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Indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine: is it possible to predict the surgical results?

European Spine Journal volume 18, pages 943–948 (2009)Cite this article

Abstract

To investigation of the outcomes of indirect posterior decompression with corrective fusion for myelopathy associated with thoracic ossification of the longitudinal ligament, and prognostic factors. Conservative treatment for myelopathy associated with thoracic ossification of the longitudinal ligament (OPLL) is mostly ineffective, and treatment is necessary. However, many authors have reported poor surgical outcomes, and no standard surgical procedure has been established. We have been performing indirect spinal cord decompression by posterior laminectomy and simultaneous corrective fusion of the thoracic kyphosis. Twenty patients underwent indirect posterior decompression with corrective fusion, and were included in this study. The follow-up period was minimum 2 years and averaged 2 years and 9 months (2–5 years 6 months). Operative results were examined using JOA scoring system (full marks: 11 points) and Hirabayashi’s recovery rate, as excellent (100–75%), good (74–50%), fair (49–25%), unchanged (24–0%) and deteriorated (i.e., decrease in score less than 0%). Cases in which the spinal cord is floating from OPLL on intraoperative ultrasonography were defined as the floating (+) group, and those without floating as the floating (−) group. In addition, we used compound muscle action potentials (CMAP) as intraoperative spinal cord monitoring and the cases were divided into three groups: Group A, no change in potential; Group B, potential decreased, and Group C, potential improved. The mean pre- and postoperative JOA scores were 6.2 and 8.9 points, respectively, and the recovery rate was 56%. The outcome was rated excellent in three, good in eight, fair in six, unchanged in two, and deteriorated in one. The mean preoperative thoracic kyphosis measured 58°, and was corrected to 51° after surgery. On intraoperative ultrasonography, 12 cases were included in the floating (+) and 8 in the floating (−) groups; the recovery rates were 58 and 52%, respectively, showing no significant difference between the recovery rates of the two groups. Regarding intraoperative CMAP, the outcome was excellent in one, good in seven, fair in four, and unchanged in one in Group A; fair in one, unchanged in one, and deteriorated in one in Group B, and excellent in two and good in one in Group C. The recovery rates were 50, 48 and 68.3% in Groups A, B and C, respectively, showing that the postoperative outcome was significantly poorer in Group B. Although indirect posterior decompression with corrective fusion using instruments obtained satisfactory outcomes, not all cases achieved good outcomes using this procedure. We consider that additional application of anterior decompressive fusion is preferable when improvement of symptoms occurs not satisfactory after indirect posterior decompression with corrective fusion using instruments. Intraoperative spinal cord monitoring of CMAP demonstrated that the spinal cord was already impaired during the laminectomy via the posterior approach. Concomitant intraoperative monitoring of CMAP to avoid impairment of the vulnerable spinal cord and corrective posterior spinal fusion with indirect spinal cord decompression is recommendable as a method capable of preventing postoperative neurological aggravation.

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References

  1. Fujimura Y, Nishi Y, Nakamura M et al (1997) Long-term follow up study of anterior decompression and fusion for thoracic myelopathy resulting from ossification of the posterior longitudinal ligament. Spine 22:305–311. doi:10.1097/00007632-199702010-00015

    PubMed  Article  CAS  Google Scholar 

  2. Kawahara N, Tomito K, Murakami H et al (2008) Circumspinal decompression with dekyphosis stabilization for thoracic myelopathy due to ossification of the posterior longitudinal ligament. Spine 33:39–46

    PubMed  Article  Google Scholar 

  3. Matsuyama Y, Sato K, Kawakami N (2000) Thoracic ossification of posterior longitudinal ligament—evaluation of postoperative deteriorated cases. Rinsho Seikeigeka 35:39–46 (in Japanese)

    Google Scholar 

  4. Matsuyama Y, Tuji T, Yoshihara H et al (2004) Thoracic ossification of posterior longitudinal ligament intraoperative spinal cord monitoring. Besatsu Seikeigeka 45:110–119 (in Japanese)

