Abstract
Introduction
Investigation of preoperative manifestations of thoracic myelopathy in a large population has not been reported. The aim of this study was to identify symptoms specific to anatomical pathology or compressed segments in thoracic myelopathy through investigation of preoperative manifestations.
Materials and methods
Subjects were 205 patients [143 men, 62 women; mean age, 62.2 (range 21–87 years)] with thoracic myelopathy who underwent surgery at our affiliate institutions from 2000 to 2011. The disease distribution included ossification of the ligamentum flavum (OLF) in 106 patients, ossification of the posterior longitudinal ligament (OPLL) in 17, OLF with OPLL in 17, intervertebral disc herniation (IDH) in 23, OLF with IDH in 3, and spondylosis in 39. We assessed (1) initial and preoperative complaints, (2) neurological findings, (3) Japanese Orthopaedic Association scores (JOA, full score, 11 points), (4) the compressed segments, and (5) preoperative duration. Multivariate analyses were performed to examine potential relationships between preoperative manifestations and anatomical pathology or compressed segments.
Results
The multivariate analyses revealed relationships between lower limb muscle weakness and T10/11 anterior compression; lower limb pain and T11/12 anterior compression; low back pain and T11/12 compression; and hyporeflexia in the patellar tendon reflex/foot drop and T12/L1 anterior compression.
Conclusion
This study elucidated symptoms specific to anatomical pathology or compressed segments in thoracic myelopathy. These relationships can be helpful in the initial investigation of thoracic diseases, although additional measures such as MRI or CT are necessary for definitive diagnosis.
Similar content being viewed by others
References
Yonenobu K, Ebara S, Fujiwara K, Yamashita K, Ono K, Yamamoto T, Harada N, Ogino H, Ojima S (1987) Thoracic myelopathy secondary to ossification of the spinal ligament. J Neurosurg 66(4):511–518
Ohtsuka K, Terayama K, Yanagihara M, Wada K, Kasuga K, Machida T, Matsushima S (1987) A radiological population study on the ossification of the posterior longitudinal ligament in the spine. Arch Orthop Trauma Surg 106(2):89–93
Toribatake Y, Baba H, Kawahara N, Mizuno K, Tomita K (1997) The epiconus syndrome presenting with radicular-type neurological features. Spinal Cord 35(3):163–170
Miyauchi A, Iwasaki M, Okuda S, Morita M, Kita K (2004) Symptoms for the patients with ossification of the ligamentum flavum. Bessatsu Seikeigeka 45:94–101
Yoon SH, Kim WH, Chung SB, Jin YJ, Park KW, Lee JW, Chung SK, Kim KJ, Yeom JS, Jahng TA, Chung CK, Kang HS, Kim HJ (2011) Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion. Eur Spine J 20(2):216–223
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
Matsumoto M, Toyama Y, Chikuda H, Takeshita K, Kato T, Shindo S, Abumi K, Takahata M, Nohara Y, Taneichi H, Tomita K, Kawahara N, Imagama S, Matsuyama Y, Yamazaki M, Okawa A (2011) Outcomes of fusion surgery for ossification of the posterior longitudinal ligament of the thoracic spine: a multicenter retrospective survey: clinical article. J Neurosurg Spine 15(4):380–385
Matsumoto M, Chiba K, Toyama Y, Takeshita K, Seichi A, Nakamura K, Arimizu J, Fujibayashi S, Hirabayashi S, Hirano T, Iwasaki M, Kaneoka K, Kawaguchi Y, Ijiri K, Maeda T, Matsuyama Y, Mikami Y, Murakami H, Nagashima H, Nagata K, Nakahara S, Nohara Y, Oka S, Sakamoto K, Saruhashi Y, Sasao Y, Shimizu K, Taguchi T, Takahashi M, Tanaka Y, Tani T, Tokuhashi Y, Uchida K, Yamamoto K, Yamazaki M, Yokoyama T, Yoshida M, Nishiwaki Y (2008) Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine: a multi-institutional retrospective study. Spine 33(9):1034–1041
Ando K, Imagama S, Wakao N, Hirano K, Tauchi R, Muramoto A, Kato F, Yukawa Y, Kawakami N, Sato K, Matsubara Y, Kanemura T, Matsuyama Y, Ishiguro N (2012) Examination of the influence of ossification of the anterior longitudinal ligament on symptom progression and surgical outcome of ossification of the thoracic ligamentum flavum: a multicenter study. J Neurosurg Spine 16(2):147–153
Anonymous (1994) Japanese orthopaedic association: scoring system for cervical myelopathy. Jpn J Orthop Assoc 68:490–503
Ando T (2002) Anatomy and symptomatology of the lower end of the spinal cord. Spine Spinal Cord 15(4):266–271
Otani K, Yoshida M, Fujii E, Nakai S, Shibasaki K (1988) Thoracic disc herniation: surgical treatment in 23 patients. Spine 13(11):1262–1267
Tokuhashi Y, Matsuzaki H, Uematsu Y, Oda H (2001) Symptoms of thoracolumbar junction disc herniation. Spine 26(22):E512–E518
Matsumoto M, Chiba K, Toyama Y (2002) Disc herniation at the thoracolumbar junction. Spine Spinal Cord 15(4):293–297
Soleiman J, Demaerel P, Rocher S, Maes F, Marchal G (2005) Magnetic resonance imaging study of the level of termination of the conus medullaris and the thecal sac: influence of age and gender. Spine 30(16):1875–1880
Wall EJ, Cohen MS, Abitbol JJ, Garfin SR (1990) Organization of intrathecal nerve roots at the level of the conus medullaris. J Bone Jt Surg Am 72(10):1495–1499
Murata Y, Kato Y, Miyamoto K, Takahashi K (2009) Clinical study of low back pain and radicular pain pathways by using l2 spinal nerve root infiltration: a randomized, controlled, clinical trial. Spine 34(19):2008–2013
Ohtori S, Nakamura S, Koshi T, Yamashita M, Yamauchi K, Inoue G, Orita S, Eguchi Y, Suzuki M, Ochiai N, Kishida S, Takaso M, Aoki Y, Kuniyoshi K, Nakamura J, Ishikawa T, Arai G, Miyagi M, Kamoda H, Suzuki M, Takahashi Y, Toyone T, Yamagata M, Takahashi K (2010) Effectiveness of L2 spinal nerve infiltration for selective discogenic low back pain patients. J Orthop Sci 15(6):731–736
Singh A, Crockard HA (1999) Quantitative assessment of cervical spondylotic myelopathy by a simple walking test. Lancet 354(9176):370–373
Miyakoshi N, Shimada Y, Suzuki T, Hongo M, Kasukawa Y, Okada K, Itoi E (2003) Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg 99(3 Suppl):251–256
Shiokawa K, Hanakita J, Suwa H, Saiki M, Oda M, Kajiwara M (2001) Clinical analysis and prognostic study of ossified ligamentum flavum of the thoracic spine. J Neurosurg 94(2 Suppl):221–226
Takei Y (1996) Posterior decompression surgery of thoracic myelopathy due to ossification of intraspinal canal ligaments. J Tokyo Med Coll 54:253–263
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Takenaka, S., Kaito, T., Hosono, N. et al. Neurological manifestations of thoracic myelopathy. Arch Orthop Trauma Surg 134, 903–912 (2014). https://doi.org/10.1007/s00402-014-2000-1
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-014-2000-1