{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:04:32Z","timestamp":1782601472272,"version":"3.54.5"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier and Cox regression analyses were performed to compare the risk of SCI between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Between January 1, 1999, and December 31, 2013, there were 17,258 patients with CSM who were followed up for 89,003.78 person-years. The overall incidence of SCI in these patients with CSM was 2.022 per 1000 person-years. Patients who had CSM with OPLL and were conservatively managed had the highest incidence of SCI, at 4.11 per 1000 person-years. Patients who had CSM with OPLL and were surgically managed had a lower incidence of SCI, at 3.69 per 1000 person-years. Patients who had CSM without OPLL and were conservatively managed had an even lower incidence of SCI, at 2.41 per 1000 person-years. Patients who had CSM without OPLL and were surgically managed had the lowest incidence of SCI, at 1.31 per 1000 person-years. The Cox regression model demonstrated that SCIs are significantly more likely to happen in male patients and in those with OPLL (HR 2.00 and 2.24, p &lt; 0.001 and p = 0.007, respectively). Surgery could significantly lower the risk for approximately 50% of patients (HR 0.52, p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Patients with CSM had an overall incidence rate of SCI at approximately 0.2% per year. Male sex, the coexistence of OPLL, and conservative management are twice as likely to be associated with subsequent SCI. Surgery is therefore suggested for male patients with CSM who also have OPLL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2016.3.focus1663","type":"journal-article","created":{"date-parts":[[2016,6,1]],"date-time":"2016-06-01T03:53:12Z","timestamp":1464753192000},"page":"E4","source":"Crossref","is-referenced-by-count":36,"title":["Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study"],"prefix":"10.3171","volume":"40","author":[{"given":"Li-Fu","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan;"},{"name":"Faculty of Medicine, National Yang-Ming University, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsung-Hsi","family":"Tu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National Yang-Ming University, Taipei;"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Chun","family":"Chen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National Yang-Ming University, Taipei;"},{"name":"Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan;"},{"name":"Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jau-Ching","family":"Wu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National Yang-Ming University, Taipei;"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng-Yuan","family":"Chang","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National Yang-Ming University, Taipei;"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan;"},{"name":"College of Medicine, Chang Gung University, Taoyuan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Cheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National Yang-Ming University, Taipei;"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su-Shun","family":"Lo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National Yang-Ming University, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrich","family":"Cheng","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National Yang-Ming University, Taipei;"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;"},{"name":"Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus1663","series-title":"J Neurosurg","first-page":"550","article-title":"Experimental chronic compressive cervical myelopathy","volume":"79","author":"al-Mefty","year":"1993"},{"key":"b2-focus1663","series-title":"J Neurosurg Spine","first-page":"150","article-title":"Laminectomy and fusion for the treatment of cervical degenerative myelopathy","volume":"11","author":"Anderson","year":"2009"},{"issue":"1 Supp1 1","key":"b3-focus1663","series-title":"Neurosurgery","first-page":"S35","article-title":"Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis","volume":"60","author":"Baron","year":"2007"},{"key":"b4-focus1663","series-title":"J Neurosurg Sci","first-page":"241","article-title":"Controversies in the management of cervical spondylotic myelopathy","volume":"57","author":"Chang","year":"2013"},{"key":"b5-focus1663","series-title":"PLoS One","first-page":"e102008","article-title":"Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament","volume":"9","author":"Chen","year":"2014"},{"key":"b6-focus1663","series-title":"PLoS One","first-page":"e39264","article-title":"Age, sex, and socio-economic status affect the incidence of pediatric spinal cord injury: an eleven-year national cohort