Clinical Outcomes and Prognostic Factors in Patients With Myelopathy Caused by Thoracic Ossification of the Ligamentum Flavum

Kim, Jae Kwang; Ryu, Ho-Suk; Moon, Bong Ju; Lee, Jung-Kil

doi:10.14245/ns.1836128.064

Cited by 22 publications

(21 citation statements)

References 24 publications

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“…Several studies have reported that some factors might affect the surgical results of OLF, including the duration of preoperative symptoms, preoperative neurological status, intramedullary signal changes in T2WI, age, sex, type of OLF, and dural tears 3,7,20,27,30,[35][36][37] . However, it is still uncertain whether these factors are predictive of the surgical results following MIS.…”

Section: Discussionmentioning

confidence: 99%

“…The severity of myelopathy before surgery, which is mostly indicated by the preoperative mJOA score, was shown to be the most important predictor of surgical results in many studies 3,24,36,38,[41][42][43] . However, few studies found a significant correlation between the preoperative mJOA score and RR according to multiple regression analysis 3,36,41 , and one study even showed no significant correlation between them in the univariate analysis 1 . Of note, we did not find a significant correlation between the preoperative mJOA score and RR in multiple regression analysis, similar to some studies 24,29,38 .…”

Section: Discussionmentioning

confidence: 99%

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Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum

Gao

et al. 2020

Sci Rep

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Minimally invasive surgery (MIS) has shown satisfactory surgical results for the treatment of thoracic myelopathy (TM) caused by ossification of the ligamentum flavum (OLF). This study investigated the prognostic factors following MIS and was based on the retrospective analysis of OLF patients who underwent percutaneous full endoscopic posterior decompression (PEPD). Thirty single-segment OLF patients with an average age of 60.4 years were treated with PEPD under local anaesthesia. Clinical data were collected from the medical and operative records. The surgical results were assessed by the recovery rate (RR) calculated from the modified Japanese Orthopaedic Association (mJOA) score. Correlations between the RR and various factors were analysed. Patients' neurological status improved from a preoperative mJOA score of 6.0 ± 1.3 to a postoperative mJOA score of 8.5 ± 2.0 (P < 0.001) at an average follow-up of 21.3 months. The average RR was 53.8%. Dural tears in two patients (6.7%, 2/30) were the only observed complications. Multiple linear regression analysis showed that a longer duration of preoperative symptoms and the presence of a high intramedullary signal on T2-weighted MRI (T2HIS) were significantly associated with poor surgical results. PEPD is feasible for the treatment of TM patients with a particular type of OLF. Patients without T2HIS could achieve a good recovery if they received PEPD early. Thoracic myelopathy (TM) is less common than cervical myelopathy and lumbar spinal stenosis 1 , and TM is mainly caused by ossification of the ligamentum flavum (OLF) in East Asian countries, such as Japan, Korea, and China 2. As the number of reported cases has increased, OLF has been studied not only in East Asia but also worldwide 3-5. Although much of its pathophysiology has been determined, the exact pathogenetic mechanism and the epidemiology of OLF remain poorly understood 6,7. Therefore, making an appropriate and timely therapeutic decision for the treatment of OLF may be hindered by the paucity of knowledge. TM caused by OLF remains a challenge for spine surgeons. OLF generally requires posterior surgical decompression due to its progressive nature and poor response to conservative therapy 8,9. Decompression procedures include traditional open surgeries, such as laminectomy with or without posterior fusion 10,11 , and minimally invasive surgery (MIS), such as microendoscopic decompression 12,13 and percutaneous endoscopic decompression 14-17. However, the prognostic guidelines are still unclear, and the surgical results vary widely despite complete decompression 3,18 .

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum

Gao

et al. 2020

Sci Rep

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“…However, in this study, the surgical outcome of patients with beak type OPLL was not poor. Many authors thought that intramedullary high signal intensity in MR image is evidence of pathologic damage to the spinal cord 11) . The pathology is considered range from acute edema to chronic myelomalacia 1,9,22) .…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes According to Dekyphosis in Patients with Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine

