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The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review

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Abstract

Purpose

Thoracic spinal stenosis (TSS) is a rare disease secondary to multiple pathological changes that differ in prevalence and clinical characteristics. The epidemiological characteristics of these pathologies are largely unknown due to the limited case samples and regional differences. Therefore, a systematic review was conducted to elucidate the prevalence and clinical characteristics of TSS.

Methods

Case series and case reports on the ossification of the posterior longitudinal ligaments (OPLL), ossification of the ligamentum flavum (OLF) and thoracic disk herniation (TDH) were screened from PubMed, Embase and Web of Science databases and systematically reviewed. Epidemiological, demographic and segmental distribution data were extracted and analyzed.

Results

A total of 129 studies including 1935 subjects were selected, of which 361 (18.7%) were diagnosed with OPLL, 804 (41.5%) with OLF, 143 (7.4%) with OPLL + OLF and 627 (32.4%) with TDH. Most reports were from China, Japan and USA. Thoracic OPLL occurred mostly at the middle-thoracic spine (43.4%), while OLF predominately occurred at the lower-thoracic spine (63.1%). TDH was mainly localized in the middle (46.0%) and lower-thoracic (50.3%) spine. Thirty-two studies involving 524 patients described tandem spinal stenosis, of which 52.1% had accompanying cervical diseases and 35.9% lumbar diseases.

Conclusions

There are significant differences in the age, sex and segment distribution characteristics of different pathologies leading to TSS. Tandem spinal stenosis is not uncommon and should be considered when diagnosing TSS. Our findings provide new insights into the prevalence and clinical characteristics of TSS and can help reduce misdiagnosis.

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References

  1. Amato V, Giannachi L, Irace C, Corona C (2012) Thoracic spinal stenosis and myelopathy: report of two rare cases and review of the literature. J Neurosurg Sci 56(4):373–378

    CAS  PubMed  Google Scholar 

  2. Barnett GH, Hardy RW, Little JR, Bay JW, Sypert GW (1987) Thoracic spinal canal stenosis. J Neurosurg 66(3):338–344

    CAS  PubMed  Google Scholar 

  3. Dommisse GF (1974) The blood supply of the spinal cord. A critical vascular zone in spinal surgery. J Bone Joint Surg Br Vol B 56(2):225–235

    CAS  Google Scholar 

  4. Lazorthes G, Gouaze A, Zadeh JO, Santini JJ, Lazorthes Y, Burdin P (1971) Arterial vascularization of the spinal cord. Recent studies of the anastomotic substitution pathways. J Neurosurg 35(3):253–262

    CAS  PubMed  Google Scholar 

  5. Li Z, Ren D, Zhao Y, Hou S, Li L, Yu S, Hou T (2016) Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases. Spinal Cord 54(3):188–196

    CAS  PubMed  Google Scholar 

  6. Yu S, Wu D, Li F, Hou T (2013) Surgical results and prognostic factors for thoracic myelopathy caused by ossification of ligamentum flavum: posterior surgery by laminectomy. Acta Neurochir (Wien) 155(7):1169–1177

    Google Scholar 

  7. Aizawa T, Sato T, Sasaki H, Matsumoto F, Morozumi N, Kusakabe T, Itoi E, Kokubun S (2007) Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. J Neurosurg Spine 7(1):13–20

    PubMed  Google Scholar 

  8. Garry JP (2018) A rare case of thoracic spinal stenosis in a white male. Current Sports Med Rep 17(1):13–15

    Google Scholar 

  9. Bajwa NS, Toy JO, Ahn NU (2012) Establishment of parameters for congenital thoracic stenosis: a study of 700 postmortem specimens. Clin Orthop Relat Res 470(11):3195–3201

    PubMed  PubMed Central  Google Scholar 

  10. Zhu Q, Qian M, Xiao J, Wu Z, Wang Y, Zhang J (2013) Myelopathy due to calcified meningiomas of the thoracic spine: minimum 3-year follow-up after surgical treatment. J Neurosurg Spine 18(5):436–442

    PubMed  Google Scholar 

  11. Pettigrew DB, Fessler RD, Farley CW, Al-Nafi S, Holtz JR, Wiebracht ND, Look AC, Kuntz C (2015) Spinal cord intramedullary pressure in thoracic scoliotic deformity: a cadaveric study. Spine 40(4):E242–247

    PubMed  Google Scholar 

  12. Takeuchi A, Miyamoto K, Hosoe H, Shimizu K (2004) Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery -Report of three cases. J Neurosurg 100(1):71–74

    PubMed  Google Scholar 

  13. Onishi E, Yasuda T, Yamamoto H, Iwaki K, Ota S (2016) Outcomes of surgical treatment for thoracic myelopathy: a single-institutional study of 73 patients. Spine (Phila Pa 1976) 41(22):E1356–E1363

    Google Scholar 

  14. Fujimori T, Watabe T, Iwamoto Y, Hamada S, Iwasaki M, Oda T (2016) Prevalence, concomitance, and distribution of ossification of the spinal ligaments: results of whole spine ct scans in 1500 Japanese patients. Spine (Phila Pa 1976) 41(21):1668–1676

