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European Spine Journal

, Volume 20, Issue 2, pp 216–223 | Cite as

Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion

  • Sang Hoon Yoon
  • Wook Ha Kim
  • Sang-Bong Chung
  • Yong Jun Jin
  • Kun Woo Park
  • Joon Woo Lee
  • Sang-Ki Chung
  • Ki-jeong Kim
  • Jin S. Yeom
  • Tae-Ahn Jahng
  • Chun Kee Chung
  • Heung Sik Kang
  • Hyun-Jib Kim
Original Article

Abstract

The aim of this study was to analyze the clinical characteristics of thoracic ossified ligamentum flavum (OLF) and to elucidate prognostic factors as well as effective surgical treatment modality. The authors analyzed 106 thoracic OLF cases retrospectively from January 1999 to December 2008. The operative (n = 40) and the non-operative group (n = 66) were diagnosed by magnetic resonance imaging (MRI) and/or computed tomography (CT) imaging. We excluded cases exhibiting ventral compressive lesions causing subarachnoid space effacement in thoracic vertebrae as well as those with a coexisting cervical compressive myelopathy. Those in the operative group were treated with decompressive laminectomy as well as resection of OLF. The preoperative neurologic status and postoperative outcomes of patients, as indicated by their modified Japanese Orthopedic Association (mJOA) scores and recovery rate (RR), Modic changes, the axial (fused or non-fused) and sagittal (omega or beak) configurations of OLF, and the ratios of the cross-sectional area (CSA) and anteroposterior diameter (APD) of the most compressed level were studied. The most commonly affected segment was the T10–11 vertebral body level (n = 49, 27.1%) and the least affected segment was the T7–8 level (n = 1, 0.6%). The ratios of the CSA in non-fused and fused types were 77.3 and 59.3% (p < 0.001). When Modic changes were present with OLF, initial mJOA score was found to be significantly lower than those without Modic change (7.62 vs. 9.09, p = 0.033). Neurological status improved after decompressive laminectomy without fusion (preoperative vs. last mJOA; 7.1 ± 2.01 vs. 8.57 ± 1.91, p < 0.001). However, one patient exhibited transient deterioration of her neurological status after surgery. In the axial configuration, fused-type OLF revealed a significant risk for a decreased postoperative mJOA score (0–7, severe and moderate) (Odds ratio: 5.54, χ 2 = 4.41, p = 0.036, 95% CI: 1.014–30.256). The results indicated that the new categorization of axial-type of OLF is a helpful predictor of postoperative patient outcome and fused type was related with poor prognosis. In OLF cases free from ventral lesions compressing the spinal cord, decompressive laminectomy is enough for successful surgical outcome. Therefore, early surgical treatment will be considered in cases with fused-type OLF compressing spinal cord even though they do not have myelopathic symptoms.

Keywords

Thoracic Ossified ligamentum flavum Compressive myelopathy Axial type Laminectomy 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Sang Hoon Yoon
    • 1
    • 5
  • Wook Ha Kim
    • 1
    • 5
  • Sang-Bong Chung
    • 6
  • Yong Jun Jin
    • 1
    • 5
  • Kun Woo Park
    • 3
    • 5
  • Joon Woo Lee
    • 4
    • 5
  • Sang-Ki Chung
    • 1
    • 5
  • Ki-jeong Kim
    • 1
    • 5
  • Jin S. Yeom
    • 3
    • 5
  • Tae-Ahn Jahng
    • 2
  • Chun Kee Chung
    • 2
  • Heung Sik Kang
    • 4
  • Hyun-Jib Kim
    • 1
    • 5
  1. 1.Department of NeurosurgerySeoul National University Bundang Hospital, Seoul National University College of MedicineGyeonggi-doSouth Korea
  2. 2.Department of NeurosurgerySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of Orthopaedic SurgerySeoul National University Bundang Hospital, Seoul National University College of MedicineGyeonggi-doSouth Korea
  4. 4.Department of RadiologySeoul National University Bundang Hospital, Seoul National University College of MedicineGyeonggi-doSouth Korea
  5. 5.The Spine CenterSeoul National University Bundang HospitalGyeonggi-doSouth Korea
  6. 6.Department of NeurosurgeryThe Armed Forces Capital HospitalGyeonggi-doSouth Korea

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