study","volume":"7","author":"Chien","year":"2012"},{"key":"b7-focus1663","series-title":"Spine J","first-page":"68","article-title":"Cervical myelopathy: current diagnostic and treatment strategies","volume":"3","author":"Edwards","year":"2003"},{"key":"b8-focus1663","series-title":"Neurosurgery","first-page":"334","article-title":"Cervical spondylotic myelopathy surgical trial: randomized, controlled trial design and rationale","volume":"75","author":"Ghogawala","year":"2014"},{"key":"b9-focus1663","series-title":"J Neurosurg Spine","first-page":"112","article-title":"Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy","volume":"11","author":"Holly","year":"2009"},{"key":"b10-focus1663","series-title":"J Neurosurg Sci","first-page":"93","article-title":"Factors predictive of surgical outcome for ossification of the posterior longitudinal ligament of the cervical spine","volume":"53","author":"Inamasu","year":"2009"},{"key":"b11-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"647","article-title":"Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty","volume":"32","author":"Iwasaki","year":"2007"},{"key":"b12-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"654","article-title":"Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 2: Advantages of anterior decompression and fusion over laminoplasty","volume":"32","author":"Iwasaki","year":"2007"},{"key":"b13-focus1663","series-title":"Eur Spine J","first-page":"1533","article-title":"Cervical spondylotic myelopathy: conservative versus surgical treatment after 10 years","volume":"20","author":"Kada\u0148ka","year":"2011"},{"key":"b14-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"2205","article-title":"Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study","volume":"27","author":"Kadanka","year":"2002"},{"issue":"22 Suppl 1","key":"b15-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"S21","article-title":"Pathophysiology and natural history of cervical spondylotic myelopathy","volume":"38","author":"Karadimas","year":"2013"},{"key":"b16-focus1663","series-title":"Spine J","first-page":"875","article-title":"Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament","volume":"15","author":"Kim","year":"2015"},{"key":"b17-focus1663","series-title":"J Orthop Surg","first-page":"2015","article-title":"Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)","volume":"10","author":"Kwon"},{"key":"b18-focus1663","series-title":"Eur Spine J","first-page":"1277","article-title":"A review of prognostic factors for surgical outcome of ossification of the posterior longitudinal ligament of cervical spine","volume":"17","author":"Li","year":"2008"},{"key":"b19-focus1663","series-title":"J Neurosurg Spine","first-page":"157","article-title":"Cervical laminoplasty for the treatment of cervical degenerative myelopathy","volume":"11","author":"Matz","year":"2009"},{"key":"b20-focus1663","series-title":"J Neurosurg Spine","first-page":"104","article-title":"The natural history of cervical spondylotic myelopathy","volume":"11","author":"Matz","year":"2009"},{"key":"b21-focus1663","series-title":"J Neurosurg Spine","first-page":"170","article-title":"Anterior cervical surgery for the treatment of cervical degenerative myelopathy","volume":"11","author":"Matz","year":"2009"},{"key":"b22-focus1663","series-title":"J Neurosurg Spine","first-page":"130","article-title":"Cervical surgical techniques for the treatment of cervical spondylotic myelopathy","volume":"11","author":"Mummaneni","year":"2009"},{"key":"b23-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"660","article-title":"Risk factors for acute cervical spinal cord injury associated with ossification of the posterior longitudinal ligament","volume":"37","author":"Onishi","year":"2012"},{"key":"b24-focus1663","series-title":"J Neurosurg Spine","first-page":"245","article-title":"Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy","volume":"11","author":"Resnick","year":"2009"},{"issue":"22 Suppl 1","key":"b25-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"S55","article-title":"Nonoperative management of cervical myelopathy: a systematic review","volume":"38","author":"Rhee","year":"2013"},{"key":"b26-focus1663","series-title":"Neurology","first-page":"5","article-title":"Surgical treatment of cervical spondylotic myelopathy: time for a controlled trial","volume":"42","author":"Rowland","year":"1992"},{"key":"b27-focus1663","series-title":"J Neurosurg Spine","first-page":"142","article-title":"Cervical laminectomy for the treatment of cervical degenerative myelopathy","volume":"11","author":"Ryken","year":"2009"},{"key":"b28-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"670","article-title":"Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review","volume":"25","author":"Sampath","year":"2000"},{"issue":"Suppl 