Evidence map›Paper›PMID 42437794›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

Whole-spine CT predictors of lumbar surgery in patients with ossification of the posterior longitudinal ligament.

Yoshinao Koike, Tsutomu Endo, Yukitoshi Shimamura, Masahiro Kanayama, Ryo Fujita, Yuichi Hasegawa, Shotaro Fukada, Masahiko Takahata, Ken Kadoya, Hideki Sudo and 5 more

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Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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5 · Who and what money

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15 authors.

Yoshinao KoikeDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
Tsutomu EndoDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan. m000053a@yahoo.co.jp.
Yukitoshi ShimamuraSpine Center, Hakodate Central General Hospital, Hakodate, Japan.
Masahiro KanayamaSpine Center, Hakodate Central General Hospital, Hakodate, Japan.
Ryo FujitaDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
Yuichi HasegawaDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
Shotaro FukadaDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
Masahiko TakahataDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
Ken KadoyaDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
Hideki SudoDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
Katsuhisa YamadaDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
M Alaa TerkawiDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
Huohuo XueDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.
Misaki IshiiSpine Center, Hakodate Central General Hospital, Hakodate, Japan.
Norimasa IwasakiDepartment of Orthopedic Surgery, Hokkaido University, Sapporo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposePatients with ossification of the posterior longitudinal ligament (OPLL) may require lumbar surgery due to ossified lesions and degenerative changes. However, risk stratification for lumbar intervention remains underexplored. We aimed to identify predictors of lumbar surgery in patients with OPLL.

methodsWe retrospectively analyzed 178 OPLL patients who underwent whole-spine computed tomography (CT) (2007-2023). Patients were classified according to whether they underwent lumbar surgery. CT obtained prior to lumbar surgery or during conservative follow-up was reviewed. Imaging parameters, including ossification distribution and degenerative changes, were compared between groups and analyzed using multivariable logistic regression to identify independent predictors.

resultsLumbar surgery was performed in 70 (39.3%) patients. The surgery group exhibited higher body mass index and greater prevalence of thoracolumbar ankylosis, thoracic and lumbar OPLL, lumbar ossification of the ligamentum flavum (OLF), and intervertebral disc (IVD) gas. Multivariable analysis identified lumbar OLF (OR, 6.49; 95% CI, 2.60-16.25) and lumbar IVD gas (OR, 5.75; 95% CI, 2.37-13.97) as independent risk factors. Coexisting OPLL and OLF at the same level was associated with younger surgical age and greater neurological severity.

conclusionsUsing whole-spine CT, we demonstrated that patients requiring lumbar surgery frequently exhibited a diffuse whole-spine ossification phenotype, characterized by thoracolumbar OPLL and ankylosis. Lumbar OLF and IVD gas were identified as independent risk factors; notably, lumbar OLF reflects this generalized ossification tendency, whereas disc gas indicates mechanical stress and degeneration. These findings support whole-spine CT-based risk stratification and longitudinal monitoring in patients with OPLL.

Indexed as

Body mass indexIntervertebral disc gasLumbar surgeryOssification of the ligamentum flavumOssification of the posterior longitudinal ligamentWhole-spine computed tomography

Identifiers

PMID42437794

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