Outcomes of fusion surgery for ossification of the posterior longitudinal ligament of the thoracic spine: a multicenter retrospective survey

Clinical article

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  • 1 Department of Orthopedic Surgery, Keio University;
  • 2 Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo;
  • 3 Department of Orthopaedic Surgery, Tokyo Medical and Dental University;
  • 4 Department of Orthopaedic Surgery, Kudanzaka Hospital, Tokyo;
  • 5 Departments of Spinal Reconstruction and
  • 6 Orthopaedics, Hokkaido University Graduate School of Medicine, Sapporo;
  • 7 Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi;
  • 8 Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa;
  • 9 Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya;
  • 10 Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizouka; and
  • 11 Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Object

The aim of this study was to evaluate the outcomes of fusion surgery in patients with ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) and to identify factors significantly related to surgical outcomes.

Methods

The study included 76 patients (34 men and 42 women with a mean age of 56.3 years) who underwent fusion surgery for T-OPLL at 7 spine centers during the 5-year period from 2003 to 2007. The authors evaluated the patient demographic data, underlying disease, preoperative comorbidities, history of spinal surgery, radiological findings, surgical methods, surgical outcomes, and complications. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score for thoracic myelopathy (11 points) and the recovery rate.

Results

The mean JOA scale score was 4.6 ± 2.1 points preoperatively and 7.7 ± 2.5 points at the time of the final follow-up examination, yielding a mean recovery rate of 45.4% ± 39.1%. The recovery rates by surgical method were 38.5% ± 37.8% for posterior decompression and fusion, 65.0% ± 35.6% for anterior decompression and fusion via an anterior approach, 28.8% ± 41.2% for anterior decompression via a posterior approach, and 57.5% ± 41.1% for circumferential decompression and fusion. The recovery rate was significantly higher in patients without diabetes mellitus (DM) than in those with DM. One or more complications were experienced by 31 patients (40.8%), including 20 patients with postoperative neurological deterioration, 7 with dural tears, 5 with epidural hematomas, 4 with respiratory complications, and 10 with other complications.

Conclusions

The outcomes of fusion surgery for T-OPLL were favorable. The absence of DM correlated with better outcomes. However, a high rate of complications was associated with the fusion surgery.

Abbreviations used in this paper: DM = diabetes mellitus; JOA = Japanese Orthopaedic Association; T-OPLL = ossification of the posterior longitudinal ligament in the thoracic spine.

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Contributor Notes

Address correspondence to: Morio Matsumoto, M.D., Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. email: morio@sc.itc.keio.ac.jp.

Please include this information when citing this paper: published online July 8, 2011; DOI: 10.3171/2011.6.SPINE10816.

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