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National Trends and Complications in the Surgical Management of Ossification of the Posterior Longitudinal Ligament (OPLL).

TitleNational Trends and Complications in the Surgical Management of Ossification of the Posterior Longitudinal Ligament (OPLL).
Publication TypeJournal Article
Year of Publication2019
AuthorsBernstein DN, Prong M, Kurucan E, Jain A, Menga EN, K Riew D, Mesfin A
JournalSpine (Phila Pa 1976)
Volume44
Issue22
Pagination1550-1557
Date Published2019 Nov 15
ISSN1528-1159
KeywordsDecompression, Surgical, Humans, Ossification of Posterior Longitudinal Ligament, Postoperative Complications, Retrospective Studies, Spinal Fusion, United States
Abstract

STUDY DESIGN: A retrospective database analysis.

OBJECTIVE: The aim of this study was to analyze US trends in surgical approaches for ossification of the posterior longitudinal ligament (OPLL); and to compare US patient and hospital characteristics, length of stay, total charges, and 30-day complications by surgical approach in OPLL management.

SUMMARY OF BACKGROUND DATA: A robust literature on surgical management of OPLL in East Asian countries, where OPLL has a higher prevalence, exists. However, there is a paucity of literature evaluating the surgical management of OPLL in non-Asian countries.

METHODS: Using the Nationwide Inpatient Sample (NIS), we identified surgically treated OPLL patients from 2003 to 2014. Data on patient characteristics, surgical approaches, complications, hospital characteristics, length of stay, and hospital charges were extracted and analyzed. Analysis of variance (ANOVA) and Chi-squared tests were used to assess variation across categorical variables. Linear regression was used to evaluate the trend of surgical management for OPLL over the study timeframe.

RESULTS: Five thousand two hundred twelve patients fit our inclusion criteria. The overall complication rate was 21.5%, but the highest complication rate was for patients undergoing a combined anterior-posterior decompression/fusion (44.7%). Patients undergoing a combined anterior-posterior decompression/fusion had a longer length of stay and higher total charges (P < 0.01). Overall, surgical OPLL cases significantly increased from 2003 to 2014 (336-920; P < 0.01).

CONCLUSION: To our knowledge, this is the largest study examining the surgical treatment of OPLL in a non-Asian country. OPLL surgical cases increased over the study timeframe and the overall surgical complication rate was 21.5%. The percentage of Asians or Pacific Islanders with OPLL undergoing surgical intervention was 10.8%, which is higher than the prevalence in the US population (4.9%). This suggests a potential genetic component to OPLL. Future work is warranted to determine how best to decrease the high complication rate.

LEVEL OF EVIDENCE: 4.

DOI10.1097/BRS.0000000000003127
Alternate JournalSpine (Phila Pa 1976)
PubMed ID31232979