The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review

Chen, Guanghui; Fan, Tianqi; Yang, Xiaoxi; Sun, Chuiguo; Fan, Dongwei; Chen, Zhongqiang

doi:10.1007/s00586-020-06520-6

Cited by 58 publications

(47 citation statements)

References 43 publications

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“…Yamada et al reviewed the CT myelograms for 61 patients who underwent surgery for symptomatic thoracic OLF and reported lumbar spinal canal stenosis as an incidental finding in up to 75% of cases [27]. Furthermore, a systematic review that included 524 patients with thoracic spinal stenosis found that the prevalence of lumbar canal stenosis was 35.9% [28]. These findings suggest that ankylosis in the thoracic spine might cause a long lever arm and then create excess loading on the lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study)

Hirai

Yoshii

Hashimoto

et al. 2022

JCM

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Background: The purpose of this study was to clarify the clinical features of ossification of the posterior longitudinal ligament (OPLL) and extreme ossification at multiple sites. Methods: This prospective study involved patients with a diagnosis of cervical OPLL at 16 institutions in Japan. Patient-reported outcome measures, including responses on the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ), JOA Back Pain Evaluation Questionnaire (JOA-BPEQ), and visual analog scale pain score, were collected to investigate clinical status. In each patient, the sum of the levels at which OPLL was located (OP index) was evaluated on whole-spine computed tomography, along with ossification of other spinal ligaments including the anterior longitudinal ligament (OALL), ligament flavum (OLF), supra- and intraspinous ligaments (SSL), and diffuse idiopathic skeletal hyperostosis (DISH). The distribution of OP index values in the study population was investigated, and the clinical and radiologic characteristics of patients in the top 10% were assessed. Results: In total, 236 patients (163 male, 73 female; mean age 63.5 years) were enrolled. Twenty-five patients with OP index ≥ 17 were categorized into a high OP index group and the remainder into a moderate/low OP index group. There were significantly more women in the high OP index group. Patients in the high OP index group also had significantly poorer scores for lower extremity function and quality of life on the JOA-CMEQ and in each domain but not for body pain on the JOA-BPEQ compared with those in the moderate/low OP index group. Patients in the high OP index group had more OALL in the cervical spine and more OLF and SSL in the thoracic spine. The prevalence of DISH was also significantly higher in the high OP index group. In the high OP index group, interestingly, OPLL was likely to be present adjacent to DISH in the cervicothoracic and thoracolumbar spine, especially in men, and often coexisted with DISH in the thoracic spine in women. Conclusion: This prospective cohort registry study is the first to demonstrate the clinical and radiologic features of patients with OPLL and a high OP index. In this study, patients with a high OP index had poorer physical function in the lumbar spine and lower extremities and were also predisposed to extreme ossification of spinal ligaments other than the OPLL.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study)

Hirai

Yoshii

Hashimoto

et al. 2022

JCM

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“…OPLL is most prevalent in East Asians, especially in Japanese, South Koreas, and Chinese. Although T‐OPLL is less common than cervical OPLL, it has an insidious onset, high disability rate, high surgical risk, and high postoperative paralysis rate 12 . CD is a promising but invasive surgical approach, removing the compressive force directly.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Follow‐Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study