2","key":"b29-focus1663","series-title":"Eur Spine J","first-page":"209","article-title":"A summary of assessment tools for patients suffering from cervical spondylotic myelopathy: a systematic review on validity, reliability and responsiveness","volume":"24","author":"Singh","year":"2015"},{"key":"b30-focus1663","series-title":"J Neurotrauma","first-page":"889","article-title":"Effects of age, gender, and socio-economic status on the incidence of spinal cord injury: an assessment using the eleven-year comprehensive nationwide database of Taiwan","volume":"29","author":"Wu","year":"2012"},{"key":"b31-focus1663","series-title":"J Neurotrauma","first-page":"462","article-title":"Conservatively treated ossification of the posterior longitudinal ligament increases the risk of spinal cord injury: a nationwide cohort study","volume":"29","author":"Wu","year":"2012"},{"key":"b32-focus1663","series-title":"J Neurosurg Spine","first-page":"216","article-title":"Acidic fibroblast growth factor for repair of human spinal cord injury: a clinical trial","volume":"15","author":"Wu","year":"2011"},{"issue":"1","key":"b33-focus1663","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study","volume":"35","author":"Wu","year":"2013"},{"key":"b34-focus1663","series-title":"Spine J","first-page":"269","article-title":"Conservative treatment for cervical spondylotic myelopathy. Prediction of treatment effects by multivariate analysis","volume":"1","author":"Yoshimatsu","year":"2001"},{"key":"b1-focus1663","series-title":"J Neurosurg","first-page":"550","article-title":"Experimental chronic compressive cervical myelopathy","volume":"79","author":"al-Mefty","year":"1993"},{"key":"b2-focus1663","series-title":"J Neurosurg Spine","first-page":"150","article-title":"Laminectomy and fusion for the treatment of cervical degenerative myelopathy","volume":"11","author":"Anderson","year":"2009"},{"issue":"1 Supp1 1","key":"b3-focus1663","series-title":"Neurosurgery","first-page":"S35","article-title":"Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis","volume":"60","author":"Baron","year":"2007"},{"key":"b4-focus1663","series-title":"J Neurosurg Sci","first-page":"241","article-title":"Controversies in the management of cervical spondylotic myelopathy","volume":"57","author":"Chang","year":"2013"},{"key":"b5-focus1663","series-title":"PLoS One","first-page":"e102008","article-title":"Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament","volume":"9","author":"Chen","year":"2014"},{"key":"b6-focus1663","series-title":"PLoS One","first-page":"e39264","article-title":"Age, sex, and socio-economic status affect the incidence of pediatric spinal cord injury: an eleven-year national cohort study","volume":"7","author":"Chien","year":"2012"},{"key":"b7-focus1663","series-title":"Spine J","first-page":"68","article-title":"Cervical myelopathy: current diagnostic and treatment strategies","volume":"3","author":"Edwards","year":"2003"},{"key":"b8-focus1663","series-title":"Neurosurgery","first-page":"334","article-title":"Cervical spondylotic myelopathy surgical trial: randomized, controlled trial design and rationale","volume":"75","author":"Ghogawala","year":"2014"},{"key":"b9-focus1663","series-title":"J Neurosurg Spine","first-page":"112","article-title":"Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy","volume":"11","author":"Holly","year":"2009"},{"key":"b10-focus1663","series-title":"J Neurosurg Sci","first-page":"93","article-title":"Factors predictive of surgical outcome for ossification of the posterior longitudinal ligament of the cervical spine","volume":"53","author":"Inamasu","year":"2009"},{"key":"b11-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"647","article-title":"Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty","volume":"32","author":"Iwasaki","year":"2007"},{"key":"b12-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"654","article-title":"Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 2: Advantages of anterior decompression and fusion over laminoplasty","volume":"32","author":"Iwasaki","year":"2007"},{"key":"b13-focus1663","series-title":"Eur Spine J","first-page":"1533","article-title":"Cervical spondylotic myelopathy: conservative versus surgical treatment after 10 years","volume":"20","author":"Kada\u0148ka","year":"2011"},{"key":"b14-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"2205","article-title":"Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study","volume":"27","author":"Kadanka","year":"2002"},{"issue":"22 Suppl 1","key":"b15-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"S21","article-title":"Pathophysiology and natural history of cervical spondylotic myelopathy","volume":"38","author":"Karadimas","year":"2013"},{"key":"b16-focus1663","series-title":"Spine