Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine - A multi-institutional retrospective study

被引：125

作者：

Matsumoto, Morio ^{[1
]}

Chiba, Kazuhiro

Toyama, Yoshiaki

Takeshita, Katsushi ^{[2
]}

Seichi, Atsushi ^{[2
]}

Nakamura, Kozo ^{[2
]}

Arimizu, Jun ^{[3
]}

Fujibayashi, Shunsuke ^{[4
]}

Hirabayashi, Shigeru ^{[5
]}

Hirano, Toru ^{[6
]}

Iwasaki, Motoki ^{[7
]}

Kaneoka, Kouji ^{[8
]}

Kawaguchi, Yoshiharu ^{[9
]}

Ijiri, Kosei ^{[10
]}

Maeda, Takeshi ^{[11
]}

Matsuyama, Yukihiro ^{[12
]}

Mikami, Yasuo ^{[13
]}

Murakami, Hideki ^{[14
]}

Nagashima, Hideki ^{[15
]}

Nagata, Kensei ^{[16
]}

Nakahara, Shinnosuke ^{[17
]}

Nohara, Yutaka ^{[18
]}

Oka, Shiro ^{[19
]}

Sakamoto, Keizo ^{[20
]}

Saruhashi, Yasuo ^{[21
]}

Sasao, Yutaka ^{[22
]}

Shimizu, Katsuji ^{[23
]}

Taguchi, Toshihiko ^{[24
]}

Takahashi, Makoto ^{[25
]}

Tanaka, Yasuhisa ^{[26
]}

Tani, Toshikazu ^{[27
]}

Tokuhashi, Yasuaki ^{[28
]}

Uchida, Kenzo ^{[29
]}

Yamamoto, Kengo ^{[30
]}

Yamazaki, Masashi ^{[31
]}

Yokoyama, Toru ^{[32
]}

Yoshida, Munehito ^{[33
]}

Nishiwaki, Yuji ^{[34
]}

机构：

[1] Keio Univ, Sch Med, Dept Musculoskeletal Reconstruct & Regenerat Surg, Shinjuku Ku, Tokyo 1608582, Japan

[2] Univ Tokyo, Tokyo 1138654, Japan

[3] Fukuoka Univ, Fukuoka, Japan

[4] Kyoto Univ, Kyoto 6068501, Japan

[5] Saitama Med Ctr, Saitama, Japan

[6] Niigata Univ, Niigata 95021, Japan

[7] Osaka Univ, Suita, Osaka 565, Japan

[8] Univ Tsukuba, Tsukuba, Ibaraki 305, Japan

[9] Toyama Univ, Toyama, Japan

[10] Kagoshima Univ, Kagoshima 890, Japan

[11] Kyushu Univ, Fukuoka 812, Japan

[12] Nagoya Univ, Nagoya, Aichi 4648601, Japan

[13] Kyoto Prefectural Univ Med, Kyoto 602, Japan

[14] Kanazawa Univ, Kanazawa, Ishikawa 9201192, Japan

[15] Tottori Univ, Tottori, Japan

[16] Kurume Univ, Kurume, Fukuoka, Japan

[17] Natl Okayama Med Ctr, Okayama, Japan

[18] Dokkyo Univ, Mibu, Tochigi, Japan

[19] Kagawa Univ, Takamatsu, Kagawa 760, Japan

[20] Showa Univ, Tokyo, Japan

[21] Shiga Univ, Otsu, Shiga, Japan

[22] St Marianna Univ, Kawasaki, Kanagawa, Japan

[23] Gifu Univ, Gifu, Japan

[24] Yamaguchi Univ, Yamaguchi, Japan

[25] Tokyo Med & Dent Univ, Tokyo, Japan

[26] Tohoku Univ, Sendai, Miyagi 980, Japan

[27] Kochi Univ, Kochi, Japan

[28] Nihon Univ, Tokyo 102, Japan

[29] Univ Fukui, Fukui, Japan

[30] Tokyo Med Univ, Tokyo, Japan

[31] Chiba Univ, Chiba, Japan

[32] Hirosaki Univ, Hirosaki, Aomori, Japan

[33] Wakayama Med Univ, Wakayama, Japan

[34] Keio Univ, Dept Prevent Med & Publ Hlth, Tokyo, Japan

来源：

SPINE | 2008年 / 33卷 / 09期

关键词：

thoracic spine; ossification of posterior longitudinal ligament; surgical outcome; spinal instrumentation;

D O I：

10.1097/BRS.0b013e31816c913b

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design. Retrospective multi-institutional study Objective. To describe the surgical outcomes in patients with ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) and to clarify factors related to the surgical outcomes. Summary of Background Data. Detailed analyses of surgical outcomes of T-OPLL have been difficult because of the rarity of this disease. Methods. The subjects were 154 patients with T-OPLL who were surgically treated at 34 institutions between 1998 and 2002. The surgical procedures were laminectomy in 36, laminoplasty in 51, anterior decompression via anterior approach in 25 and via posterior approach in 29, combined anterior and posterior fusion in 8, and sternum splitting approach in 5 patients. Instrumentation was conducted in 52 patients. Assessments were made on (1) The Japanese Orthopedic Association (JOA) scores (full score, 11 points), its recovery rates, (2) factors related to surgical results, and (3) complications and their consequences. Results. (1) The mean JOA score before surgery was 4.6 +/- 2.0 and, 7.1 +/- 2.5 after surgery. The mean recovery rate was 36.8% +/- 47.4%. (2) The recovery rate was 50% or higher in 72 patients (46.8%). Factors significantly related to this were location of the maximum ossification (T1-T4) (odds ratio, 2.43-4.17) and the use of instrumentation (odds ratio, 3.37). (3) The frequent complications were deterioration of myelopathy immediately after surgery in 18 (11.7%) and dural injury in 34 (22.1%) patients. Conclusion. The factors significantly associated with favorable surgical results were maximum ossification located at the upper thoracic spine and use of instrumentation. T-OPLL at the nonkyphotic upper thoracic spine can be treated by laminoplasty that is relatively a safe surgical procedure for neural elements. The use of instrumentation allows correction of kyphosis or prevention of progression of kyphosis, thereby, enhancing and maintaining decompression effect, and its use should be considered with posterior decompression.

引用

页码：1034 / 1041

页数：8

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