Liu

Zhai

Song

et al. 2021

Orthopaedic Surgery

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Objective: To examine the postoperative progression of multilevel thoracic posterior longitudinal ligament (OPLL) at circumferential decompression (CD) levels and evaluate the long-term results after CD via the posterior approach.Methods: Clinical data from 16 patients with thoracic myelopathy secondary to OPLL who underwent CD at a single center were evaluated retrospectively from 2007 to 2014 and were followed up for more than 60 months. Patients of all sexes and ages were included in the study. Thin-slice computed tomography scans obtained at the time of surgery and the most recent follow-up were analyzed. The ossified area was measured on the axial reconstructed scan of the most obvious protrusion of ossification at the CD level. The neurological outcomes were evaluated using modified Japanese Orthopaedic Association (JOA) scores and Hirabayashi recovery rates (HRRs). Continuous variables were presented as the mean AE standard deviation and were analyzed using the Student's t-test, while categorical variables were tested using Fisher's exact test.Results: Among all patients, the most predominant type was the mixed type (9/16, 56.3%), while the circumscribed type was only found in two patients (12.5%), and the continuous type was found in five patients (31.2%). Six cases were associated with ossification of the ligamentum flavum, and two cases were combined with cervical OPLL. The OPLL area at the CD level increased in all patients. The mean follow-up period was 5.5 AE 0.92 years (range 5-8 years). The mean area of ossification increased from 35.63 AE 39.23 mm 2 at the time of surgery to 99.94 AE 65.39 mm 2 at the last follow-up visit (P < 0.01). There was no internal fixation disorder on any computed tomography scan after the operation. The average JOA score of all patients improved from 4.2 AE 2.2 points before surgery to 8.4 AE 2.6 points at the final follow-up (P < 0.01). The overall HRR was 61.8%. None of the patients exhibited any neurological deterioration due to OPLL progression. One patient developed a severe gait disturbance due to worsening lumbar canal stenosis, an unrelated cause, but the other 15 experienced gait disturbance improvements.Conclusions: According to the long-term follow-up results, although OPLL progression did not decrease or stop after removing the OPLL mass, CD is a safe and effective procedure that can provide adequate reserve ventral space to cope with postoperative OPLL progression.

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“…Thoracic ossification of ligamentum flavum (TOLF) is the most prevalent contributor to thoracic myelopathy (TM), which mainly involves the Asian population [ 1 ]. The majority of TOLF patients present with an insidious and progressive natural history, and exhibit neurologic impairments in the middle-aged and elderly [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Diffuse Idiopathic Skeletal Hyperostosis on Clinico-Radiological Profiles and Prognosis for Thoracic Ossification of Ligamentum Flavum-Myelopathy: A Propensity-Matched Monocentric Analysis

Zhang

Chen

et al. 2022

Diagnostics

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Background: Diffuse idiopathic skeletal hyperostosis (DISH) has been evaluated as a potential risk factor of poor surgical outcomes for lumbar spinal stenosis, whereas the influence of DISH on neuroimaging characteristics and postoperative prognosis of patients with thoracic myelopathy has not been established. Therefore, this study aimed to shed light on this issue. Methods: A monocentric study enrolled 167 eligible patients with thoracic ossification of ligamentum flavum (TOLF), who were followed up for at least 2 years. Clinico-radiological parameters and surgical outcomes were compared between the DISH+ and DISH− groups before and after propensity matching. Subgroup analysis was conducted to compare the functional outcomes between mild DISH (M-DISH) and moderately severe DISH (MS-DISH) groups. Results: Fifty-eight patients were diagnosed as DISH, and its prevalence was 34.7%. Patients with DISH presented with older age, more males, taller stature, heavier weight, more commonly diffuse-type TOLF (p < 0.05). The DISH group showed significantly worse recovery rate (RR) at the final follow-up before and after propensity matching (p < 0.01), and slightly lower preoperative VAS, higher postoperative VAS and lower VAS reduction, despite not reaching the significant differences. Subgroup analysis demonstrated that the M-DISH group was associated with the lower mJOA score (p = 0.01) and RR at the final follow-up (p = 0.001), and tended to present higher preoperative VAS than the MS-DISH group. Conclusions: DISH has a significant predisposition to the elderly males with diffuse-type TOLF. Although the presence of M-DISH might bring about a suboptimal surgical outcome, both DISH and non-DISH patients experienced good neurological function improvements and pain relief through thoracic posterior decompression.

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The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review

Cited by 58 publications

References 43 publications

Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study)

Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study)

Long‐Term Follow‐Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study

Impact of Diffuse Idiopathic Skeletal Hyperostosis on Clinico-Radiological Profiles and Prognosis for Thoracic Ossification of Ligamentum Flavum-Myelopathy: A Propensity-Matched Monocentric Analysis

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