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  • Ovid Technologies (Wolters Kluwer Health)  (51)
  • 1
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    MP73-12 VERTICAL INVASION IS IMPORTANT PREDICTOR FOR PT1 BLADDER CANCER PROGRESSION-EFFICACY OF EN-BLOC TUR SPECIMEN-
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Urology Vol. 203, No. Supplement 4 ( 2020-04)
    Details
    In: Journal of Urology, Ovid Technologies (Wolters Kluwer Health), Vol. 203, No. Supplement 4 ( 2020-04)
    Type of Medium: Online Resource
    ISSN: 0022-5347 , 1527-3792
    URL: Article
    DOI: 10.1097/JU.0000000000000959.012
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 2
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    Comparison of Surgical Outcomes of Anterior and Posterior Fusion Surgeries for K-line (−) Cervical Ossification of the Posterior Longitudinal Ligament : A Prospective Multicenter Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Spine Vol. 48, No. 13 ( 2023-07-1), p. 937-943
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 13 ( 2023-07-1), p. 937-943
    Abstract: A prospective multicenter study. Objective. The objective of this study is to compare the surgical outcomes of anterior and posterior fusion surgeries in patients with K-line (−) cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data. Although laminoplasty is effective for patients with K-line (+) OPLL, fusion surgery is recommended for those with K-line (−) OPLL. However, whether the anterior or posterior approach is preferable for this pathology has not been effectively determined. Materials and Methods. A total of 478 patients with myelopathy due to cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for two years. Of the 478 patients, 45 and 46 with K-line (−) underwent anterior and posterior fusion surgeries, respectively. After adjusting for confounders in baseline characteristics using a propensity score-matched analysis, 54 patients in both the anterior and posterior groups (27 patients each) were evaluated. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Results. Both approaches showed comparable neurological and functional recovery. The cervical range of motion was significantly restricted in the posterior group because of the large number of fused vertebrae compared with the anterior group. The incidence of surgical complications was comparable between the cohorts, but the posterior group demonstrated a higher frequency of segmental motor paralysis, whereas the anterior group more frequently reported postoperative dysphagia. Conclusions. Clinical improvement was comparable between anterior and posterior fusion surgeries for patients with K-line (−) OPLL. The ideal surgical approach should be informed based on the balance between the surgeon’s technical preference and the risk of complications.
    Type of Medium: Online Resource
    ISSN: 0362-2436
    URL: Article
    DOI: 10.1097/BRS.0000000000004634
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2002195-1
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  • 3
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    Clinical Indicators of Surgical Outcomes After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Spine Vol. 47, No. 15 ( 2022-08-1), p. 1077-1083
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 15 ( 2022-08-1), p. 1077-1083
    Abstract: A prospective multicenter study. Objective. This study aims to evaluate patient-reported outcomes using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and clarify clinical factors that affect the therapeutic effects for patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data. Although previous studies identified factors that affected the surgical outcomes, their assessment was mainly based on the Japanese Orthopedic Association score, which only includes neurological function. Investigating this pathology through multiple functions and quality of life (QOL) is pivotal to understanding the comprehensive clinical pictures of the cervical OPLL and its therapeutic outcomes. Materials and Methods. This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of the patients, 168 received laminoplasties and fully completed questionnaires. Demographic information, imaging findings, and clinical outcomes were collected. Patients were grouped according to effective or ineffective surgical outcomes as defined by the JOACMEQ using logistic regression analyses. Results. Laminoplasty resulted in functional improvement in the cervical spine and upper extremity around 40% of the patients, while QOL showed only 21.4% ( P 〈 0.01). Multivariable analyses revealed that younger age and a postoperative decrease in arm or hand pain were correlated with significantly improved function of the upper extremities. A reduction in lower limb pain favorably affected the postoperative lower extremity function. A postoperative reduction in upper extremity pain enhanced the QOL recovery. Conclusions. Surgeons should recognize the diversity of surgical outcomes after laminoplasty and understand the necessity of pain management even after the surgery to enhance bodily functions and QOL in patients with cervical OPLL.
