Surgery-related predictable risk factors influencing postoperative clinical outcomes for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a multicenter retrospective study

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  • 1 Department of Orthopedic Surgery, Graduate School of Medical Sciences;
  • 2 Department of Immunobiology and Neuroscience, Medical Institute of Bioregulation, Kyushu University, Fukuoka;
  • 3 Department of Orthopedic Surgery, Kyushu University Beppu Hospital, Oita;
  • 4 Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka;
  • 5 Oita Orthopedic Hospital, Oita;
  • 6 Shimonoseki City Hospital, Yamaguchi;
  • 7 Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Fukuoka;
  • 8 Department of Orthopedic Surgery, National Hospital Organization, Kyushu Medical Center, Fukuoka;
  • 9 Department of Orthopedic Surgery, Kyushu Rosai Hospital, Fukuoka;
  • 10 Department of Orthopedic Surgery, Kyushu Central Hospital, Fukuoka;
  • 11 Department of Orthopedic Surgery, Fukuoka City Hospital, Fukuoka; and
  • 12 Department of Orthopedic Surgery, Sada Hospital, Fukuoka, Japan

OBJECTIVE

Compression of the spinal cord by thoracic ossification of the posterior longitudinal ligament (T-OPLL) often causes severe thoracic myelopathy. Although surgery is the most effective treatment for T-OPLL, problems associated with surgical intervention require resolution because surgical outcomes are not always favorable, and a small number of patients experience deterioration of their neurological status after surgery. The aim of the present study was to examine the surgery-related risk factors contributing to poor clinical outcomes for myelopathy caused by T-OPLL.

METHODS

Data were extracted from the records of 55 patients with thoracic myelopathy due to T-OPLL at institutions in the Fukuoka Spine Group. The mean follow-up period was 5.3 years. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale. To investigate the definitive factors associated with surgical outcomes, univariate and multivariate regression analyses were performed with several patient-related and surgery-related factors, including preoperative comorbidities, radiological findings, JOA score, surgical methods, surgical outcomes, and complications.

RESULTS

Neurological status improved in 33 patients (60.0%) and deteriorated in 10 patients (18.2%) after surgery. The use of instrumentation was significantly associated with an improved outcome. In the comparison of surgical approaches, posterior decompression and fusion resulted in a significantly higher neurological recovery rate than did anterior decompression via a posterior approach and fusion or decompression alone. It was also found that postoperative neurological status was significantly poorer when there were fewer instrumented spinal levels than decompression levels. CSF leakage was a predictable risk factor for deterioration following surgery.

CONCLUSIONS

It is important to identify preventable risk factors for poor surgical outcomes for T-OPLL. The findings of the present study suggest that intraoperative CSF leakage and a lower number of instrumented spinal fusion levels than decompression levels were exacerbating factors for the neurological improvement in T-OPLL surgery.

ABBREVIATIONS JOA = Japanese Orthopaedic Association; OLF = ossification of the ligamentum flavum; OPLL = ossification of the posterior longitudinal ligament; T-OPLL = thoracic OPLL.

Contributor Notes

Correspondence Hirokazu Saiwai: Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. hsaiwai@med.kyushu-u.ac.jp.

INCLUDE WHEN CITING Published online December 27, 2019; DOI: 10.3171/2019.10.SPINE19831.

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

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