18,
Hirotaka Haro
15,
Katsushi Takeshita
14,
Morio Matsumoto
5,
Masaya Nakamura
5,
Satoru Egawa
1,
Yu Matsukura
1,
Hiroyuki Inose
1,
Atsushi Okawa
1,
Masashi Yamazaki
10 and
Yoshiharu Kawaguchi
19add Show full author list remove Hide full author list
1
Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo 113-8519, Japan
2
Department of Orthopaedic Surgery, Shiga University of Medical Science, Ōtsu 520-2192, Japan
3
Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
4
Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata 951-8520, Japan
5
Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
6
Department of Orthopedic Surgery, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan
7
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube 755-8505, Japan
8
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
9
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
10
Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
11
Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University, Nagoya 464-8601, Japan
12
Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku, Tokyo 160-8402, Japan
13
Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
14
Department of Orthopedics, Jichi Medical University, Shimotsuke 329-0498, Japan
15
Department of Orthopedic Surgery, University of Yamanashi, Chuo 409-3898, Japan
16
Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara 259-1193, Japan
17
Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu 431-3125, Japan
18
Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Japan
19
Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-8555, Japan
 
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Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(13), 3694; https://doi.org/10.3390/jcm11133694
Submission received: 29 April 2022 / Revised: 17 June 2022 / Accepted: 23 June 2022 / Published: 27 June 2022
(This article belongs to the Special Issue Ossification of the Posterior Longitudinal Ligament—Clinical Management)
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Abstract

Background: The purpose of this study was to clarify the clinical features of ossification of the posterior longitudinal ligament (OPLL) and extreme ossification at multiple sites. Methods: This prospective study involved patients with a diagnosis of cervical OPLL at 16 institutions in Japan. Patient-reported outcome measures, including responses on the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ), JOA Back Pain Evaluation Questionnaire (JOA-BPEQ), and visual analog scale pain score, were collected to investigate clinical status. In each patient, the sum of the levels at which OPLL was located (OP index) was evaluated on whole-spine computed tomography, along with ossification of other spinal ligaments including the anterior longitudinal ligament (OALL), ligament flavum (OLF), supra- and intraspinous ligaments (SSL), and diffuse idiopathic skeletal hyperostosis (DISH). The distribution of OP index values in the study population was investigated, and the clinical and radiologic characteristics of patients in the top 10% were assessed. Results: In total, 236 patients (163 male, 73 female; mean age 63.5 years) were enrolled. Twenty-five patients with OP index ≥ 17 were categorized into a high OP index group and the remainder into a moderate/low OP index group. There were significantly more women in the high OP index group. Patients in the high OP index group also had significantly poorer scores for lower extremity function and quality of life on the JOA-CMEQ and in each domain but not for body pain on the JOA-BPEQ compared with those in the moderate/low OP index group. Patients in the high OP index group had more OALL in the cervical spine and more OLF and SSL in the thoracic spine. The prevalence of DISH was also significantly higher in the high OP index group. In the high OP index group, interestingly, OPLL was likely to be present adjacent to DISH in the cervicothoracic and thoracolumbar spine, especially in men, and often coexisted with DISH in the thoracic spine in women. Conclusion: This prospective cohort registry study is the first to demonstrate the clinical and radiologic features of patients with OPLL and a high OP index. In this study, patients with a high OP index had poorer physical function in the lumbar spine and lower extremities and were also predisposed to extreme ossification of spinal ligaments other than the OPLL.
Keywords: ossification of posterior longitudinal ligament; prospective multi-institutional study; pain; patient-reported outcomes; OP index ossification of posterior longitudinal ligament; prospective multi-institutional study; pain; patient-reported outcomes; OP index

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MDPI and ACS Style

Hirai, T.; Yoshii, T.; Hashimoto, J.; Ushio, S.; Mori, K.; Maki, S.; Katsumi, K.; Nagoshi, N.; Takeuchi, K.; Furuya, T.; et al. Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study). J. Clin. Med. 2022, 11, 3694. https://doi.org/10.3390/jcm11133694

AMA Style

Hirai T, Yoshii T, Hashimoto J, Ushio S, Mori K, Maki S, Katsumi K, Nagoshi N, Takeuchi K, Furuya T, et al. Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study). Journal of Clinical Medicine. 2022; 11(13):3694. https://doi.org/10.3390/jcm11133694

Chicago/Turabian Style

Hirai, Takashi, Toshitaka Yoshii, Jun Hashimoto, Shuta Ushio, Kanji Mori, Satoshi Maki, Keiichi Katsumi, Narihito Nagoshi, Kazuhiro Takeuchi, Takeo Furuya, and et al. 2022. "Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study)" Journal of Clinical Medicine 11, no. 13: 3694. https://doi.org/10.3390/jcm11133694

APA Style

Hirai, T., Yoshii, T., Hashimoto, J., Ushio, S., Mori, K., Maki, S., Katsumi, K., Nagoshi, N., Takeuchi, K., Furuya, T., Watanabe, K., Nishida, N., Nishimura, S., Watanabe, K., Kaito, T., Kato, S., Nagashima, K., Koda, M., Nakashima, H., ... Kawaguchi, Y. (2022). Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study). Journal of Clinical Medicine, 11(13), 3694. https://doi.org/10.3390/jcm11133694

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