Kim

Hyun

Kim

et al. 2020

J Korean Neurosurg Soc

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Objective : Ossification of posterior longitudinal ligament (OPLL) in the thoracic spine may cause chronic compressive myelopathy that is usually progressive, and unfavorable by conservative treatment. Although surgical intervention is often needed, the standard surgical method has not been established. Recently, it has been reported that posterior decompression with dekyphosis is effective surgical technique for favorable clinical outcome. The purpose of this study was to evaluate the surgical outcomes in patients with thoracic OPLL according to dekyphosis procedure and to identify predictive factors for the surgical results. Methods : A total of 25 patients with thoracic OPLL who underwent surgery for myelopathy from May 2004 to March 2017, were retrospectively reviewed. Patients with cervical myelopathy were excluded. We assessed the clinical outcomes according to various surgical approaches. The modified Japanese orthopedic association (JOA) scores for the thoracic spine (total, 11 points) and JOA recovery rates were used for investigating surgical outcomes. Results : Of the 25 patients, 10 patients were male and the others were female. The mean JOA score was 6.7±2.3 points preoperatively and 8.8±1.8 points postoperatively, yielding a mean recovery rate of 53.8±31.0%. The mean patients' age at surgery was 52.4 years and mean follow-up period was 40.2 months. According to surgical approaches, seven patients underwent anterior approaches, 13 patients underwent posterior approaches, five patients underwent combined approaches. There was no significant difference of the surgical outcomes related with different surgical approaches. Age (≥55 years) and high signal intensity on preoperative magnetic resonance (MR) image in the thoracic spine were significant predictors of the lower recovery rate after surgery (p<0.05). Posterior decompression with dekyphosis procedure was related to the excellent surgical outcomes (p=0.047). Dekyphosis did not affect the complication rates. Conclusion : In this study, our result elucidated that old age (≥55 years) and presence of intramedullary high signal intensity on preoperative MR images were risk factors related to poor surgical outcomes. In the meanwhile, posterior decompression with dekyphosis affected favorable clinical outcome. Posterior approach with dekyphosis procedure can be a recommendable surgical option for favorable results.

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“…The number of spine surgeries has been increasing with the development of diagnostic modalities, improved surgical techniques, increased options for minimally invasive surgeries and increased number of patients with spinal disease [27]. LF is an important anatomical barrier for prevention of postoperative scar tissue [5,12,13,28,29] and mechanical stabilization of the lumbar segment [30,31]. Because most patients with LDH do not have spinal instability, preservation of LF may be beneficial considering long-term stability of the lumbar spinal segment and prevention of postoperative adhesions.…”

Section: Discussionmentioning

confidence: 99%

Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes?

et al. 2019

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Objective Ligamentum flavum (LF) is an important anatomical structure for prevention of postoperative adhesions, but the opening of LF is necessary for percutaneous endoscopic lumbar interlaminar discectomy (PEID). Although the defect in LF is small with conventional PEID, the defect could be minimized with LF splitting technique. The objective of this study was to compare clinical outcomes of PEID with opening of LF versus splitting of LF. Methods A retrospective study was performed for patients underwent PEID for L5–S1. PEID with the opening of LF (open-group) was performed for 55 patients and with splitting of LF (split-group) was performed for 34 patients. The defect of LF in Open-group was 3–5 mm, but the defect was negligible in split-group because the split LF was reapproximated by its elasticity. Clinical outcomes were evaluated with Korean version of the Oswestry Disability Index (K-ODI) and visual analogue pain scores for back (VASB) and leg (VASL). The changes of clinical outcomes during postoperative 24 months between groups were evaluated with linear mixed-effects model. Results The clinical outcomes were similar between groups for K-ODI (p=0.98), VASB (p=0.52), and VASL (p=0.59). Each outcome demonstrated significant improvement from preoperative baseline throughout the postoperative 24 months (p<0.05). Complications included recurrence in 4 patients and dural tear in 1 in open-group (9.1%), and residual disc herniation in 2 patients and transient weakness in 1 in split-group (8.8%). Conclusion Splitting versus opening LF in PEID may be left to the surgeon’s discretion. The potential risks and benefits of LF handling should be considered when performing this surgical technique in PEID.

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Clinical Outcomes and Prognostic Factors in Patients With Myelopathy Caused by Thoracic Ossification of the Ligamentum Flavum

Cited by 22 publications

References 24 publications

Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum

Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum

Surgical Outcomes According to Dekyphosis in Patients with Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine

Does Preservation of Ligamentum Flavum in Percutaneous Endoscopic Lumbar Interlaminar Discectomy Improve Clinical Outcomes?

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