Guidelines
Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of ossification of the spinal ligament, 2019

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Introduction

This guideline (GL) is the first version of the “Clinical Practice Guidelines for Ossification of Spinal Ligaments.” To date, with regard to the ossification of spinal ligaments, the first version (2005) and revised 2nd edition (2011) of the “Clinical Practice Guidelines for Ossification of the Posterior Longitudinal Ligament of the Cervical Spine” have been published. However, ossification of spinal ligaments includes ossification of the posterior longitudinal ligament of the thoracic spine and ossification of the thoracic ligament flavum; thus, it is presented as the first edition.

This GL was developed in reference to the “Minds Handbook for Clinical Practice Guideline Development” revised in 2014 [1], and the description of the clinical practice for ossification of the cervical posterior longitudinal ligament differs greatly to that used currently. That is, the structure is divided into background questions (BQs) and clinical questions (CQs). For BQs, the descriptions are presented in a textbook-like format, with a summary of existing findings. For the CQs, the evidence strength and level of recommendation were determined by all members following review of the available literature, and the agreement rate was recorded.

For this project, the task of searching the necessary literature regarding the epidemiology, etiology, diagnosis, and treatment of ossification of spinal ligaments was delegated to the secretary of the Department of Orthopaedic Surgery, Osaka University, who gladly accepted the task. Furthermore, each committee member and peer review cooperator added modifications to the level of recommendation and commentary through a series of tasks, i.e., first choice, report review, and structured abstract preparation from such a large volume of articles, to create the revised version.

I would like to express my deepest gratitude to Professor Masahiro Yoshida of the Japan Council for Quality Health Care, who provided detailed advice, Nahoko Fukada of the International Medical Information Center and Tomoya Gezu of Nankodo for their considerable cooperation in organizing the report.

A large amount of literature is available in Japan regarding the ossification of spinal ligaments, and it would be no exaggeration to say that Japan is the leader in this field. This is also the world's first such GL, and the fact that it is published in Japan is significant. The entire editorial committee hopes that this GL will serve as a suitable index for medical treatment by general clinicians and that it will be utilized for the diagnosis and treatment, as well as explanation to the patients who suffer from ossification of spinal ligaments. On the other hand, presuming that the treatment for this condition will be determined appropriately on a case-by-case basis according to the extensive knowledge and experience of the attending physician, I would like to emphasize that the wishes and sense of values of each individual patient, as well as the discretion of physicians, are respected. Therefore, I sincerely hope that this GL will not be used as a resource that is limited to and rules out details of medical treatment for ossification of the spinal ligaments but that it will be used appropriately as a guide to support treatment.

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Declaration of competing interest

None.

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References (1)

  • Minds Handbook for Clinical Practice Guideline Development revised in 2014, Igakusyoin, Tokyo, Japan

    (2014)

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The members of the 2019 Clinical Practice Guideline for Ossification of Spinal Ligaments working group are listed in this article. The original version of this clinical practice guidelines appeared in Japanese as Sekichu Jintai Kokkashou Shinryo Guidelines 2019, published by the Japanese Orthopaedic Association and the Japanese Society for Spine Surgery and Related Research.

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