Several pathologies cause delayed postoperative paralysis following posterior decompression and spinal fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament

2019 ◽  
Author(s):  
Toshimitsu Eto ◽  
Toshimi Aizawa ◽  
Haruo Kanno ◽  
Ko Hashimoto ◽  
Eiji Itoi ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Posterior Longitudinal Ligament ◽  
Thoracic Myelopathy ◽  
Posterior Decompression

Microsurgical resection of ossification of the posterior longitudinal ligament in the thoracic spine via the transthoracic approach without spinal fusion: case series and technical note

2019 ◽  
Vol 31 (3) ◽  
pp. 326-333
Author(s):  
Ryo Kanematsu ◽  
Junya Hanakita ◽  
Toshiyuki Takahashi ◽  
Yosuke Tomita ◽  
Manabu Minami
Keyword(s):  
Spinal Cord ◽  
Spinal Fusion ◽  
Thoracic Spine ◽  
Posterior Longitudinal Ligament ◽  
Anterolateral Approach ◽  
Thoracic Myelopathy ◽  
Kyphotic Angle ◽  
Thoracic Spinal Cord ◽  
Csf Leakage ◽  
The Mean

OBJECTIVESurgical management of thoracic ossification of the posterior longitudinal ligament (OPLL) remains challenging because of the anatomical complexity of the thoracic spine and the fragility of the thoracic spinal cord. Several surgical approaches have been described, but it remains unclear which of these is the most effective. The present study describes the microsurgical removal of OPLL in the middle thoracic level via the transthoracic anterolateral approach without spinal fusion, including the surgical outcome and operative tips.METHODSBetween 2002 and 2017, a total of 8 patients with thoracic myelopathy due to OPLL were surgically treated via the transthoracic anterolateral approach without spinal fusion. The surgical techniques are described in detail. Clinical outcome, surgical complications, and the pre- and postoperative thoracic kyphotic angle were assessed.RESULTSThe mean patient age at the time of surgery was 55 years (range 47–77 years). There were 5 women and 3 men. The surgically treated levels were within T3–9. The clinical symptoms and Japanese Orthopaedic Association (JOA) score improved postoperatively in 7 cases, but did not change in 1 case. The mean JOA score increased from 6.4 preoperatively to 7.5 postoperatively (recovery rate 26%). Intraoperative CSF leakage occurred in 4 cases, and was successfully treated with fibrin glue sealing and spinal drainage. The mean follow-up period was 82.6 months (range 15.3–169 months). None of the patients had deterioration of the thoracic kyphotic angle.CONCLUSIONSAnterior decompression is the logical and ideal procedure to treat thoracic myelopathy caused by OPLL on the concave side of the spinal cord; however, this procedure is technically demanding. Microsurgery via the transthoracic anterolateral approach enables direct visualization of the thoracic ventral ossified lesion. The use of microscopic procedures might negate the need for bone grafting or spinal instrumentation.

Surgical results of nonambulatory patients caused by ossification of the posterior longitudinal ligaments in the thoracic spine: retrospective comparative study between posterior decompression and instrumented spinal fusion versus anterior decompression through a posterior approach

2020 ◽  
pp. 1-6
Author(s):  
Toshimi Aizawa ◽  
Toshimitsu Eto ◽  
Ko Hashimoto ◽  
Haruo Kanno ◽  
Eiji Itoi ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Posterior Approach ◽  
Japanese Orthopaedic Association ◽  
Case Series ◽  
Walking Ability ◽  
Surgical Results ◽  
Anterior Decompression ◽  
Thoracic Myelopathy ◽  
Retrospective Case ◽  
Posterior Decompression

OBJECTIVEThoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) remains one of the most difficult-to-treat disorders for spine surgeons. In Japan, approximately 75% of patients with this condition are treated using posterior decompression with instrumented spinal fusion (PDF). In contrast, anterior decompression is the most effective method for relieving spinal cord compression. The authors treated nonambulatory patients with thoracic OPLL by either PDF or by their technique using anterior decompression through a posterior approach. In this study the surgical results of these procedures are compared.METHODSThis was a retrospective case series. From 2008 to 2018, 9 patients with thoracic OPLL who could not walk preoperatively were treated surgically. Three patients were treated by PDF (the PDF group) and 6 patients were treated by anterior decompression through a posterior approach (the modified Ohtsuka group). The degree of surgical invasion and the neurological conditions of the patients were assessed.RESULTSThe PDF group had a shorter operative duration (mean 477 ± 122 vs 569 ± 92 minutes) and less intraoperative blood loss (mean 613 ± 380 vs 1180 ± 614 ml), although the differences were not statistically significant. The preoperative Japanese Orthopaedic Association (JOA) score was almost identical between the two groups; however, the latest JOA score and the recovery rate were significantly better in the modified Ohtsuka group than in the PDF group (8.8 ± 1.5 vs 5.0 ± 1.7 and 71.3% ± 23.7% vs 28.3% ± 5.7%, respectively). The walking ability was evaluated using the modified Frankel scale. According to this scale, 3 patients showed three grade improvements, 2 patients showed two grade improvements, and 1 patient showed one grade improvement in the modified Ohtsuka group. Three patients in the modified Ohtsuka group could walk without any support at the final follow-up.CONCLUSIONSThe present study clearly indicated that the surgical outcomes of the authors’ modified Ohtsuka procedure were significantly better than those of PDF for patients who could not walk preoperatively.

Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level

2010 ◽  
Vol 13 (1) ◽  
pp. 116-122 ◽  
Author(s):  
Hong-Qi Zhang ◽  
Ling-Qiang Chen ◽  
Shao-Hua Liu ◽  
Di Zhao ◽  
Chao-Feng Guo
Keyword(s):  
Thoracic Kyphosis ◽  
Ligamentum Flavum ◽  
Posterior Instrumentation ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Thoracic Myelopathy ◽  
Posterior Decompression ◽  
Decompressive Laminectomy ◽  
Kyphosis Correction

Object The object of this study was to evaluate the efficacy and safety of posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) at the same level. Methods Between January 2003 and December 2005, 11 patients (8 men and 3 women) with thoracic myelopathy due to OLF and OPLL at the same level underwent posterior decompressive laminectomy and excision of OLF. Posterior instrumentation was also performed for stabilization of the spine and reducing the thoracic kyphosis angle by approximately 5–15° (kyphosis correction), and spinal fusion was performed in all cases. The follow-up period ranged from 2 to 4 years (mean 2.8 years). The outcomes were evaluated using a recovery scale based on the Japanese Orthopaedic Association classification. The score of each patient was calculated before surgery, 1 year after surgery, and at the final follow-up visit. Results After surgery, the thoracic kyphosis in the stabilization area was reduced from 30.0 ± 4.02° to 20.8 ± 2.14° on average. The mean score on the Japanese Orthopaedic Association scale improved from 3.5 ± 1.69 preoperatively to 8.5 ± 1.63 at the final follow-up, with a recovery rate of 68.0%. The results were good in 9 patients and fair in 2 patients. Postoperative MR imaging showed that the spinal cord was shifted posteriorly and decompressed completely in all cases. Myelopathy was not aggravated in any case after surgery. Conclusions A considerable degree of neurological recovery was observed after posterior decompression and kyphosis correction. The procedure is easy to perform with a low risk of postoperative paralysis. The authors therefore suggest that the procedure is useful for patients whose spinal cords are severely impinged by OLF and OPLL at the same level.

scholarly journals Thoracic Myelopathy Caused by Ossification of the Yellow Ligament as a Distal Adjacent Segmental Disease after Posterior Cervical-Middle Thoracic Fusion Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Toru Funayama ◽  
Kentaro Mataki ◽  
Tetsuya Abe ◽  
Hiroshi Noguchi ◽  
Kousei Miura ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Posterior Longitudinal Ligament ◽  
Careful Monitoring ◽  
Short Term ◽  
Thoracic Myelopathy ◽  
Posterior Decompression ◽  
Fusion Surgery ◽  
Initial Surgery ◽  
Local Flexibility ◽  
Lower Thoracic Spine

Although adjacent segmental disease after posterior thoracic fusion surgery is rare, thoracic myelopathy due to ossification of the yellow ligament in the lower thoracic spine could develop because of mechanical stress when the lower instrumented vertebra has been set to the middle thoracic spine during the initial surgery. We report an extremely rare case of distal adjacent segmental disease after posterior cervical-middle thoracic fusion surgery requiring reoperation after exhibiting thoracic myelopathy due to ossification of the yellow ligament in the lower thoracic spine. An obese 53-year-old man with diabetes had undergone C3-6 laminoplasty and C7-T8 posterior decompression plus fusion due to ossification of the posterior longitudinal ligament at C5-T5. Although the short-term clinical course after the initial surgery was good, symptoms of myelopathy reappeared because of the ossification of the yellow ligament that developed at T9-11 with local flexibility. Thus, reoperation with fusion extension surgery was needed 1 year and 6 months after the initial surgery. Altogether, we recommend careful monitoring of the postoperative clinical progression and, if necessary, reoperation at the earliest.

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