    Google Scholar 

  15. Guo JJ, Luk KD, Karppinen J, Yang H, Cheung KM (2010) Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine (Phila Pa 1976) 35(1):51–56

    CAS  Google Scholar 

  16. Kudo S, Ono M, Russell WJ (1983) Ossification of thoracic ligamenta flava. Am J Roentgenol 141(1):117–121

    CAS  Google Scholar 

  17. Williams DM, Gabrielsen TO, Latack JT, Martel W, Knake JE (1984) Ossification in the cephalic attachment of the ligamentum flavum. An anatomical and CT study. Radiology 150(2):423–426

    CAS  PubMed  Google Scholar 

  18. Ohtsuka K, Terayama K, Yanagihara M, Wada K, Kasuga K, Machida T, Furukawa K (1986) An epidemiological survey on ossification of ligaments in the cervical and thoracic spine in individuals over 50 years of age. Nihon Seikeigeka Gakkai zasshi 60(11):1087–1098

    CAS  PubMed  Google Scholar 

  19. Mori K, Imai S, Kasahara T, Nishizawa K, Mimura T, Matsusue Y (2014) Prevalence, distribution, and morphology of thoracic ossification of the posterior longitudinal ligament in Japanese: results of CT-based cross-sectional study. Spine (Phila Pa 1976) 39(5):394–399

    Google Scholar 

  20. Ono M, Russell WJ, Kudo S, Kuroiwa Y, Takamori M, Motomura S et al (1982) Ossification of the thoracic posterior longitudinal ligament in a fixed population. Radiological and neurological manifestations. Radiology 143(2):469–474

    CAS  PubMed  Google Scholar 

  21. Liang H, Liu G, Lu S, Chen S, Jiang D, Shi H, Fei Q (2019) Epidemiology of ossification of the spinal ligaments and associated factors in the Chinese population: a cross-sectional study of 2000 consecutive individuals. BMC Musculoskelet Disord 20(1):253

    PubMed  PubMed Central  Google Scholar 

  22. Arce CA, Dohrmann GJ (1985) Herniated thoracic disks. Neurol Clin 3(2):383–392

    CAS  PubMed  Google Scholar 

  23. Carson J, Gumpert J, Jefferson A (1971) Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 34(1):68–77

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Overley SC, Kim JS, Gogel BA, Merrill RK, Hecht AC (2017) Tandem spinal stenosis: a systematic review. JBJS Rev 5(9):e2

    PubMed  Google Scholar 

  25. Hou X, Sun C, Liu X, Liu Z, Qi Q, Guo Z, Li W, Zeng Y, Chen Z (2016) Clinical features of thoracic spinal stenosis-associated myelopathy: a retrospective analysis of 427 cases. Clin Spine Surg 29(2):86–89

    PubMed  Google Scholar 

  26. Mori K, Kasahara T, Mimura T, Nishizawa K, Murakami Y, Matsusue Y, Imai S (2013) Prevalence, distribution, and morphology of thoracic ossification of the yellow ligament in Japanese: results of CT-based cross-sectional study. Spine (Phila Pa 1976) 38(19):E1216–1222

    Google Scholar 

  27. Moon BJ, Kuh SU, Kim S, Kim KS, Cho YE, Chin DK (2015) Prevalence, distribution, and significance of incidental thoracic ossification of the ligamentum flavum in Korean patients with back or leg pain : mr-based cross sectional study. J Korean Neurosurg Soc 58(2):112–118

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Moher D, Liberati A, Tetzlaff J, Altman DG, Grp P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ Br Med J 339:7

    Google Scholar 

  29. Kim SI, Ha KY, Lee JW, Kim YH (2018) Prevalence and related clinical factors of thoracic ossification of the ligamentum flavum-a computed tomography-based cross-sectional study. Spine J 18(4):551–557

    PubMed  Google Scholar 

  30. Gao R, Yuan W, Yang L, Shi G, Jia L (2013) Clinical features and surgical outcomes of patients with thoracic myelopathy caused by multilevel ossification of the ligamentum flavum. Spine J 13(9):1032–1038

    PubMed  Google Scholar 

  31. Nishiura I, Isozumi T, Nishihara K, Handa H, Koyama T (1999) Surgical approach to ossification of the thoracic yellow ligament. Surg Neurol 51(4):368–372

    CAS  PubMed  Google Scholar 

  32. Aizawa T, Sato T, Tanaka Y, Ozawa H, Hoshikawa T, Ishii Y, Morozumi N, Ishibashi K, Kasama F, Hyodo H, Murakami E, Nishihira T, Kokubun S (2006) Thoracic myelopathy in Japan: epidemiological retrospective study in Miyagi Prefecture during 15 years. Tohoku J Exp Med 210(3):199–208

    PubMed  Google Scholar 

  33. He SS, Hussain N, Li SH, Hou TS (2005) Clinical and prognostic analysis of ossified ligamentum flavum in a Chinese population. J Neurosurg Spine 3(5):348–354

    PubMed  Google Scholar 

  34. Ben Hamouda K, Jemel H, Haouet S, Khaldi M (2003) Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases. J Neurosurg 99(2):157–161

