Connection of discontinuous segments in early functional recovery from thoracic ossification of the posterior longitudinal ligament treated with posterior instrumented surgery

View More View Less
  • Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The objective of this study was to investigate the relationship between morphological changes in thoracic ossification of the posterior longitudinal ligament (T-OPLL) and postoperative neurological recovery after thoracic posterior fusion surgery. Changes of OPLL morphology and postoperative recovery in cases with T-OPLL have not been examined.

METHODS

In this prospective study, the authors evaluated data from 44 patients (23 male and 21 female) who underwent posterior decompression and fusion surgery with instrumentation for the treatment of T-OPLL at our hospital. The patients’ mean age at surgery was 50.7 years (range 38–68 years). The minimum duration of follow-up was 2 years. The location of thoracic ossification of the ligamentum flavum (T-OLF), T-OLF at the OPLL level, OPLL morphology, fusion range, estimated blood loss, operative time, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, and JOA recovery rate were investigated. Reconstructed sagittal multislice CT images were obtained before and at 3 and 6 months and 1 and 2 years after surgery. The basic fusion area was 3 vertebrae above and below the OPLL lesion. All parameters were compared between patients with and without continuity across the disc space at the OPLL at 3 and 6 months after surgery.

RESULTS

The preoperative morphology of OPLL was discontinuous across the disc space between the rostral and caudal ossification regions on sagittal CT images in all but one of the patients. Postoperatively, these segments became continuous in 42 patients (97.7%; occurring by 6.6 months on average) without progression of OPLL thickness. Patients with continuity at 3 months had significantly lower rates of diabetes mellitus (p < 0.05) and motor palsy in the lower extremities (p < 0.01). The group with continuity also had significantly higher mean postoperative JOA scores at 3 (p < 0.01) and 6 (p < 0.05) months and mean JOA recovery rates at 3 and 6 months (both p < 0.01) after surgery.

CONCLUSIONS

Preoperatively, discontinuity of rostral and caudal ossified lesions was found on CT in all patients but one of this group of 44 patients who needed surgery for T-OPLL. Rigid fixation with instrumentation may have allowed these segments to connect at the OPLL. Such OPLL continuity at an early stage after surgery may accelerate spinal cord recovery.

ABBREVIATIONS

BMI = body mass index; DM = diabetes mellitus; EBL = estimated blood loss; JOA = Japanese Orthopaedic Association; MHLW = Ministry of Health, Labor and Welfare; OLF = ossification of the ligamentum flavum; OPLL = ossification of the posterior longitudinal ligament; T-OLF = thoracic OLF; T-OPLL = thoracic OPLL.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Shiro Imagama: Nagoya University Graduate School of Medicine, Aichi, Japan. imagama@med.nagoya-u.ac.jp.

INCLUDE WHEN CITING Published online November 8, 2019; DOI: 10.3171/2019.8.SPINE19604.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Ando K, Imagama S, Ito Z, Kobayashi K, Ukai J, Muramoto A, et al. : Radiologic evaluation after posterior instrumented surgery for thoracic ossification of the posterior longitudinal ligament: union between rostral and caudal ossifications. J Spinal Disord Tech 27:181184, 2014

    • Search Google Scholar
    • Export Citation
  • 2

    Ando K, Imagama S, Kobayashi K, Hida T, Ito K, Tsushima M, et al. : Comparative study of surgical treatment and nonsurgical follow up for thoracic ossification of the posterior longitudinal ligament: radiological and clinical evaluation. Spine (Phila Pa 1976) 42:407410, 2017

    • Search Google Scholar
    • Export Citation
  • 3

    Gortler H, Rusyn J, Godbout C, Chahal J, Schemitsch EH, Nauth A: Diabetes and healing outcomes in lower extremity fractures: a systematic review. Injury 49:177183, 2018

    • Search Google Scholar
    • Export Citation
  • 4

    Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K: Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 6:354364, 1981