    Type of Medium: Online Resource
    ISSN: 0362-2436
    URL: Article
    DOI: 10.1097/BRS.0000000000004359
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 4
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    Severity of Myelopathy is Closely Associated With Advanced Age and Signal Intensity Change in Cervical Ossification of the Posterior Longitudinal Ligament : A Prospective Nationwide Investigation
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Clinical Spine Surgery: A Spine Publication Vol. 35, No. 1 ( 2022-02), p. E155-E161
    Details
    In: Clinical Spine Surgery: A Spine Publication, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 1 ( 2022-02), p. E155-E161
    Abstract: Prospective, nationwide case series. Objective: To identify preoperative factors associated with myelopathy and neurological impairment in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data: Various studies have reported clinical outcomes following the surgical treatment of OPLL. However, there has been no large-scale study of preoperative clinical features in patients with cervical OPLL. Materials and Methods: Data were prospectively collected from 28 institutions nationwide in Japan. In total, 512 patients with neurological impairment caused by cervical OPLL requiring surgery were enrolled. Basic demographic and clinical data, including age, sex, diabetes status, body mass index, smoking history, and disease duration were collected. C2–7 lordotic angle, canal narrowing ratio, range of motion in flexion-extension at C2–7, and type of OPLL were evaluated on lateral radiographs to identify factors influencing the clinical features of patients with OPLL in whom surgery was planned. Results: Complete documentation was available for 490 patients (362 male, 128 female). In total, 34 patients had the localized type, 181 had the segmental type, 64 had the continuous type, and 211 had the mixed type. Although there were no significant differences in age, body mass index, disease duration, Japanese Orthopedic Association (JOA) score, and lordotic angle at C2–7 according to the type of OPLL, significant differences were observed in a range of motion at C2–7 and the canal narrowing ratio among the 4 types. Multiple regression analysis revealed that the JOA score was significantly associated with age and signal intensity change on magnetic resonance imaging. Conclusions: This is the first large-scale, prospective, multicenter case series study to investigate factors influencing preoperative neurological status in patients with OPLL. Age and signal intensity change on magnetic resonance images were significantly associated with JOA score in patients requiring surgery. Level of Evidence: Level II.
    Type of Medium: Online Resource
    ISSN: 2380-0186
    URL: Article
    DOI: 10.1097/BSD.0000000000001164
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2849652-8
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  • 5
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    Perioperative Complications in Posterior Surgeries for Cervical Ossification of the Posterior Longitudinal Ligament : A Prospective Nationwide Investigation
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Clinical Spine Surgery: A Spine Publication Vol. 34, No. 10 ( 2021-12), p. E594-E600
    Details
    In: Clinical Spine Surgery: A Spine Publication, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 10 ( 2021-12), p. E594-E600
    Abstract: This was a prospective multicenter study. Objective: The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data: Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures. Materials and Methods: We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications. Results: Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2−C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery. Conclusions: In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2−C7 angle were the independent risk factors for motor palsy. Level of Evidence: Level III.
    Type of Medium: Online Resource
    ISSN: 2380-0186
    URL: Article
    DOI: 10.1097/BSD.0000000000001243
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 6
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    Residual Neuropathic Pain in Postoperative Patients With Cervical Ossification of Posterior Longitudinal Ligament
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Clinical Spine Surgery: A Spine Publication Vol. 36, No. 6 ( 2023-07), p. E277-E282
    Details
    In: Clinical Spine Surgery: A Spine Publication, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 6 ( 2023-07), p. E277-E282
