Risk factors for progression of ossification of the posterior longitudinal ligament in asymptomatic subjects
Risk factors for progression of ossification of the posterior longitudinal ligament in asymptomatic subjects
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DOI：
10.3171/2020.3.spine2082
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发表时间：
2020-09-01
影响因子：
2.8
通讯作者：
Oshima, Yasushi
中科院分区：
文献类型：
--
作者：
Doi, Toru;Sakamoto, Ryuji;Oshima, Yasushi
目的：后纵韧带骨化（OPLL）进展的发生率和危险因素在手术和非手术治疗的症状性患者中已有报道。然而，在无症状OPLL受试者中OPLL进展的相关性尚未得到很好的表征。本研究旨在阐明OPLL进展的发病率和危险因素，在无症状的受试者的基础上，全身CT.METHODS作者回顾性分析了2585例健康受试者进行全身CT在一个单一的健康中心，从2007年9月至2011年12月。本研究纳入了接受两次CT扫描（间隔至少5年）的OPLL无症状受试者。根据初始和最终CT扫描评估OPLL的进展。受试者分为两组：非进展（OPLL-NP）和进展（OPLL-P）组。比较两组患者的临床特征、骨密度、OPLL类型及多椎体OPLL受累情况。结果109例OPLL患者（男性91例，女性18例）中，20例（18.3%）OPLL进展（OPLL-P组）。与OPLL-NP组相比，OPLL-P组受试者明显更年轻（p = 0.031），多节段OPLL受累（p = 0.041）和连续型OPLL（p = 0.015）的患病率更高，初始CT检查时尿酸（UA）水平更高（p = 0.004）。低龄化（校正比值比[aOR] 0.95，95% CI 0.90-0.99），多个椎体节段OPLL受累（aOR 2.88，95% CI 1.06-7.83），连续型OPLL（aOR 4.21，95% CI 1.35-13.10），以及较高的UA水平（aOR 2.09，95%CI 1.24-3.53）是OPLL进展的重要危险因素。UA水平升高是无症状受试者OPLL进展的重要危险因素。
OBJECTIVE The incidence and risk factors for the progression of ossification of the posterior longitudinal ligament (OPLL) have been previously reported in surgically and nonsurgically treated symptomatic patents. However, the correlates of OPLL progression in asymptomatic subjects with OPLL are not well characterized. This study aimed to clarify the incidence and risk factors for OPLL progression in asymptomatic subjects based on whole-body CT.METHODS The authors retrospectively reviewed 2585 healthy subjects who underwent whole-body CT at a single health center from September 2007 to December 2011. This study included asymptomatic subjects with OPLL who underwent CT scans twice with an interval of at least 5 years. Progression of OPLL was assessed based on initial and final CT scan. Subjects were divided into two groups: nonprogression (OPLL-NP) and progression (OPLL-P) groups. Clinical characteristics, bone mineral density status, OPLL types, and OPLL involvement of multiple vertebral levels between the two groups were compared. Risk factors for progression of OPLL were identified by logistic regression analysis after propensity score adjustment.RESULTS Of the 109 subjects with OPLL (91 men and 18 women), 20 (18.3%) exhibited OPLL progression (OPLL-P group). Subjects in the OPLL-P group were significantly younger (p = 0.031), had higher prevalence of multilevel OPLL involvement (p = 0.041) and continuous type of OPLL (p = 0.015), and had higher uric acid (UA) levels (p = 0.004) at the time of initial CT examination compared to the OPLL-NP group. Younger age (adjusted odds ratio [aOR] 0.95, 95% CI 0.90-0.99), OPLL involvement of multiple vertebral levels (aOR 2.88, 95% CI 1.06-7.83), continuous type of OPLL (aOR 4.21, 95% CI 1.35-13.10), and higher UA levels (aOR 2.09, 95% CI 1.24-3.53) were significant risk factors for OPLL progression.CONCLUSIONS Younger age, OPLL involvement of multiple vertebral levels, continuous type of OPLL, and higher UA levels are significant risk factors for OPLL progression in asymptomatic subjects.