    PubMed  Google Scholar 

  35. Pascal-Moussellard H, Cabre P, Smadja D, Catonne Y (2005) Symptomatic ossification of the ligamentum flavum: a clinical series from the French Antilles. Spine 30(14):E400–E405

    PubMed  Google Scholar 

  36. Love JG, Schorn VG (1967) Thoracic disk protrusions. Rheumatism 23(1):2–10

    CAS  PubMed  Google Scholar 

  37. Lang N, Yuan HS, Wang HL, Liao J, Li M, Guo FX, Shi S, Chen ZQ (2013) Epidemiological survey of ossification of the ligamentum flavum in thoracic spine: CT imaging observation of 993 cases. Eur Spine J 22(4):857–862

    PubMed  Google Scholar 

  38. Akune T, Ogata N, Seichi A, Ohnishi I, Nakamura K, Kawaguchi H (2001) Insulin secretory response is positively associated with the extent of ossification of the posterior longitudinal ligament of the spine. J bone Joint Surg Am 83(10):1537–1544

    CAS  PubMed  Google Scholar 

  39. Kobashi G, Washio M, Okamoto K, Sasaki S, Yokoyama T, Miyake Y, Sakamoto N, Ohta K, Inaba Y, Tanaka H (2004) High body mass index after age 20 and diabetes mellitus are independent risk factors for ossification of the posterior longitudinal ligament of the spine in Japanese subjects: a case-control study in multiple hospitals. Spine 29(9):1006–1010

    PubMed  Google Scholar 

  40. Shingyouchi Y, Nagahama A, Niida M (1996) Ligamentous ossification of the cervical spine in the late middle-aged Japanese men. Its relation to body mass index and glucose metabolism. Spine 21(21):2474–2478

    CAS  PubMed  Google Scholar 

  41. Okamoto K, Kobashi G, Washio M, Sasaki S, Yokoyama T, Miyake Y, Sakamoto N, Ohta K, Inaba Y, Tanaka H (2004) Dietary habits and risk of ossification of the posterior longitudinal ligaments of the spine (OPLL); findings from a case-control study in Japan. J Bone Miner Metab 22(6):612–617

    PubMed  Google Scholar 

  42. Washio M, Kobashi G, Okamoto K, Sasaki S, Yokoyama T, Miyake Y, Sakamoto N, Ohta K, Inaba Y, Tanaka H (2004) Sleeping habit and other life styles in the prime of life and risk for ossification of the posterior longitudinal ligament of the spine (OPLL): a case-control study in Japan. J Epidemiol 14(5):168–173

    PubMed  Google Scholar 

  43. Feng FB, Sun CG, Chen ZQ (2015) Progress on clinical characteristics and identification of location of thoracic ossification of the ligamentum flavum. Orthop Surg 7(2):87–96

    PubMed  PubMed Central  Google Scholar 

  44. Takenaka S, Kaito T, Hosono N, Miwa T, Oda T, Okuda S, Yamashita T, Oshima K, Ariga K, Asano M, Fuchiya T, Kuroda Y, Nagamoto Y, Makino T, Yamazaki R, Yonenobu K (2014) Neurological manifestations of thoracic myelopathy. Arch Orthop Trauma Surg 134(7):903–912

    PubMed  Google Scholar 

  45. Ojo OA, Kaye AH (2010) An unusual cause of spinal cord compression. J Clin Neurosci 17(1):86, 156.

  46. Giblin EM, Hochheiser GM (2008) Thoracic disk herniation resulting in acutely progressing paraplegia in a pediatric patient. Pediatr Emerg Care 24(8):550–553

    PubMed  Google Scholar 

  47. Tsukamoto N, Maeda T, Miura H, Jingushi S, Hosokawa A, Harimaya K, Higaki H, Kurata K, Iwamoto Y (2006) Repetitive tensile stress to rat caudal vertebrae inducing cartilage formation in the spinal ligaments: a possible role of mechanical stress in the development of ossification of the spinal ligaments. J Neurosurg Spine 5(3):234–242

    PubMed  Google Scholar 

  48. Kawaguchi Y, Nakano M, Yasuda T, Seki S, Hori T, Kimura T (2013) Ossification of the posterior longitudinal ligament in not only the cervical spine, but also other spinal regions: analysis using multidetector computed tomography of the whole spine. Spine (Phila Pa 1976) 38(23):E1477–1482

    Google Scholar 

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Author notes

  1. Guanghui Chen and Tianqi Fan have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Peking University Third Hospital, Peking University, #38 Xueyuan Road, Beijing, 1000191, China

    Guanghui Chen, Tianqi Fan, Xiaoxi Yang, Chuiguo Sun, Dongwei Fan & Zhongqiang Chen

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  1. Guanghui Chen
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Correspondence to Zhongqiang Chen.

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Chen, G., Fan, T., Yang, X. et al. The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review. Eur Spine J 29, 2164–2172 (2020). https://doi.org/10.1007/s00586-020-06520-6

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  • DOI: https://doi.org/10.1007/s00586-020-06520-6

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