    Abstract: A prospective multi-institutional observational study. Objective: To investigate and identify risk factors for residual neuropathic pain after surgery in patients with cervical ossification of posterior longitudinal ligament (c-OPLL). Summary of Background Data: Patients with c-OPLL often require surgery for numbness and paralysis of the extremities; however, postoperative neuropathic pain can considerably deteriorate their quality of life. Methods: Out of 479 patients identified from multicenter c-OPLL registries between 2014 and 2017, 292 patients who could be followed up for 2 years postoperatively were reviewed, after excluding patients with nervous system comorbidities. Demographic details; medical history; radiographic factors including the K-line, spinal canal occupancy rate of OPLL, cervical kyphosis angle, and presence of spinal cord myelomalacia; preoperative Japanese Orthopaedic Association (JOA) score; surgical procedure (fusion or decompression surgery); postoperative neurological deterioration; and the visual analogue scale for pain and numbness in the upper extremities (U/E) or trunk/lower extremities (L/E) at baseline and at 2 years postoperatively were assessed. Patients were grouped into residual and non-residual groups based on a postoperative visual analogue scale ≥40 mm. Risk factors for residual neuropathic pain were evaluated by multiple logistic regression analysis. Results: The prevalence of U/E and L/E residual pain in postoperative c-OPLL patients was 51.7% and 40.4%, respectively. The U/E residual group had a poor preoperative JOA score and longer illness duration, and fusion surgery was more common in the residual group than in non-residual group. The L/E residual group was older with a poorer preoperative JOA score. On multivariate analysis, risk factors for U/E residual pain were long illness duration and poor preoperative JOA score, whereas those for L/E residual pain were age and poor preoperative JOA score. Conclusions: The risk factors for residual spinal neuropathic pain after c-OPLL surgery were age, long duration of illness, and poor preoperative JOA score. Level of Evidence: IV
    Type of Medium: Online Resource
    ISSN: 2380-0186
    URL: Article
    DOI: 10.1097/BSD.0000000000001449
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 7
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    Comparison of Surgical Outcomes After Open- and Double-Door Laminoplasties for Patients with Cervical Ossification of the Posterior Longitudinal Ligament : A Prospective Multicenter Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Spine Vol. 46, No. 23 ( 2021-12-1), p. E1238-E1245
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 23 ( 2021-12-1), p. E1238-E1245
    Type of Medium: Online Resource
    ISSN: 0362-2436 , 1528-1159
    URL: Article
    DOI: 10.1097/BRS.0000000000004094
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2002195-1
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  • 8
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    Factors Associated With Loss of Cervical Lordosis After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament : Data From a Prospective Multicenter Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Spine Vol. 48, No. 15 ( 2023-08-1), p. 1047-1056
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 15 ( 2023-08-1), p. 1047-1056
    Abstract: A prospective multicenter study. Objective. The objective of this study was to investigate the incidence of loss of cervical lordosis after laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). We also sought to determine associated risk factors and the relationship with patient-reported outcomes. Summary of Background Data. Loss of cervical lordosis is a sequelae often observed after laminoplasty, which may adversely impact surgical outcomes. Cervical kyphosis, especially in OPLL, is associated with reoperation, but risk factors and relationship to postoperative outcomes remain understudied at this time. Materials and Methods. This study was conducted by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. We included 165 patients who underwent laminoplasty and completed Japanese Orthopaedic Association (JOA) score or Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaires (JOACMEQ), as well as Visual Analog Scales (VAS) for pain, with imaging. The participants were divided into two groups: those with loss of cervical lordosis of 〉 10° or 20° after surgery and those without loss of cervical lordosis. A paired t test was applied to evaluate the association between changes in cervical spinal angles, range of motion, and cervical JOA and VAS scores before and at 2 years postoperatively. Mann-Whitney U test was used for JOACMEQ. Results. Postoperative loss of cervical lordosis 〉 10° and 〉 20° was observed in 32 (19.4%) and 7 (4.2%), respectively. JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small extension range of motion (eROM) was significantly associated with postoperative loss of cervical lordosis, and the cutoff values of eROM were 7.4° [area under the curve (AUC): 0.76] and 8.2° (AUC: 0.92) for loss of cervical lordosis 〉 10° and 〉 20°, respectively. A large occupation ratio of OPLL was also associated with loss of cervical lordosis, with a cutoff value of 39.9% (AUC: 0.94). Laminoplasty resulted in functional improvement in most patient-reported outcomes; however, neck pain and bladder function tended to become worse postoperatively in cases with postoperative loss of cervical lordosis 〉 20°. Conclusions. JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small eROM and large OPLL may represent factors associated with loss of cervical lordosis after laminoplasty in patients with OPLL.
