Associations Between Both Clinical Symptoms And Radiological Features With Nerve Function And Ability Of Daily Living In Patients With Cervical Ossification Of The Posterior Longitudinal Ligament

BACKGROUND: Cervical ossification of the posterior longitudinal ligament(C-OPLL)is an ossification disease in which the ossification of posterior longitudinal ligament compresses the spinal cord and nerve roots.Then it cause the limb sensory and movement disorders and visceral autonomic dysfunction.In this study,the subjects are patients from The First Affiliated Hospital of Guangxi Medical University who were diagnosed with C-OPLL during 2016 to 2020.I hope this study can play a guiding role in both clinical work and scientific research.OBJECTIVE: We want to find out the associations between clinical symptoms,radiologic symptoms and patient’s activities of daily living,the nerve function.METHODS: This study retrospectively analyzed the data of 175 patients(Including 106 males and 69 females)who were hospitalized with ossification of the posterior longitudinal ligament of the cervical spine from January 2016 to July 2020.The data of clinical and radiologic symptoms contains age,sexuality,C-OPLL classification,hypertrophic osteoarthropathy,cervical disc herniation,other cervical ligament calcification,diabetes,hypertension,smoking history,drinking history,Ossification index,spinal canal occupancy rate,K line(±),ossification foci density,cervical vertebral body density,normal ligaments density,Cobb angle,TIA angle,T1 angle.The date of patient’s activities of daily living and nerve function contains cervical JOA score,ADL score,VAS score.Compare the difference in means between two groups with independent Sample T Test.Compare the difference over two groups with Variance Analysis.Compare the associations between numerical variables with Pearson Correlation Test.RESULTS: Part of Measurement data:The narrowest spinal canal diameter(p<0.01,r=0.311)is positively correlated with the cervical spine JOA score.Ossification index(p<0.01,r=-0.264),maximum thickness of ossified ligament(p<0.01,r=-0.220),spinal canal occupancy rate(p<0.01,r=-0.293),ossification foci density(p<0.05,r=-0.176)was negatively correlated with the JOA score.The narrowest spinal canal diameter(p<0.01,r=0.180)is positively correlated with the patient’s ADL score.Ossification index(p<0.01,r=-0.230),maximum thickness of ossified ligament(p<0.01,r=-0.312),spinal canal occupancy rate(p<0.01,r=-0.298),ossification foci density(p<0.01,r=-0.241)was negatively correlated with the ADL score.Age(P<0.01,r=-0.202),cone bone density(p<0.05,r-0.81),Cobb angle of C1-7(p < 0.05,r=-0.158),Cobb angle of C2-7(P<0.05,r=-0.161)was negatively correlated with VAS score.Part of Categorical data: The study included 175 patients,including 106 males and 69 females.The JOA score of the female group(15.174±1.645)was significantly higher than the male group(14.085±2.256)(p<0.01,t=3.688);The ADL score of the female group(93.043±11.981)was also higher than that of the male group(84.481±22.730)(t=3.247,p<0.01).There were 53 patients in the diabetes group,122 patients in the non-diabetic group.We found no significant difference in JOA score,ADL score,and VAS score between the two groups.81 patients in the hypertension group and 94 patients in the non-hypertension group.We found no significant difference in JOA score,ADL score,and VAS score between the two groups.Here were 53 patients in the smoking history group and 122 patients in the no smoking history group.The JOA score of patients in the smoking group(13.755±2.139)was significantly lower than that in the no-smoking group(14.844±2.004)(p<0.01,t=3.238).There were 42 patients in the drinking history group and 133 patients have no drinking history.We found no significant difference in JOA score,ADL score,and VAS score between the two groups.63 patients in the herniated-intervertebral-disc group and 112 patients without herniated disc.The JOA score of patients with cervical disc herniation(14.016±2.240)was significantly lower than that of the non-combined group(14.795±1.973)(p<0.05,t=2.386).32 patients in the K-line(+)group and 140 patients in the K-line(-)group.The JOA score(12.844±2.503)of the K-line(+)group was significantly lower than that of the K-line(-)group(14.888±1.808)(p<0.01,t=4.372).The ADL score of the K-line(+)group was(72.656±26.488)was also significantly lower than the(-)group(91.259±15.983)(p<0.01,t=3.820).There were 140 patients in the bone hyperplasia group and 35 patients in the non-osteogenesis group.We found no significant difference in JOA score,ADL score,and VAS score between the two groups.There were 94 patients with calcification of other ligaments except the posterior longitudinal ligament,and81 patients without other ligament calcification.The JOA score(14.117±2.179)of patients with other ligament ossification group was significantly lower than that of the group without calcification of other ligaments(14.975±1.917)(p<0.01,t=2.745).There were 52 patients in focal type,37 patients in continuous type,55 patients in segmental type and 31 patients in mixed type.We found no significant difference in four groups.CONCLUSIONS: Patients’ sexuality,Ossification index,spinal canal occupancy rate,ossification foci density,K line(±)show strong correlation with both cervical JOA score and ADL score.Cervical disc herniation,other cervical ligament calcification,smoking history show strong correlation with only cervical JOA score.Age,cervical vertebral body density,Cobb angle show correlation with VAS score.Normal ligaments density,T1 angle,TIA angle,C-OPLL classification,diabetes,hypertension,hypertrophic osteoarthropathy,drinking history show no correlation with any score.