Outcomes of Surgery for Thoracic Myelopathy Due to Thoracic Ossification of the Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients: Is Instrumented Fusion Necessary?

Kei Ando, Shiro Imagama, Takashi Kaito, Shota Takenaka, Kenichiro Sakai, Shigeo Shindo, Koota Watanabe, Morio Matsumoto, Hideaki Nakashima, Kanichiro Wada, Atsushi Kimura, Katsushi Takeshita, Satoshi Kato, Hideki Murakami, Kazuhiro Takeuchi, Masahiko Takahata, Masao Koda, Masashi Yamazaki, Masahiko Watanabe, Shunsuke FujibayashiTakeo Furuya, Yoshiharu Kawaguchi, Yukihiro Matsuyama, Toshitaka Yoshii, Atsushi Okawa

Research output: Contribution to journalArticle

Abstract

Study Design. Prospectively collected, multicenter, nationwide study. Objective. To investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF). Summary of Background Data. A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items. Methods. Surgical methods, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association (JOA) score), symptoms, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 223 cases. Differences in these factors between fusion and non-fusion procedures for T-OLF were examined. The minimum follow-up period was 2 year after surgery Result. The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0%, 40.9%, and 41.4% respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9%). There were 45 perioperative complications in 30 cases (13.5%), with aggravation of motor disturbance in the lower extremities being most common (4.0%, n = 9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at CT, and intramedullary high intensity area at MRI (p < .01). The preoperative JOA score was lower (p < .05) and the JOA recovery rate at 1 year after surgery was significantly higher in cases treated without fusion (44.9% vs. 37.1%, p < .05). Conclusions. The high rate of surgery with instrumentation of 48.9% reflects the current major trend toward posterior instrumented fusion surgery for T-OLF. Fusion surgery with instrumentation may be appropriate for patients with severe OLF and preoperative myelopathy. A further prospective study of long-term outcomes is required with a focus on optimal surgical timing and the surgical procedure for T-OPLL.Level of Evidence: 3.

Original languageEnglish
JournalSpine
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Ligamentum Flavum
Spinal Cord Diseases
Osteogenesis
Thoracic Surgery
Thorax
Multicenter Studies
Orthopedics
Intraoperative Neurophysiological Monitoring
Prospective Studies
Decompression
Gait
Occupations
Lower Extremity
Retrospective Studies

Keywords

  • Fusion surgery
  • Intraoperative neurophysiological monitoring
  • JOA recovery rate
  • Nationwide multicenter prospectively collected study
  • perioperative complication
  • Preoperative severe myelopathy
  • Surgical procedure
  • Thoracic ossification of the ligamentum flavum

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Outcomes of Surgery for Thoracic Myelopathy Due to Thoracic Ossification of the Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients : Is Instrumented Fusion Necessary? / Ando, Kei; Imagama, Shiro; Kaito, Takashi; Takenaka, Shota; Sakai, Kenichiro; Shindo, Shigeo; Watanabe, Koota; Matsumoto, Morio; Nakashima, Hideaki; Wada, Kanichiro; Kimura, Atsushi; Takeshita, Katsushi; Kato, Satoshi; Murakami, Hideki; Takeuchi, Kazuhiro; Takahata, Masahiko; Koda, Masao; Yamazaki, Masashi; Watanabe, Masahiko; Fujibayashi, Shunsuke; Furuya, Takeo; Kawaguchi, Yoshiharu; Matsuyama, Yukihiro; Yoshii, Toshitaka; Okawa, Atsushi.

In: Spine, 01.01.2019.

Research output: Contribution to journalArticle

Ando, K, Imagama, S, Kaito, T, Takenaka, S, Sakai, K, Shindo, S, Watanabe, K, Matsumoto, M, Nakashima, H, Wada, K, Kimura, A, Takeshita, K, Kato, S, Murakami, H, Takeuchi, K, Takahata, M, Koda, M, Yamazaki, M, Watanabe, M, Fujibayashi, S, Furuya, T, Kawaguchi, Y, Matsuyama, Y, Yoshii, T & Okawa, A 2019, 'Outcomes of Surgery for Thoracic Myelopathy Due to Thoracic Ossification of the Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients: Is Instrumented Fusion Necessary?', Spine. https://doi.org/10.1097/BRS.0000000000003208
Ando, Kei ; Imagama, Shiro ; Kaito, Takashi ; Takenaka, Shota ; Sakai, Kenichiro ; Shindo, Shigeo ; Watanabe, Koota ; Matsumoto, Morio ; Nakashima, Hideaki ; Wada, Kanichiro ; Kimura, Atsushi ; Takeshita, Katsushi ; Kato, Satoshi ; Murakami, Hideki ; Takeuchi, Kazuhiro ; Takahata, Masahiko ; Koda, Masao ; Yamazaki, Masashi ; Watanabe, Masahiko ; Fujibayashi, Shunsuke ; Furuya, Takeo ; Kawaguchi, Yoshiharu ; Matsuyama, Yukihiro ; Yoshii, Toshitaka ; Okawa, Atsushi. / Outcomes of Surgery for Thoracic Myelopathy Due to Thoracic Ossification of the Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients : Is Instrumented Fusion Necessary?. In: Spine. 2019.
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title = "Outcomes of Surgery for Thoracic Myelopathy Due to Thoracic Ossification of the Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients: Is Instrumented Fusion Necessary?",
abstract = "Study Design. Prospectively collected, multicenter, nationwide study. Objective. To investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF). Summary of Background Data. A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items. Methods. Surgical methods, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association (JOA) score), symptoms, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 223 cases. Differences in these factors between fusion and non-fusion procedures for T-OLF were examined. The minimum follow-up period was 2 year after surgery Result. The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0{\%}, 40.9{\%}, and 41.4{\%} respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9{\%}). There were 45 perioperative complications in 30 cases (13.5{\%}), with aggravation of motor disturbance in the lower extremities being most common (4.0{\%}, n = 9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at CT, and intramedullary high intensity area at MRI (p < .01). The preoperative JOA score was lower (p < .05) and the JOA recovery rate at 1 year after surgery was significantly higher in cases treated without fusion (44.9{\%} vs. 37.1{\%}, p < .05). Conclusions. The high rate of surgery with instrumentation of 48.9{\%} reflects the current major trend toward posterior instrumented fusion surgery for T-OLF. Fusion surgery with instrumentation may be appropriate for patients with severe OLF and preoperative myelopathy. A further prospective study of long-term outcomes is required with a focus on optimal surgical timing and the surgical procedure for T-OPLL.Level of Evidence: 3.",
keywords = "Fusion surgery, Intraoperative neurophysiological monitoring, JOA recovery rate, Nationwide multicenter prospectively collected study, perioperative complication, Preoperative severe myelopathy, Surgical procedure, Thoracic ossification of the ligamentum flavum",
author = "Kei Ando and Shiro Imagama and Takashi Kaito and Shota Takenaka and Kenichiro Sakai and Shigeo Shindo and Koota Watanabe and Morio Matsumoto and Hideaki Nakashima and Kanichiro Wada and Atsushi Kimura and Katsushi Takeshita and Satoshi Kato and Hideki Murakami and Kazuhiro Takeuchi and Masahiko Takahata and Masao Koda and Masashi Yamazaki and Masahiko Watanabe and Shunsuke Fujibayashi and Takeo Furuya and Yoshiharu Kawaguchi and Yukihiro Matsuyama and Toshitaka Yoshii and Atsushi Okawa",
year = "2019",
month = "1",
day = "1",
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language = "English",
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TY - JOUR

