Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients

Toshimi Aizawa M.D., Ph.D., Tetsuro Sato M.D., Ph.D., Hirotoshi Sasaki M.D., Fujio Matsumoto M.D., Ph.D., Naoki Morozumi M.D., Takashi Kusakabe M.D., Eiji Itoi M.D., Ph.D., and Shoichi Kokubun M.D., Ph.D.
View More View Less
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

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

USD  $612.00
Print or Print + Online

Object

Thoracic myelopathy is uncommon compared with cervical myelopathy. In this study, data obtained in patients with thoracic myelopathy caused by degenerative processes of the spine were retrospectively analyzed to clarify the surgical outcomes and to examine the various factors affecting the postoperative improvement.

Methods

Between 1988 and 2002, 132 patients with thoracic myelopathy underwent surgery and a minimum 2-year observation period. Clinical data were collected from medical and operative records, and sagittal alignment of the spine was measured on radiographs. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors affecting the preoperative severity of myelopathy and postoperative improvement were also examined.

Results

The population consisted of 97 men (mean age at surgery was 58 years) and 35 women (mean age at surgery 62 years). Myelopathy was caused by ossification of the ligamentum flavum (OLF) in 73 patients, ossification of the posterior longitudinal ligament (OPLL) in 21, combined OLF–OPLL in 10, intervertebral disc herniation (IDH) in 15, posterior bone spur in 11, and OLF with IDH or posterior bone spur in one patient each. The surgical outcome was relatively good: a mean preoperative JOA score of 5.3 improved to a mean score of 7.8 at the last follow-up, 50 months on average after surgery. Thoracic myelopathy caused by OPLL, however, was associated with lower postoperative scores and recovery rates. In more than half of the patients the authors documented an increase of kyphosis of less than 2°.

Conclusions

Patients with a shorter preoperative duration of symptoms and milder myelopathy experienced significantly better postoperative neurological conditions, which indicated that those who present earlier with fewer disabilities should be recommended to undergo surgery in time, although the surgical treatment for OPLL still involves many problems.

Abbreviations used in this paper:

IDH = intervertebral disc herniation; JOA = Japanese Orthopaedic Association; OLF = ossification of the ligamentum flavum; OPLL = ossification of the posterior longitudinal ligament; PBS = posterior bone spur.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

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

USD  $612.00
  • 1

    Abumi K, , Panjabi MM, , Kramer KM, , Duranceau J, , Oxland T, & Crisco JJ: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 15:11421147, 1990

    • Search Google Scholar
    • Export Citation
  • 2

    Aizawa T, , Sato T, , Sasaki H, , Kusakabe T, , Morozumi N, & Kokubun S: Thoracic myelopathy caused by ossification of the ligamentum flavum: its clinical features and surgical results in the Japanese population. J Neurosurg Spine 5:515519, 2006

    • Search Google Scholar
    • Export Citation
  • 3

    Aizawa T, , Sato T, , Tanaka Y, , Ozawa H, , Hoshikawa T, & Ishii Y, et al.: Thoracic myelopathy in Japan: epidemiological retrospective study in Miyagi prefecture during 15 years. Tohoku J Exp Med 210:199208, 2006

    • Search Google Scholar
    • Export Citation
  • 4

    Fujimura Y, , Nishi Y, , Nakamura M, , Toyama Y, & Suzuki N: Long-term follow-up study of anterior decompression and fusion for thoracic myelopathy resulting from ossification of the posterior longitudinal ligament. Spine 22:305311, 1997

    • Search Google Scholar
    • Export Citation
  • 5

    Fong SY, & Wong HK: Thoracic myelopathy secondary to ligamentum flavum ossification. Annals Acad Med 33:340346, 2004

  • 6

    Japanese Orthopaedic Association: [Scoring system for cervical myelopathy.]. Jpn J Orthop Assoc 68:490503, 1994. (Jpn)

  • 7

    Kokubun S, , Kashimoto O, , Ozawa H, , Hashimoto Y, , Kikawa A, & Gomibuchi S, et al.: [Anterior decompression in the thoracic spine through a diagonal antero-posterior approach.]. Tohoku Archives Orthop Surg Traumatol 35:7174, 1991. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 8

    Kokubun S, , Sato S, , Ishii Y, & Tanaka Y: Cervical myelopathy in the Japanese. Clin Orthop Relat Res 323:129138, 1996

  • 9

    Liao CC, , Chen TY, , Jung SM, & Chen LR: Surgical experience with symptomatic thoracic ossification of the ligamentum flavum. J Neurosurg Spine 2:3439, 2005

    • Search Google Scholar
    • Export Citation
  • 10

    Lesoin F, , Rousseaux M, , Autricque A, , Reesaul Y, , Villette L, & Clarisse J, et al.: Thoracic disc herniations: evolution in the approach and indications. Acta Neurochir (Wien) 80:3034, 1986

    • Search Google Scholar
    • Export Citation
  • 11

    Matsumoto M, , Chiba K, , Ishikawa M, , Maruiwa H, , Fujimura Y, & Toyama Y: Relationships between outcomes of conservative treatment and magnetic resonance imaging findings in patients with mild cervical myelopathy caused by soft disc herniations. Spine 26:15921598, 2001

