1249 - Postoperative Rehabilitation for Ossification of the Posterior Longitudinal Ligament: A Systematic Review

Objectives:

Background: Effective post-operative rehabilitation (POR) is pivotal for functional recovery in patients with ossification of the posterior longitudinal ligament (OPLL). However, there are no standardized rehabilitation protocols. Further, the emergence of novel rehabilitation robotics like the hybrid assistive limb (HAL) necessitates a comprehensive understanding of commonly reported POR methods and their effectiveness.



Design:

Methods: A systematic review of POR strategies for OPLL was conducted and identified 273 articles across PubMed, Embase, Web of Science, Cochrane Library, and Ovid/MEDLINE databases from inception to January 2023. Quality assessment of studies was conducted using the Joanna Briggs Institute critical appraisal checklist based on the different study designs.



Results: Ten articles (one randomized controlled trial, three case series, and six case reports) met inclusion criteria. One hundred and two study participants reported symptomatic OPLL requiring surgical decompression. The majority of participants began rehabilitation during the acute post-operative period; few began within the chronic post-operative period. Conventional rehabilitation therapy primarily targeted post-operative pain, postural management, and strategies to augment strength, range of motion, and ambulation. Integration of HAL further enhanced ambulatory performance and promoted functional independence beyond what was possible with conventional rehabilitation. There was a large variation in the rehabilitation programs and assessment tools used to measure effectiveness. Despite this, notable findings included greater improvement in muscle coordination for OPLL patients that started in the acute postoperative period. Further, all the previous conventional rehabilitation primary targets demonstrated marked improvement, except post-operative pain management.

Conclusions: Nevertheless, the lack of standardization of rehabilitation protocols and assessment tools did not allow for the deduction of which rehabilitation program was superior, demonstrating the need for standardization.

Conventional POR remains crucial for functional recovery in post-operative OPLL patients. Integrating HAL therapy may further foster the restorative process, particularly motor function. Further validation and standardization of protocols for POR OPLL patients is needed.