A review of factors predictive of surgical outcome for ossification of the ligamentum flavum of the thoracic spine

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Object

Ossification of the ligamentum flavum (OLF) is a pathological condition that affects the ligament and causes slowly progressive myeloradiculopathy in adults. Although OLF has been regarded as endemic to East Asian countries, studies from outside these areas have increasingly been reported. Because of long-standing compression of the spinal cord by OLF, a patient’s functional prognosis may not always be favorable, and attempts have been made in recent studies to identify clinical factors that are predictive of the surgical outcome of patients with thoracic OLF.

Methods

The authors conducted a review of the literature published in the English, Japanese, and Korean languages. They examined studies in which correlation between clinical factors and outcome was statistically evaluated. The clinical factors included sex, age, level of the ossified ligamentum flavum, number of segments affected by OLF, coexisting ossification of the posterior longitudinal ligament (OPLL) or other spinal disorders, preoperative duration of symptoms, preoperative neurological score, computed tomography (CT)–based classification, and the presence of intramedullary high signal intensity on T2-weighted magnetic resonance images.

Conclusions

The clinical factors that are unlikely to be predictive of outcome include sex, age, level of the ossified lesion, number of OLF-affected segments, coexisting OPLL, CT classification, and the presence of high signal intensity. It is unclear whether the preoperative duration of symptoms or neurological score is predictive of outcome because the results have been inconsistent among the studies. Analysis of the more recent literature, however, suggests that these two factors are predictive of outcome. The use of a neurological score should be standardized so that compilation and comparison of data can be facilitated.

Abbreviations used in this paper:CT = computed tomography; JOA = Japanese Orthopaedic Association; MR = magnetic resonance; mRS = modified Rankin Scale; OLF = ossification of the ligamentum flavum; OPLL = ossification of the posterior longitudinal ligament.

Article Information

Address reprint requests to: Joji Inamasu, M.D., Ph.D., Department of Neurosurgery, University of South Florida College of Medicine, HMT Suite 730, 4 Columbia Drive, Tampa, Florida 33606. email: ginamasu@aol.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Classification of OLF into five subgroups based on axial CT scans. The following lesions are represented: lateral type (A), extended type (B), enlarged type (C), fused type (D), and tuberous type (E). Figure contains portion of figures that originally appeared in Miyakoshi N, Shimada Y, Suzuki T, Hongo M, Kasukawa Y, Okada K, et al: Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg 99 (3 Suppl):251–256, 2003. Reprinted with permission of the American Association of Neurological Surgeons.

  • View in gallery

    Classification of OLF into two subgroups based on sagittal MR images. The following schematically represented subtypes are shown: round (left) and beak (right). Figure contains portion of figures that originally appeared in Kuh SU, Kim YS, Cho YE, Jin BH, Kim KS, Yoon YS, et al: Contributing factors affecting the prognosis surgical outcome for thoracic OLF. Eur Spine J 15: 485–491, 2006. Reprinted with permission of Springer Verlag.

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