    • Search Google Scholar
    • Export Citation
  • 12

    Matsuyama Y, , Sato K, , Kawakami N, & Iwata H: [Thoracic ossification of posterior longitudinal ligament; evaluation of postoperative deteriorated cases.]. Clin Orthop Surg 35:3946, 2000. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 13

    Mitra SR, , Gurjar SG, & Mitra KR: Degenerative disease of the thoracic spine in central India. Spinal Cord 34:333337, 1996

  • 14

    Ohtsuka K, , Terayama K, , Tsuchiya T, , Wada K, , Furukawa K, & Ohkubu M: [A surgical procedure of the anterior decompression of the thoracic spinal cord through the posterior approach.]. Orthop Surg Traumatol 26:10831090, 1983. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 15

    Otani K, , Yoshida M, , Fujii E, , Nakai S, & Shibasaki K: Thoracic disc herniation. Surgical treatment in 23 patients. Spine 13:12621267, 1988

    • Search Google Scholar
    • Export Citation
  • 16

    Polgár F: Über interakuelle wirbelverkalkung. Fortschr Geb Rontgenstr Nuklearmed Erganzungsband 40:292298, 1920

  • 17

    Rogers WA: Treatment of fracture-dislocation of the cervical spine. J Bone Joint Surg Am 24:245258, 1942

  • 18

    Sato T: [Operative method for thoracic myelopathy based on each spinal pathological factor.]. Orthop Surg Traumatol 46:523531, 2003. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 19

    Sato T, , Kokubun S, & Ishii Y: [Choice of operative method for ossification of ligamentum flavum based on CT findings.]. Clin Orthop Surg 31:541545, 1996. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 20

    Sato T, , Kokubun S, , Tanaka Y, & Ishii Y: Thoracic myelopathy in the Japanese: epidemiological and clinical observations on the cases in Miyagi Prefecture. Tohoku J Exp Med 184:111, 1997

    • Search Google Scholar
    • Export Citation
  • 21

    Sato T, , Tanaka Y, , Aizawa T, , Koizumi Y, & Kokubun S: [Surgical treatment for ossification of ligamentum flavum in the thoracic spine and its complications.]. Spine Spinal Cord 11:505510, 1998. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 22

    Shiokawa K, , Hanakita J, , Suwa H, , Saiki M, , Oda M, & Kajiwara M: Clinical analysis and prognostic study of ossified ligamentum flavum of the thoracic spine. J Neurosurg 94:2 Suppl 221226, 2001

    • Search Google Scholar
    • Export Citation
  • 23

    Shiraishi T, , Fukuda K, , Yato Y, , Nakamura M, & Ikegami T: Results of skip laminectomy—minimum 2-year follow-up study, compared with open-door laminoplasty. Spine 28:26672672, 2003

    • Search Google Scholar
    • Export Citation
  • 24

    Smith DE, & Godersky JC: Thoracic spondylosis: an unusual cause of myelopathy. Neurosurgery 20:589593, 1987

  • 25

    Stillerman CB, & Weiss MH: Management of thoracic disc disease. Clin Neurosurg 38:325352, 1992

  • 26

    Takayama H, , Muratsu H, , Doita M, , Harada T, , Kurosaka M, & Yoshiya S: Proprioceptive recovery of patients with cervical myelopathy after surgical decompression. Spine 30:10391044, 2005

    • Search Google Scholar
    • Export Citation
  • 27

    Tanaka Y, , Kokubun S, , Sato T, & Ishii Y: [Changes on spine and spinal cord lesions in frequencies of their surgeries; an observation based on the registered cases for 14 years.]. Orthop Surg Traumatol 46:391398, 2003. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 28

    Tomita K, , Kawahara N, , Baba H, , Kikuchi Y, & Nishimura H: Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and ligamentum flavum. Spine 15:11141120, 1990

    • Search Google Scholar
    • Export Citation
  • 29

    Trivedi P, , Behari S, , Paul L, , Banerji D, , Jain VK, & Chhabra DK: Thoracic myelopathy secondary to ossified ligamentum flavum. Acta Neurochir (Wien) 143:775782, 2001

    • Search Google Scholar
    • Export Citation
  • 30

    Tsuzuki N, , Hirabayashi S, , Abe R, & Saiki K: Staged spinal cord de-compression through posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine 26:16231630, 2001

    • Search Google Scholar
    • Export Citation
  • 31

    Vanichkachorn JS, & Vaccaro A: Thoracic disk disease: diagnosis and treatment. J Am Acad Orthop Surg 8:159169, 2000

  • 32

    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 31:14521460, 2006

    • Search Google Scholar
    • Export Citation
  • 33

    Yonenobu K, , Ebara S, , Fujiwara K, , Yamashita K, , Ono K, & Yamamoto T, et al.: Thoracic myelopathy secondary to ossification of the spinal ligament. J Neurosurg 66:511518, 1987

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1278 360 22
Full Text Views 252 48 2
PDF Downloads 209 46 2
EPUB Downloads 0 0 0