title: Resection of Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament from a Posterior Approach under Intraoperative Neurophysiological Monitoring for Paralysis after Posterior Decompression and Fusion Surgery.
abstract: Study DesignProspective clinical study.ObjectivePosterior decompression and fusion surgery for beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) generally has a favorable outcome. However, some patients require additional surgery for postoperative severe paralysis, a condition that is inadequately discussed in the literature. The objective of this study was to describe the efficacy of a procedure we refer to as "resection at an anterior site of the spinal cord from a posterior approach" (RASPA) for severely paralyzed patients after posterior decompression and fusion surgery for beak-type T-OPLL.MethodsAmong 58 consecutive patients who underwent posterior decompression and fusion surgery for beak-type T-OPLL since 1999, 3 with postoperative paralysis (5%) underwent RASPA in our institute. Clinical records, the Japanese Orthopaedic Association score, gait status, intraoperative neurophysiological monitoring (IONM) findings, and complications were evaluated in these cases.ResultsAll three patients experienced a postoperative decline in Manual Muscle Test (MMT) scores of 0 to 2 after the first surgery. RASPA was performed 3 weeks after the first surgery. All patients showed gradual improvements in MMT scores for the lower extremity and in ambulatory status; all could walk with a cane at an average of 4 months following RASPA surgery. There were no postoperative complications.ConclusionsRASPA surgery for beak-type T-OPLL after posterior decompression and fusion surgery resulted in good functional outcomes as a salvage surgery for patients with severe paralysis. Advantages of RASPA include a wide working space, no spinal cord retraction, and additional decompression at levels without T-OPLL resection and spinal cord shortening after additional dekyphosis and compression maneuvers. When used with IONM, this procedure may help avoid permanent postoperative paralysis.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Ando
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Zenya
authors.initials: Z
authors.lastname: Ito
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Hida
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Kenyu
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Yoshimoto
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Mikito
authors.initials: M
authors.lastname: Tsushima
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Akiyuki
authors.initials: A
authors.lastname: Matsumoto
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Morozumi
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Machino
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Kyotaro
authors.initials: K
authors.lastname: Ota
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakashima
authors.affiliation: Department of Orthopaedic Surgery, Aichi Medical University, Aichigun, Aichi-Ken, Japan.
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Wakao
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nishida
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
keywords: RASPA; T-OPLL; additional dekyphosis; intraoperative neurophysiological monitoring; salvage surgery for paralysis; spinal cord shortening