Surgical Strategy for the Treatment of Thoracic Ossification of the Posterior Longitudinal Ligament via the Anterior Approach

Abstract

Ossification of the posterior longitudinal ligament OPLL in the thoracic spine cause myelopathy with anterior spinal cord compression, the cause is usually progressive and refractory to conservative treatment. Therefore, early decompressive surgery is imperative in such cases. However, decompression surgery of thoracic OPLL is difficult, and its outcome is often poor. We investigated whether anterior decompression and bony fusion via the anterior approach can be used for the treatment of myelopathy secondary to thoracic OPLL. The outcome and complications associated with this method were analyzed in 9 patients who were treated with this procedure. Of the 9 patients, 3 were treated using transsternal approach, and 6 were treated using transthoracic approach. Mean blood loss was 291.6 mL for the transsternal approach and 379.1 mL for the transthoracic approach. The Japanese Orthopaedic Association score JOA score was used to evaluate the severity of myelopathy possible highest score, 11 points. The recovery rate of JOA score was used to evaluate the surgical outcome. The mean preoperative JOA score was 4.7, and it improved to an average of 7.8 at the final evaluation. The average recovery rate of the JOA score was 52.2. The clinical symptoms and JOA score improved compared to the preoperative conditions in 8 patients but remained unchanged in 1 patient. Surgical complications included dural tear in 2 patients and intercostal neuralgia in 1 patient. One patient had to be transferred to a rehabilitation facility. In the other 8 patients, the mean hospitalization was 15.4 days. Anterior decompression and fusion is an effective surgical procedure for the treatment of thoracic OPLL and yields good and stable long term results. An anterior procedure that results in adequate decompression of the spinal cord and affords good spinal stability is recommended for anterior lesions such as OPLL, which compress the anterior spinal cord at the thoracic spine.

Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases

“…One of the alternative intraoperative dural repair methods is the application of a polyglycolic acid sheet (Neovel ® ) with fibrin glue, and suction drainage with slight negative pressure. 5,6 Although Neovel patch with fibrin glue cannot be compared with the direct repair, it can be helped to perform such suboptimal procedure in severe circumstances of ventral dural injury during anterior thoracic surgery for spinal tumors and OPLL. Well-known postoperative treatment for CSF leakage is spinal drainage using a subarachnoid catheter.…”