Anterior Decompression for Myelopathy Resulting From Thoracic Ossification of the Posterior Longitudinal Ligament

Abstract

Total removal of the ossification might be required to manage severe myelopathy in patients with thoracic ossification of the posterior longitudinal ligament. Complete removal of the ossification gave good results in eight patients. Patients whose ossification of the posterior longitudinal ligament had not been completely removed, however, had a poor outcome.

Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament

“…This incident thus suggests that the decompression procedure itself in patients with a severely compressed spinal cord entails a risk of postoperative paralysis, such that even the selection of PDF as our surgical procedure for thoracic OPLL cannot completely eliminate the risk of postoperative paralysis. However, in light of what appears to be a higher risk of postoperative paralysis following other surgical procedures such as laminectomy alone [5,19] and OPLL extirpation [2,4,10,13], we would suggest that PDF is the safest surgical procedure among the alternatives for thoracic OPLL.…”

“…Surgeons have employed a variety of surgical procedures to treat thoracic OPLL, including laminectomy [5], OPLL extirpation through thoracotomy [2,4,10], OPLL extirpation through a posterior approach [13], and circumspinal decompression [6,15]. However, postoperative paraplegia remains a major risk [2, 4, 8-10, 13, 15].…”

“…In addition, PDF was associated with an extremely low risk of postoperative paralysis and late neurological deterioration, compared with complication rates for laminectomy [5] and OPLL extirpation [2,4]. However, the mechanisms by which PDF produced neurological recovery in thoracic OPLL patients have not yet been fully established.…”

Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review

“…Second, if extirpation of OPLL is conducted, the spinal cord at the site of compression is vulnerable to damage. Several procedures for thoracic OPLL, including anterior, posterior, and combined anterior and posterior approaches, have been shown to have a high risk of postoperative neurological deterioration; the reported rates range from 2.7 to 18.8% [30,[32][33][34][35]. Tomita et al [32] evaluated the outcomes of circumspinal decompression in the treatment of myelopathy due to OPLL and OLF.…”

“…In two patients who underwent anterior decompression through thoracotomy, CSF leaked into the intrathoracic space, causing a hydrothorax that was very difficult to regulate [30]. Additionally, massive postoperative epidural venous bleeding, which required a second operation, and cystic swelling of the subarachnoid space were also reported with the anterior approach [33].…”