    Type of Medium: Online Resource
    ISSN: 0362-2436
    URL: Article
    DOI: 10.1097/BRS.0000000000004706
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2002195-1
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  • 9
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    Preoperative Symptom Duration Influences Neurological Recovery and Patient-Reported Outcome Measures After Surgical Treatment of Cervical Ossification of the Posterior Longitudinal Ligament
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Spine Vol. 48, No. 18 ( 2023-09-15), p. 1259-1265
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 18 ( 2023-09-15), p. 1259-1265
    Abstract: A prospective multicenter study. Objective: To investigate the effect of preoperative symptom duration on neurological recovery for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data: The optimal timing to perform surgery in the setting of cervical OPLL remains unknown. It is important to know the influence of symptom duration on postoperative outcomes to facilitate discussions regarding the timing of surgery. Patients and Methods: The study included 395 patients (291 men and 104 women; mean age, 63.7 ± 11.4 yr): 204 were treated with laminoplasty, 90 with posterior decompression and fusion, 85 with anterior decompression and fusion, and 16 with other procedures. The Japanese Orthopedic Association (JOA) score and patient-reported outcomes of the JOA Cervical Myelopathy Evaluation Questionnaire were used to assess clinical outcomes preoperatively and 2 years after surgery. Logistic regression analysis was used to identify factors associated with the achievement of minimum clinically important difference (MCID) after surgery. Results: The recovery rate was significantly lower in the group with symptom duration of ≥5 years compared with the groups with durations of 〈 0.5 years, 0.5 to 1 year, and 1 to 2 years. Improvement of JOA Cervical Myelopathy Evaluation Questionnaire in the upper extremity function score ( P 〈 0.001), lower extremity function ( P = 0.039), quality of life ( P = 0.053), and bladder function ( P = 0.034) were all decreased when the symptom duration exceeded 2 years. Duration of symptoms ( P = 0.001), age ( P 〈 0.001), and body mass index ( P 〈 0.001) were significantly associated with the achievement of MCID. The cutoff value we established for symptom duration was 23 months (area under the curve, 0.616; sensitivity, 67.4%; specificity, 53.5%). Conclusions: Symptom duration had a significant impact on neurological recovery and patient-reported outcome measures in this series of patients undergoing surgery for cervical OPLL. Patients with symptom duration exceeding 23 months may be at greater risk of failing to achieve MCID after surgery. Level of Evidence. 3.
    Type of Medium: Online Resource
    ISSN: 0362-2436
    URL: Article
    DOI: 10.1097/BRS.0000000000004762
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 10
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    Machine Learning Approach in Predicting Clinically Significant Improvements After Surgery in Patients with Cervical Ossification of the Posterior Longitudinal Ligament
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Spine Vol. 46, No. 24 ( 2021-12-15), p. 1683-1689
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 24 ( 2021-12-15), p. 1683-1689
    Abstract: A retrospective analysis of prospectively collected data. Objective. This study aimed to create a prognostic model for surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using machine learning (ML). Summary of Background Data. Determining surgical outcomes helps surgeons provide prognostic information to patients and manage their expectations. ML is a mathematical model that finds patterns from a large sample of data and makes predictions outperforming traditional statistical methods. Methods. Of 478 patients, 397 and 370 patients had complete follow-up information at 1 and 2 years, respectively, and were included in the analysis. A minimal clinically important difference (MCID) was defined as an acquired Japanese Orthopedic Association (JOA) score of ≥2.5 points, after which a ML model that predicts whether MCID can be achieved 1 and 2 years after surgery was created. Patient background, clinical symptoms, and imaging findings were used as variables for analysis. The ML model was created using LightGBM, XGBoost, random forest, and logistic regression, after which the accuracy and area under the receiver-operating characteristic curve (AUC) were calculated. Results. The mean JOA score was 10.3 preoperatively, 13.4 at 1 year after surgery, and 13.5 at 2 years after surgery. XGBoost showed the highest AUC (0.72) and high accuracy (67.8) for predicting MCID at 1 year, whereas random forest had the highest AUC (0.75) and accuracy (69.6) for predicting MCID at 2 years. Among the included features, total preoperative JOA score, duration of symptoms, body weight, sensory function of the lower extremity sub-score of the JOA, and age were identified as having the most significance in most of ML models. Conclusion. Constructing a prognostic ML model for surgical outcomes in patients with OPLL is feasible, suggesting the potential application of ML for predictive models of spinal surgery. Level of Evidence: 4
    Type of Medium: Online Resource
    ISSN: 0362-2436 , 1528-1159
    URL: Article
    DOI: 10.1097/BRS.0000000000004125
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2002195-1
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