Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine: a multi-institutional retrospective study.
METHODS
Retrospective multi-institutional study


OBJECTIVE
To describe the surgical outcomes in patients with ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) and to clarify factors related to the surgical outcomes.


BACKGROUND
Detailed analyses of surgical outcomes of T-OPLL have been difficult because of the rarity of this disease.


METHODS
The subjects were 154 patients with T-OPLL who were surgically treated at 34 institutions between 1998 and 2002. The surgical procedures were laminectomy in 36, laminoplasty in 51, anterior decompression via anterior approach in 25 and via posterior approach in 29, combined anterior and posterior fusion in 8, and sternum splitting approach in 5 patients. Instrumentation was conducted in 52 patients. Assessments were made on (1) The Japanese Orthopedic Association (JOA) scores (full score, 11 points), its recovery rates, (2) factors related to surgical results, and (3) complications and their consequences.


RESULTS
(1) The mean JOA score before surgery was 4.6 +/- 2.0 and, 7.1 +/- 2.5 after surgery. The mean recovery rate was 36.8% +/- 47.4%. (2) The recovery rate was 50% or higher in 72 patients (46.8%). Factors significantly related to this were location of the maximum ossification (T1-T4) (odds ratio, 2.43-4.17) and the use of instrumentation (odds ratio, 3.37). (3) The frequent complications were deterioration of myelopathy immediately after surgery in 18 (11.7%) and dural injury in 34 (22.1%) patients.


CONCLUSIONS
The factors significantly associated with favorable surgical results were maximum ossification located at the upper thoracic spine and use of instrumentation. T-OPLL at the nonkyphotic upper thoracic spine can be treated by laminoplasty that is relatively a safe surgical procedure for neural elements. The use of instrumentation allows correction of kyphosis or prevention of progression of kyphosis, thereby, enhancing and maintaining decompression effect, and its use should be considered with posterior decompression.
Matsumoto
Morio
M
Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University, Department of Orthopedic Surgery, Tokyo, Japan. morio@sc.itc.keio.ac.jp
Chiba
Kazuhiro
K
Toyama
Yoshiaki
Y
Takeshita
Katsushi
K
Seichi
Atsushi
A
Nakamura
Kozo
K
Arimizu
Jun
J
Fujibayashi
Shunsuke
S
Hirabayashi
Shigeru
S
Hirano
Toru
T
Iwasaki
Motoki
M
Kaneoka
Kouji
K
Kawaguchi
Yoshiharu
Y
Ijiri
Kosei
K
Maeda
Takeshi
T
Matsuyama
Yukihiro
Y
Mikami
Yasuo
Y
Murakami
Hideki
H
Nagashima
Hideki
H
Nagata
Kensei
K
Nakahara
Shinnosuke
S
Nohara
Yutaka
Y
Oka
Shiro
S
Sakamoto
Keizo
K
Saruhashi
Yasuo
Y
Sasao
Yutaka
Y
Shimizu
Katsuji
K
Taguchi
Toshihiko
T
Takahashi
Makoto
M
Tanaka
Yasuhisa
Y
Tani
Toshikazu
T
Tokuhashi
Yasuaki
Y
Uchida
Kenzo
K
Yamamoto
Kengo
K
Yamazaki
Masashi
M
Yokoyama
Toru
T
Yoshida
Munehito
M
Nishiwaki
Yuji
Y
D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007564:Japan; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation; D017887:Ossification of Posterior Longitudinal Ligament / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013123:Spinal Fusion; D013249:Sternum / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome