Asian Spine J.  2019 Oct;13(5):832-841. 10.31616/asj.2018.0278.

Surgical Results of Patients with Myelopathy due to Ossification of the Ligamentum Flavum with Ossification of the Posterior Longitudinal Ligament or a Vertebral Fracture at the Same Level of the Thoracic Spine: A Retrospective Comparative Study

• Kasukawa Y
• Miyakoshi
• Hongo M
• Ishikawa Y
• Kudo D
• Kimura R
• Ono Y
• Iida J
• Sato C
• Shimada Y

• KMID: 2462014
• DOI: http://doi.org/10.31616/asj.2018.0278

Abstract

STUDY DESIGN: Retrospective and comparative study. PURPOSE: We assessed surgical treatment outcomes in patients with thoracic myelopathy due to ossification of the ligamentum flavum (OLF), and OLF combined with ossification of the posterior longitudinal ligament (OPLL) or vertebral fracture (VF) at the same level. OVERVIEW OF LITERATURE: OLF and OPLL cause severe thoracic myelopathy. Osteoporotic VF commonly occurs at the thoracolumbar junction. There have been no investigations of thoracic myelopathy due to OLF and VF.
METHODS
Forty patients were divided among three groups: the OLF group (n=23): myelopathy due to OLF, the OLF+OPLL group (n=12): myelopathy due to OLF and OPLL, and the OLF+VF group (n=5): myelopathy due to OLF and VF. We recorded OLF, OPLL, and VF sites and operative procedures. Each patient's neurological status, according to the Japanese Orthopaedic Association (JOA) score, and walking ability were evaluated pre- and postoperatively.
RESULTS
Patients in the OLF+OPLL group were significantly younger than those in the other two groups. The preoperative JOA score was significantly lower in the OLF+VF than OLF group. The final JOA score was significantly lower in the OLF+VF than OLF and OLF+OPLL groups. The JOA score recovery rate was significantly lower in the OLF+VF than OLF group. Final walking ability was significantly worse in the OLF+OPLL and OLF+VF groups than in the OLF group and significantly worse in the OLF+VF than OLF+OPLL group.
CONCLUSIONS
Thoracic myelopathy due to OLF+VF occurs primarily in older females, who also exhibit worse preoperative and postoperative neurological status, and worse walking ability, than patients with thoracic myelopathy due to OLF or OLF+OPLL.

Keyword

Ligamentum flavum ossification; Posterior longitudinal ligament ossification; Osteoporotic fracture; Compression fracture; Myelopathy

MeSH Terms

Asian Continental Ancestry Group
Female
Fractures, Compression
Humans
Ligamentum Flavum*
Longitudinal Ligaments*
Ossification of Posterior Longitudinal Ligament
Osteoporotic Fractures
Retrospective Studies*
Spinal Cord Diseases*
Spine*
Surgical Procedures, Operative
Walking