J","first-page":"875","article-title":"Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament","volume":"15","author":"Kim","year":"2015"},{"key":"b17-focus1663","series-title":"J Orthop Surg","first-page":"2015","article-title":"Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)","volume":"10","author":"Kwon"},{"key":"b18-focus1663","series-title":"Eur Spine J","first-page":"1277","article-title":"A review of prognostic factors for surgical outcome of ossification of the posterior longitudinal ligament of cervical spine","volume":"17","author":"Li","year":"2008"},{"key":"b19-focus1663","series-title":"J Neurosurg Spine","first-page":"157","article-title":"Cervical laminoplasty for the treatment of cervical degenerative myelopathy","volume":"11","author":"Matz","year":"2009"},{"key":"b20-focus1663","series-title":"J Neurosurg Spine","first-page":"104","article-title":"The natural history of cervical spondylotic myelopathy","volume":"11","author":"Matz","year":"2009"},{"key":"b21-focus1663","series-title":"J Neurosurg Spine","first-page":"170","article-title":"Anterior cervical surgery for the treatment of cervical degenerative myelopathy","volume":"11","author":"Matz","year":"2009"},{"key":"b22-focus1663","series-title":"J Neurosurg Spine","first-page":"130","article-title":"Cervical surgical techniques for the treatment of cervical spondylotic myelopathy","volume":"11","author":"Mummaneni","year":"2009"},{"key":"b23-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"660","article-title":"Risk factors for acute cervical spinal cord injury associated with ossification of the posterior longitudinal ligament","volume":"37","author":"Onishi","year":"2012"},{"key":"b24-focus1663","series-title":"J Neurosurg Spine","first-page":"245","article-title":"Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy","volume":"11","author":"Resnick","year":"2009"},{"issue":"22 Suppl 1","key":"b25-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"S55","article-title":"Nonoperative management of cervical myelopathy: a systematic review","volume":"38","author":"Rhee","year":"2013"},{"key":"b26-focus1663","series-title":"Neurology","first-page":"5","article-title":"Surgical treatment of cervical spondylotic myelopathy: time for a controlled trial","volume":"42","author":"Rowland","year":"1992"},{"key":"b27-focus1663","series-title":"J Neurosurg Spine","first-page":"142","article-title":"Cervical laminectomy for the treatment of cervical degenerative myelopathy","volume":"11","author":"Ryken","year":"2009"},{"key":"b28-focus1663","series-title":"Spine (Phila Pa 1976)","first-page":"670","article-title":"Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review","volume":"25","author":"Sampath","year":"2000"},{"issue":"Suppl 2","key":"b29-focus1663","series-title":"Eur Spine J","first-page":"209","article-title":"A summary of assessment tools for patients suffering from cervical spondylotic myelopathy: a systematic review on validity, reliability and responsiveness","volume":"24","author":"Singh","year":"2015"},{"key":"b30-focus1663","series-title":"J Neurotrauma","first-page":"889","article-title":"Effects of age, gender, and socio-economic status on the incidence of spinal cord injury: an assessment using the eleven-year comprehensive nationwide database of Taiwan","volume":"29","author":"Wu","year":"2012"},{"key":"b31-focus1663","series-title":"J Neurotrauma","first-page":"462","article-title":"Conservatively treated ossification of the posterior longitudinal ligament increases the risk of spinal cord injury: a nationwide cohort study","volume":"29","author":"Wu","year":"2012"},{"key":"b32-focus1663","series-title":"J Neurosurg Spine","first-page":"216","article-title":"Acidic fibroblast growth factor for repair of human spinal cord injury: a clinical trial","volume":"15","author":"Wu","year":"2011"},{"issue":"1","key":"b33-focus1663","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study","volume":"35","author":"Wu","year":"2013"},{"key":"b34-focus1663","series-title":"Spine J","first-page":"269","article-title":"Conservative treatment for cervical spondylotic myelopathy. Prediction of treatment effects by multivariate analysis","volume":"1","author":"Yoshimatsu","year":"2001"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/40\/6\/article-pE4.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/40\/6\/article-pE4.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/40\/6\/article-pE4.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T08:32:09Z","timestamp":1779525129000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/40\/6\/article-pE4.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6]]},"references-count":68,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2016.3.focus1663","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,6]]}}}