T1 - Outcomes of Surgery for Thoracic Myelopathy Due to Thoracic Ossification of the Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients

T2 - Is Instrumented Fusion Necessary?

AU - Ando, Kei

AU - Imagama, Shiro

AU - Kaito, Takashi

AU - Takenaka, Shota

AU - Sakai, Kenichiro

AU - Shindo, Shigeo

AU - Watanabe, Koota

AU - Matsumoto, Morio

AU - Nakashima, Hideaki

AU - Wada, Kanichiro

AU - Kimura, Atsushi

AU - Takeshita, Katsushi

AU - Kato, Satoshi

AU - Murakami, Hideki

AU - Takeuchi, Kazuhiro

AU - Takahata, Masahiko

AU - Koda, Masao

AU - Yamazaki, Masashi

AU - Watanabe, Masahiko

AU - Fujibayashi, Shunsuke

AU - Furuya, Takeo

AU - Kawaguchi, Yoshiharu

AU - Matsuyama, Yukihiro

AU - Yoshii, Toshitaka

AU - Okawa, Atsushi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Study Design. Prospectively collected, multicenter, nationwide study. Objective. To investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF). Summary of Background Data. A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items. Methods. Surgical methods, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association (JOA) score), symptoms, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 223 cases. Differences in these factors between fusion and non-fusion procedures for T-OLF were examined. The minimum follow-up period was 2 year after surgery Result. The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0%, 40.9%, and 41.4% respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9%). There were 45 perioperative complications in 30 cases (13.5%), with aggravation of motor disturbance in the lower extremities being most common (4.0%, n = 9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at CT, and intramedullary high intensity area at MRI (p < .01). The preoperative JOA score was lower (p < .05) and the JOA recovery rate at 1 year after surgery was significantly higher in cases treated without fusion (44.9% vs. 37.1%, p < .05). Conclusions. The high rate of surgery with instrumentation of 48.9% reflects the current major trend toward posterior instrumented fusion surgery for T-OLF. Fusion surgery with instrumentation may be appropriate for patients with severe OLF and preoperative myelopathy. A further prospective study of long-term outcomes is required with a focus on optimal surgical timing and the surgical procedure for T-OPLL.Level of Evidence: 3.

AB - Study Design. Prospectively collected, multicenter, nationwide study. Objective. To investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF). Summary of Background Data. A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items. Methods. Surgical methods, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association (JOA) score), symptoms, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 223 cases. Differences in these factors between fusion and non-fusion procedures for T-OLF were examined. The minimum follow-up period was 2 year after surgery Result. The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0%, 40.9%, and 41.4% respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9%). There were 45 perioperative complications in 30 cases (13.5%), with aggravation of motor disturbance in the lower extremities being most common (4.0%, n = 9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at CT, and intramedullary high intensity area at MRI (p < .01). The preoperative JOA score was lower (p < .05) and the JOA recovery rate at 1 year after surgery was significantly higher in cases treated without fusion (44.9% vs. 37.1%, p < .05). Conclusions. The high rate of surgery with instrumentation of 48.9% reflects the current major trend toward posterior instrumented fusion surgery for T-OLF. Fusion surgery with instrumentation may be appropriate for patients with severe OLF and preoperative myelopathy. A further prospective study of long-term outcomes is required with a focus on optimal surgical timing and the surgical procedure for T-OPLL.Level of Evidence: 3.

KW - Fusion surgery

KW - Intraoperative neurophysiological monitoring

KW - JOA recovery rate

KW - Nationwide multicenter prospectively collected study

KW - perioperative complication

KW - Preoperative severe myelopathy

KW - Surgical procedure

KW - Thoracic ossification of the ligamentum flavum

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DO - 10.1097/BRS.0000000000003208

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