    • Search Google Scholar
    • Export Citation
  • 5

    Imagama S, Ando K, Ito Z, Kobayashi K, Hida T, Ito K, et al. : Risk factors for ineffectiveness of posterior decompression and dekyphotic corrective fusion with instrumentation for beak-type thoracic ossification of the posterior longitudinal ligament: a single institute study. Neurosurgery 80:800808, 2017

    • Search Google Scholar
    • Export Citation
  • 6

    Imagama S, Ando K, Kobayashi K, Hida T, Ito K, Tsushima M, et al. : Atypical vertebral column fracture at the middle of fused area after instrumented posterior decompression and fusion surgery for beak type thoracic ossification of the posterior longitudinal ligament. J Orthop Sci 23:11001104, 2018

    • Search Google Scholar
    • Export Citation
  • 7

    Imagama S, Ando K, Kobayashi K, Hida T, Ito K, Tsushima M, et al. : Factors for a good surgical outcome in posterior decompression and dekyphotic corrective fusion with instrumentation for thoracic ossification of the posterior longitudinal ligament: prospective single-center study. Oper Neurosurg (Hagerstown) 13:661669, 2017

    • Search Google Scholar
    • Export Citation
  • 8

    Imagama S, Ando K, Takeuchi K, Kato S, Murakami H, Aizawa T, et al. : Perioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study. Spine (Phila Pa 1976) 43:E1389E1397, 2018

    • Search Google Scholar
    • Export Citation
  • 9

    Imagama S, Ito Z, Ando K: [Tips for good surgical results of indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine.] Rinsho Seikei Geka 47:829835, 2012 (Japanese)

    • Search Google Scholar
    • Export Citation
  • 10

    Iwasaki M, Kawaguchi Y, Kimura T, Yonenobu K: Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg 96 (2 Suppl):180189, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Kawaguchi Y, Kanamori M, Ishihara H, Ohmori K, Nakamura H, Kimura T: Minimum 10-year followup after en bloc cervical laminoplasty. Clin Orthop Relat Res (411):129139, 2003

    • Search Google Scholar
    • Export Citation
  • 12

    Martyn CN, Hughes RA: Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry 62:310318, 1997

  • 13

    Matsumoto M, Chiba K, Toyama Y, Takeshita K, Seichi A, Nakamura K, et al. : Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine: a multi-institutional retrospective study. Spine (Phila Pa 1976) 33:10341041, 2008

    • Search Google Scholar
    • Export Citation
  • 14

    Matsuyama Y, Sakai Y, Katayama Y, Imagama S, Ito Z, Wakao N, 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 18:943948, 2009

    • Search Google Scholar
    • Export Citation
  • 15

    Matsuyama Y, Yoshihara H, Tsuji T, Sakai Y, Yukawa Y, Nakamura H, et al. : 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 18:492498, 2005

    • Search Google Scholar
    • Export Citation
  • 16

    Yamazaki M, Koda M, Okawa A, Aiba A: Transient paraparesis after laminectomy for thoracic ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum. Spinal Cord 44:130134, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Yamazaki M, Mochizuki M, Ikeda Y, Sodeyama T, Okawa A, Koda M, et al. : Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion. Spine (Phila Pa 1976) 31:14521460, 2006

    • Search Google Scholar
    • Export Citation
  • 18

    Yamazaki M, Okawa A, Fujiyoshi T, Furuya T, Koda M: Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament. Eur Spine J 19:691698, 2010

    • Search Google Scholar
    • Export Citation
  • 19

    Yamazaki M, Okawa A, Koda M, Goto S, Minami S, Moriya H: Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of the posterior longitudinal ligament: a case report. Spine (Phila Pa 1976) 30:E343E346, 2005

    • Search Google Scholar
    • Export Citation
  • 20

    Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K: Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976) 26:18901895, 2001

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 611 269 6
Full Text Views 114 52 8
PDF Downloads 125 40 9
EPUB Downloads 0 0 0