A systematic review of complications in thoracic spine surgery for ossification of ligamentum flavum

Study design Systematic review. Objectives The aim of this systematic review is to summarize the incidence of complications, to relate complication incidence to procedures performed, to assess the impact of the year of study publication and follow-up duration on complication incidence. Methods The authors conducted the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE searches for relevant literatures. The incidence of complications was summarized. Correlation of the incidence with year of study publications, follow-up duration, and the surgical outcome was statistically evaluated. Results A total of 16 studies met our inclusion criteria, including 475 patients. All of these studies were retrospective case series. The mean age of patients ranged from 55 to 64 years. Average follow-up duration ranged from 26 to 65 months. Partial patients in four studies underwent surgeries and reserved posterior structure of the spinal canal. The others underwent operations removing posterior structure of spinal canal. The mean recovery rate from each individual study varied between 31 and 68% and the pooled neurologic function recovery rate was 53% (95% CI: 43-62%). The mean complication rate was 24%. Cerebrospinal fluid leakage was the most reported postoperative complication (19%), then neurologic deterioration (5%). Other complications included local infections, wound dehiscence, increased kyphotic deformity, an hematoma. Conclusions Operations removing posterior structure of spinal canal are the main technique to decompress spinal cord. Cerebrospinal fluid leakage and postoperative neurologic deterioration were the most reported complications.