Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of the posterior longitudinal ligament: a case report.
METHODS
Case report.


OBJECTIVE
We report a case with thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL) of the spine, in which neurologic deterioration progressed after laminectomy and was markedly reversed after additional posterior instrumented fusion.


BACKGROUND
Many different surgical procedures may be used in the treatment of thoracic OPLL. However, the possibility of postoperative paraplegia remains a major risk, and consistent protocols and procedures for surgical correction of thoracic OPLL have not been established.


METHODS
The patient was a 53-year-old man with continuous OPLL at T3-T8 that compressed the spinal cord anteriorly. Anterior decompression surgery employing a posterior approach was initiated, but during OPLL extirpation electrophysiologic monitoring of spinal cord activity showed abnormalities. As a result, the procedure was converted to a wide laminectomy. Over the next 4 weeks, kyphosis of the thoracic spine increased and myelopathy worsened, producing severe paraparesis.


RESULTS
Four weeks after surgery, posterior instrumented fusion (T1-L1) was performed without correction of the kyphosis. After the fusion, neurologic deficits gradually recovered and the patient was fully recovered after 10 months. At follow-up 15 years after the fusion, no neurologic deterioration was seen despite the presence of residual anterior impingement of spinal cord by OPLL.


CONCLUSIONS
The present case suggests that kyphosis and instability are major factors that affect the severity of thoracic myelopathy due to OPLL, and posterior fusion with spinal instrumentation is a safe and effective adjunct procedure for surgical treatment of thoracic OPLL.
Yamazaki
Masashi
M
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. masashiy@faculty.chiba-u.jp
Okawa
Akihiko
A
Koda
Masao
M
Goto
Sumio
S
Minami
Shohei
S
Moriya
Hideshige
H
D019299:Decompression, Surgical / Q000009:adverse effects*; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D020335:Paraparesis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011183:Postoperative Complications; D011859:Radiography; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013904:Thoracic Vertebrae