title: Progression of ossification of the posterior longitudinal ligament of the thoracic spine following posterior decompression and stabilization.
abstract: OBJECTIVE
  Despite its potential clinical impact, information regarding progression of thoracic ossification of the posterior longitudinal ligament (OPLL) is scarce. Posterior decompression with stabilization is currently the primary surgical treatment for symptomatic thoracic OPLL; however, it remains unclear whether thoracic OPLL increases in size following spinal stabilization. It is also unknown whether patients' clinical symptoms worsen as OPLL size increases. In this retrospective case series study, the authors examined the postoperative progression of thoracic OPLL.
  
  
  METHODS
  Nine consecutive patients with thoracic OPLL who underwent posterior decompression and fixation with a minimum follow-up of 3 years were included in this study. Thin-slice CT scans of the thoracic spine obtained at the time of surgery and the most recent follow-up were analyzed. The level of the most obvious protrusion of ossification was determined using the sagittal reconstructions, and the ossified area was measured on the axial reconstructed scan at the level of the most obvious protrusion of ossification using the DICOM (digital imaging and communications in medicine) software program. Myelopathy severity was assessed according to the Japanese Orthopaedic Association (JOA) scale score for lower-limb motor function on admission, at postoperative discharge, and at the last follow-up visit.
  
  
  RESULTS
  The OPLL area was increased in all patients. The mean area of ossification increased from 83.6 ± 25.3 mm(2) at the time of surgery to 114.8 ± 32.4 mm(2) at the last follow-up visit. No patients exhibited any neurological deterioration due to OPLL progression.
  
  
  CONCLUSIONS
  The present study demonstrated that the size of the thoracic OPLL increased after spinal stabilization. Despite diminished local spinal motion, OPLL progression did not decrease or stop. Physicians should pay attention to ossification progression in patients with thoracic OPLL.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo ; and.
authors.forename: Shurei
authors.initials: S
authors.lastname: Sugita
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Chikuda
authors.forename: Katsushi
authors.initials: K
authors.lastname: Takeshita
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seichi
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed
keywords: JOA = Japanese Orthopaedic Association; OPLL = ossification of the posterior longitudinal ligament; ossification of the posterior longitudinal ligament; posterior decompression and fixation; progression; thoracic spine