    Google Scholar 

  5. Matsuyama Y, Yoshihara H, Tsuji T et al (2005) Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options. J Spinal Disord Tech 18(6):492–497. doi:10.1097/01.bsd.0000155033.63557.9c

    PubMed  Article  Google Scholar 

  6. Matsuyama Y, Yoshihara H, Sakai Y et al (2006) The effectiveness of intraoperative CMAP monitoring for intramedurally spinal cord tumor and thoracic OPLL. Spine Spinal Cord 19:41–48 (in Japanese)

    Google Scholar 

  7. Matsuyama Y, Yoshihara H, Tsuji T et al. (2006) Surgical treatment for ossification of the posterior longitudinal ligament of the thoracic spine: outcomes of one-stage posterior decompression with corrective fusion surgery. OPLL, 2nd edn. Springer, Heidelberg, pp 259–264

  8. Matsuyama Y, Tsuji T, Yoshihara H, et al. (2006) Surgical treatment of thoracic ossification of the posterior longitudinal ligament: intraoperative spinal cord monitoring. OPLL, 2nd edn. Springer, Heidelberg, pp 279–286

  9. Nakagawa Y, Tamaki T, Yamada H et al (2002) Discrepancy between decrease in the amplitude of compound muscle action potential and loss of motor function caused by ischemic and compressive insults to the spinal cord. J Orthop Sci 7:102–110. doi:10.1007/s776-002-8430-x

    PubMed  Article  Google Scholar 

  10. Ohtani K, Nakai S, Fujimura Y et al (1982) Anterior surgical decompression for thoracic myelopathy as the result of ossification for the posterior longitudinal ligament. Clin Orthop Relat Res 166:82–88

    PubMed  Google Scholar 

  11. Ohotsuka K, Terayama K, Tsuchiya S (1983) Anterior decompression via posterior approach for the spinal cord in the thoracic lesion. Orthop Surg Traumatol 26:1083–1090 (in Japanese)

    Google Scholar 

  12. Tokuhashi Y, Matsuzaki H, Oda H et al (2006) Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine. Spine 31:26–30. doi:10.1097/01.brs.0000193940.75354.e5

    Article  Google Scholar 

  13. Tomita K, Kawahara N, Baba H et al (1990) Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and ligamentum flavum. Spine 15:1114–1120. doi:10.1097/00007632-199011010-00006

    PubMed  Article  CAS  Google Scholar 

  14. Tsuzuki N, Hirabayashi S, Abe R et al (2001) Staged spinal cord decompression through posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine 26:1623–1630. doi:10.1097/00007632-200107150-00025

    PubMed  Article  CAS  Google Scholar 

  15. Yamasaki M, Akihiko Okawa, Masao Koda et al (2005) Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of posterior longitudinal ligament. Spine 30:343–346. doi:10.1097/01.brs.0000166504.31627.06

    Article  Google Scholar 

  16. Yonenobu K, Korkusuz F, Hosono N et al (1990) Lateral rhachotomy for thoracic spinal lesions. Spine 15:1121–1125. doi:10.1097/00007632-199011010-00007

    PubMed  Article  CAS  Google Scholar 

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Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Nagoya University, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan

    Yukihiro Matsuyama, Yoshihito Sakai, Yoshito Katayama, Shiro Imagama, Zenya Ito, Norimitsu Wakao, Yasutsugu Yukawa, Keigo Ito, Mitsuhiro Kamiya, Tokumi Kanemura, Koji Sato & Naoki Ishiguro

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  1. Yukihiro Matsuyama
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  2. Yoshihito Sakai
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Correspondence to Yukihiro Matsuyama.

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Matsuyama, Y., Sakai, Y., Katayama, Y. et al. Indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine: is it possible to predict the surgical results?. Eur Spine J 18, 943–948 (2009). https://doi.org/10.1007/s00586-009-0956-2

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  • DOI: https://doi.org/10.1007/s00586-009-0956-2

Keywords

  • Ossification of the posterior longitudinal ligament
  • Thoracic myelopathy
  • Spinal cord monitoring
  • Intraoperative ultrasonography