Abstract
Background
Thoracic ossification of ligamentum flavum (TOLF) of the spine is characterized by a heterotopic bone formation in the thoracic ligamentum flavum, which causes slowly progressing spinal cord injury. Surgical decompression is the most common treatment of choice for patients with compressive myelopathy due to TOLF. However, the surgical outcome is not always satisfactory.
Methods
To identify the predictors of surgical outcome, we retrospectively studied the associations between various clinical and radiological parameters and postoperative recovery in 78 patients who underwent decompressive laminectomy for thoracic myelopathy due to TOLF between October 1998 and June 2011. Surgical outcomes were assessed using modified Japanese Orthopedic Association (mJOA) recovery rate (RR)/outcome scores.
Results
At a minimum of 1 year after surgery for TOLF treatment, the postoperative clinical scores showed statistically significant changes with improvement in the JOA scores. The results indicated that a longer duration of preoperative symptoms, fused-type TOLF, and the degree of compression of the anteroposterior diameter and ossified region (middle thoracic OLF) was related to poor prognosis.
Conclusion
Early diagnosis and sufficient surgical decompression improved the functional outcomes of TOLF patients. The surgical risk is relatively higher due to the tenuous blood supply of the spinal cord and the limited spinal canal volume of the middle thoracic spine extending from T4 to T9.
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Ethics statement
The study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards established in the 1964 Declaration of Helsinki and its later amendments. All participants provided informed consent prior to their inclusion in the study.
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The authors thank their patients for their permission to publish this article.
Comment
The authors present their results in a series of patients treated for thoracic myelopathy due to ossification of the yellow ligament. They note that prognosis is not as good in patients with disease in the mid thoracic spine, and attribute this to differences in vascular supply to the spinal cord. I agree with their hypothesis, although there is no absolute proof presented.
Daniel Resnick
Madison, USA
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Yu, S., Wu, D., Li, F. et al. Surgical results and prognostic factors for thoracic myelopathy caused by ossification of ligamentum flavum: posterior surgery by laminectomy. Acta Neurochir 155, 1169–1177 (2013). https://doi.org/10.1007/s00701-013-1694-0
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DOI: https://doi.org/10.1007/s00701-013-1694-0