title: Gradual spinal cord decompression through migration of floated plaques after anterior decompression via a posterolateral approach for OPLL in the thoracic spine.
abstract: OBJECTIVE
  Several surgical procedures have been developed to treat thoracic OPLL (ossification of the posterior longitudinal ligament). However, favorable surgical results are not always achieved, and consistent protocols and procedures for surgical treatment of OPLL in this region have not been established. Beak-type OPLL in the thoracic spine is known to be the most complicated form of OPLL to treat surgically. In this study, the authors examine the clinical outcomes after anterior decompression via a posterolateral approach for beak-type OPLL in the thoracic spine and address the gradual spinal cord decompression caused by migration of the floated plaques after surgery.
  
  
  METHODS
  Between 2011 and 2013, a total of 12 patients with thoracic myelopathy due to OPLL were surgically treated at the authors' institute. The study group for this paper comprises 6 of those 12 patients. These 6 patients, who had beak-type OPLL, underwent with anterior decompression and instrumented fusion via the authors' posterolateral approach-based surgical technique. The other 6 patients, who exhibited other types of OPLL, underwent posterior decompression and instrumented fusion. In the study group (the 6 patients with beak-type OPLL), half of the patients (the 3 patients who were treated first) were treated with removal of the ossified ligament. These patients are referred to as the removal group. The other 3 patients were treated by means of "floating" the OPLL plaques and are referred to as the floating group. Clinical and radiographic outcomes were evaluated in these 6 cases.
  
  
  RESULTS
  The recovery rates were 52.4% in the removal group and 60.0% in the floating group. Two patients in the removal group had operative complications, including a dural tear and temporary neurological deterioration. No operative complications were encountered in the floating group. In all 3 cases in the floating group, floating of the ossified ligament was completely achieved, and the floated plaque gradually migrated into the ventral bone resection areas. The mean migration distances of the floated plaque were 2.4 mm, 4.3 mm, 4.7 mm, and 4.8 mm at 1, 3, 6, and 12 months after surgery.
  
  
  CONCLUSIONS
  Treatment of beak-type OPLL in the thoracic spine via the posterolateral approach-based floating plaque technique was safe and effective in this small case series. Gradual migration of the floated plaques provided additional spinal cord decompression during the postoperative course.
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Murakami
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Demura
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Yoshioka
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Yokogawa
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Xiang
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
keywords: JOA = Japanese Orthopaedic Association; OPLL = ossification of the PLL; PLL = posterior longitudinal ligament; anterior decompression; gradual spinal cord decompression; migrating floated plaques; ossification of the posterior longitudinal ligament; posterolateral approach; thoracic spine