Skip to main content

Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament

European Spine Journal volume 19, pages 691–698 (2010)Cite this article

Abstract

We evaluated the clinical results of posterior decompression with instrumented fusion (PDF) for thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). A total of 24 patients underwent PDF, and their surgical outcomes were evaluated by the Japanese Orthopaedic Association (JOA) scores (0–11 points) and by recovery rates calculated at 3, 6, 9 and 12 months after surgery and at a mean final follow-up of 4 years and 5 months. The mean JOA score before surgery was 3.7 points. Although transient paralysis occurred immediately after surgery in one patient (3.8%), all patients showed neurological recovery at the final follow-up with a mean JOA score of 8.0 points and a mean recovery rate of 58.1%. The mean recovery rate at 3, 6, 9 and 12 months after surgery was 36.7, 48.8, 54.0 and 56.8%, respectively. The median time point that the JOA score reached its peak value was 9 months after surgery. No patient chose additional anterior decompression surgery via thoracotomy. The present findings demonstrate that despite persistent anterior impingement of the spinal cord by residual OPLL, PDF can result in considerable neurological recovery with a low risk of postoperative paralysis. Since neurological recovery progresses slowly after PDF, we suggest that additional anterior decompression surgery is not desirable during the early stage of recovery.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Ataka H, Tanno T, Yamazaki M (2009) Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. Eur Spine J 18:69–76

    Article  PubMed  Google Scholar 

  2. 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

    Article  CAS  PubMed  Google Scholar 

  3. Fujiyoshi T, Yamazaki M, Kawabe J et al (2008) A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line. Spine 33:E990–E993

    Article  PubMed  Google Scholar 

  4. Hanai K, Ogikubo O, Miyashita T (2002) Anterior decompression for myelopathy resulting from thoracic ossification of the posterior longitudinal ligament. Spine 27:1070–1076

    Article  PubMed  Google Scholar 

  5. Hasegawa K, Kaneda K, Abumi K, et al (1996) Operative indication of posterior decompression for thoracic ossification of the posterior longitudinal ligament. Investigation Committee Report on the Ossification of the Spinal Ligaments. Japanese Ministry of Health, Labour and Welfare, Tokyo, pp 305–309 (in Japanese)

  6. Kawahara N, Tomita 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

    Article  PubMed  Google Scholar 

  7. Masaki Y, Yamazaki M, Okawa A et al (2007) An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament: anterior decompression with spinal fusion versus laminoplasty. J Spinal Disord Tech 20:7–13

    Article  PubMed  Google Scholar 

  8. Matsumoto M, Chiba K, Toyama Y et al (2008) Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine: a multi-institutional retrospective study. Spine 33:1034–1041

    Article  PubMed  Google Scholar 

  9. 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 18:492–497

    Article  PubMed  Google Scholar 

  10. Min JH, Jang JS, Lee SH (2008) Clinical results of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine treated by anterior decompression. J Spinal Disord Tech 21:116–119

    Article  PubMed  Google Scholar 

  11. Mochizuki M, Aiba A, Hashimoto M et al (2009) Cervical myelopathy in patients with ossification of the posterior longitudinal ligament. J Neurosurg Spine 10:122–128

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  13. Takahata M, Ito M, Abumi K et al (2008) Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine 33:1199–1208

    Article  PubMed  Google Scholar 

  14. 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: usefulness of the ossification-kyphosis angle on MRI. Spine 31:E26–E30

    Article  PubMed  Google Scholar 

  15. 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

    Article  CAS  PubMed  Google Scholar 

  16. Yamazaki M, Koda M, Okawa A et al (2006) Transient paraparesis after laminectomy for thoracic ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum. Spinal Cord 44:130–134

    Article  CAS  PubMed  Google Scholar 

  17. Yamazaki M, Okawa A, Koda M et al (2005) Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of the posterior longitudinal ligament: a case report. Spine 30:E343–E346

    Article  PubMed  Google Scholar 

  18. Yamazaki M, Mochizuki M, Ikeda Y et al (2006) Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion. Spine 31:1452–1460

    Article  PubMed  Google Scholar 

  19. Yonenobu K, Ebara S, Fujiwara K et al (1987) Thoracic myelopathy secondary to ossification of the spinal ligament. J Neurosurg 66:511–518

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Professor Kazuhisa Takahashi (Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine) for his kind support in the present analysis. This work was supported by the Health Labour Science Research Grant of Japan.

Author information

Affiliations

  1. Spine Section, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan

    Masashi Yamazaki, Akihiko Okawa, Takayuki Fujiyoshi, Takeo Furuya & Masao Koda

Authors
  1. Masashi Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akihiko Okawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takayuki Fujiyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takeo Furuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masao Koda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masashi Yamazaki.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Yamazaki, M., Okawa, A., Fujiyoshi, T. et al. Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament. Eur Spine J 19, 691–698 (2010). https://doi.org/10.1007/s00586-009-1266-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-009-1266-4

Keywords

  • Thoracic myelopathy
  • Ossification of posterior longitudinal ligament
  • Kyphosis
  • Spinal mobility
  • Instrumented fusion