title: Examination of the influence of ossification of the anterior longitudinal ligament on symptom progression and surgical outcome of ossification of the thoracic ligamentum flavum: a multicenter study.
abstract: OBJECTIVE
  The purpose of this study was to provide the first evidence for the influence of an ossified anterior longitudinal ligament (OALL) on the clinical features and surgical outcomes in an ossified ligamentum flavum (OLF) in the thoracic region.
  
  
  METHODS
  Sixty-three patients who underwent surgery for a 1-level thoracic OLF were identified, and preoperative symptoms, severity of symptoms and myelopathy, disease duration, MR imaging and CT findings, surgical procedure, intraoperative findings, complications, and postoperative recovery were investigated in these patients. Entities of OALLs were found on sagittal CT images to be adjacent to or at the same vertebral level as the OLF were classified into 4 types: no discernible type (Type N), one-sided (Type O), discontinuous (Type D), and continuous (Type C).
  
  
  RESULTS
  The duration of symptoms was especially long for Types D and C OALLs. Patients with Type D OALLs had a significantly worse percentage of recovery, as well as worse preoperative JOA scores.
  
  
  CONCLUSIONS
  The authors' results showed that a Type D OALL had strong associations with preoperative severity of symptoms and surgical outcomes. These findings may allow surgeons to determine the severity of preoperative symptoms and the probable surgical outcomes from the OALL classifications. Moreover, surgery with instrumentation for Type D OALLs may produce better surgical outcomes.
authors.affiliation: Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi 466-8550, Japan. keikeiando@hotmail.co.jp
authors.forename: Kei
authors.initials: K
authors.lastname: Ando
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Wakao
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hirano
authors.forename: Ryoji
authors.initials: R
authors.lastname: Tauchi
authors.forename: Akio
authors.initials: A
authors.lastname: Muramoto
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kato
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Yukawa
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kawakami
authors.forename: Koji
authors.initials: K
authors.lastname: Sato
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsubara
authors.forename: Tokumi
authors.initials: T
authors.lastname: Kanemura
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D019299:Decompression, Surgical; D018450:Disease Progression; D005260:Female; D006801:Humans; D017843:Ligamentum Flavum / Q000000981:diagnostic imaging* / Q000601:surgery; D017846:Longitudinal Ligaments / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012720:Severity of Illness Index; D013122:Spinal Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome