Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options.
OBJECTIVE
Ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine produces myelopathy through anterior spinal cord compression that is usually progressive and unaffected by conservative treatment. Therefore, early decompressive surgery is imperative. However, decompression surgery of thoracic myelopathy is difficult, and the outcome is often poor. A retrospective study was conducted to investigate the surgical outcome of 21 patients with thoracic OPLL to evaluate which type of surgical approach is better and which type of thoracic OPLL results in a better surgical outcome.


METHODS
A total of 21 patients with thoracic OPLL (10 men and 11 women; mean age 54 years), who underwent surgical treatment at our department from March 1985 to October 2000, were included in the study. Seven patients exhibited the flat-type OPLL and underwent either anterior decompression and fusion (one patient), anterior decompression via a posterior approach (three patients), or expansive laminoplasty (three patients). Fourteen patients exhibited the beak-type OPLL and also underwent either anterior decompression and fusion (two patients), anterior decompression via a posterior approach (six patients), or expansive laminoplasty (six patients).


RESULTS
Regarding of operative time and blood loss, there were no marked differences between the two types of OPLL, regardless of the type of surgical procedure; anterior decompression and fusion and anterior decompression via a posterior approach yielded longer operative times and larger blood loss volumes than expansive laminoplasty. Concerning clinical outcome, there were five cases of neurologic deterioration. All of the five deteriorated cases were of the beak-type OPLL treated by a posterior approach. Two of these patients were treated with expansive laminoplasty.


CONCLUSIONS
There were five instances of neurologic deterioration in our thoracic OPLL series, and all of them exhibited beak-type OPLL. In the beak-type OPLL, a subtle alteration in the spinal alignment during posterior decompression procedures may increase spinal cord compression, leading to the deterioration of symptoms. A potential increase in kyphosis following laminectomy should be avoided by fixation with a temporary rod. If intraoperative monitoring suggests spinal cord dysfunction, an anterior decompression procedure should be attempted as soon as possible.
Matsuyama
Yukihiro
Y
Department of Orthopedic Surgery, Spine Service, Nagoya University School of Medicine, Aichi, Japan. spine-yu@tsuru.med.nagoya-u.ac.jp
Yoshihara
Hisatake
H
Tsuji
Taichi
T
Sakai
Yoshihito
Y
Yukawa
Yasutsugu
Y
Nakamura
Hiroshi
H
Ito
Keigo
K
Ishiguro
Naoki
N
D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000145:classification / Q000175:diagnosis* / Q000601:surgery*; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome