Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament

A Nationwide Multicenter Prospective Study

Shiro Imagama, Kei Ando, Kazuhiro Takeuchi, Satoshi Kato, Hideki Murakami, Toshimi Aizawa, Hiroshi Ozawa, Tomohiko Hasegawa, Yukihiro Matsuyama, Masao Koda, Masashi Yamazaki, Hirotaka Chikuda, Shigeo Shindo, Yukihiro Nakagawa, Atsushi Kimura, Katsushi Takeshita, Kanichiro Wada, Hiroyuki Katoh, Masahiko Watanabe, Kei Yamada & 9 others Takeo Furuya, Takashi Tsuji, Shunsuke Fujibayashi, Kanji Mori, Yoshiharu Kawaguchi, Koota Watanabe, Morio Matsumoto, Toshitaka Yoshii, Atsushi Okawa

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

STUDY DESIGN: Prospective, multicenter, nationwide study. OBJECTIVE: To investigate perioperative complications and risk factors in surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) using data from the registry of the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. SUMMARY OF BACKGROUND DATA: There is no prospective multicenter study of surgical complications and risk factors for T-OPLL, and previous multicenter retrospective studies have lacked details. METHODS: Surgical methods, preoperative radiographic findings, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association [JOA] score), prone and supine position test (PST), intraoperative ultrasonography, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 115 cases (males: 55, females: 60, average age 53.1 y). Factors related to perioperative complications and risk factors for postoperative motor palsy were identified. RESULTS: Posterior decompression and fusion with instrumentation with or without dekyphosis was performed in 85 cases (74%). The JOA recovery rate at 1 year after surgery in all cases was 55%. Motor palsy occurred postoperatively in 37 cases (32.2%), with a mean recovery period of 2.7 months. A long recovery period for postoperative motor palsy was significantly associated with a high number of T-OPLL levels (P < 0.0001), lower preoperative JOA score (P < 0.05), and greater estimated blood loss (P < 0.05). Perioperative complications or postoperative motor palsy were significantly related to a higher number of T-OPLL levels, comorbid ossification of ligamentum flavum rate, lower preoperative JOA score, higher preoperative positive PST rate, more surgical invasiveness, a lower rate of intraoperative spinal cord floating in ultrasonography, and higher rate of deterioration of IONM. CONCLUSION: This study firstly demonstrated the perioperative complications with high postoperative motor palsy rate in a nationwide multicenter prospective study. Surgical outcomes for T-OPLL should be improved by identifying and preventing perioperative complications with significant risk factors.3.

Original languageEnglish
Pages (from-to)E1389-E1397
JournalSpine
Volume43
Issue number23
DOIs
Publication statusPublished - 2018 Dec 1

Fingerprint

Ossification of Posterior Longitudinal Ligament
Paralysis
Thoracic Surgery
Multicenter Studies
Thorax
Prospective Studies
Intraoperative Neurophysiological Monitoring
Orthopedics
Osteogenesis
Ultrasonography
Ligamentum Flavum
Prone Position
Spinal Cord Diseases
Supine Position
Decompression
Ligaments
Postoperative Period
Registries
Spinal Cord
Retrospective Studies

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament : A Nationwide Multicenter Prospective Study. / Imagama, Shiro; Ando, Kei; Takeuchi, Kazuhiro; Kato, Satoshi; Murakami, Hideki; Aizawa, Toshimi; Ozawa, Hiroshi; Hasegawa, Tomohiko; Matsuyama, Yukihiro; Koda, Masao; Yamazaki, Masashi; Chikuda, Hirotaka; Shindo, Shigeo; Nakagawa, Yukihiro; Kimura, Atsushi; Takeshita, Katsushi; Wada, Kanichiro; Katoh, Hiroyuki; Watanabe, Masahiko; Yamada, Kei; Furuya, Takeo; Tsuji, Takashi; Fujibayashi, Shunsuke; Mori, Kanji; Kawaguchi, Yoshiharu; Watanabe, Koota; Matsumoto, Morio; Yoshii, Toshitaka; Okawa, Atsushi.

In: Spine, Vol. 43, No. 23, 01.12.2018, p. E1389-E1397.

Research output: Contribution to journalArticle

Imagama, S, Ando, K, Takeuchi, K, Kato, S, Murakami, H, Aizawa, T, Ozawa, H, Hasegawa, T, Matsuyama, Y, Koda, M, Yamazaki, M, Chikuda, H, Shindo, S, Nakagawa, Y, Kimura, A, Takeshita, K, Wada, K, Katoh, H, Watanabe, M, Yamada, K, Furuya, T, Tsuji, T, Fujibayashi, S, Mori, K, Kawaguchi, Y, Watanabe, K, Matsumoto, M, Yoshii, T & Okawa, A 2018, 'Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament: A Nationwide Multicenter Prospective Study', Spine, vol. 43, no. 23, pp. E1389-E1397. https://doi.org/10.1097/BRS.0000000000002703
Imagama, Shiro ; Ando, Kei ; Takeuchi, Kazuhiro ; Kato, Satoshi ; Murakami, Hideki ; Aizawa, Toshimi ; Ozawa, Hiroshi ; Hasegawa, Tomohiko ; Matsuyama, Yukihiro ; Koda, Masao ; Yamazaki, Masashi ; Chikuda, Hirotaka ; Shindo, Shigeo ; Nakagawa, Yukihiro ; Kimura, Atsushi ; Takeshita, Katsushi ; Wada, Kanichiro ; Katoh, Hiroyuki ; Watanabe, Masahiko ; Yamada, Kei ; Furuya, Takeo ; Tsuji, Takashi ; Fujibayashi, Shunsuke ; Mori, Kanji ; Kawaguchi, Yoshiharu ; Watanabe, Koota ; Matsumoto, Morio ; Yoshii, Toshitaka ; Okawa, Atsushi. / Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament : A Nationwide Multicenter Prospective Study. In: Spine. 2018 ; Vol. 43, No. 23. pp. E1389-E1397.
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abstract = "STUDY DESIGN: Prospective, multicenter, nationwide study. OBJECTIVE: To investigate perioperative complications and risk factors in surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) using data from the registry of the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. SUMMARY OF BACKGROUND DATA: There is no prospective multicenter study of surgical complications and risk factors for T-OPLL, and previous multicenter retrospective studies have lacked details. METHODS: Surgical methods, preoperative radiographic findings, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association [JOA] score), prone and supine position test (PST), intraoperative ultrasonography, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 115 cases (males: 55, females: 60, average age 53.1 y). Factors related to perioperative complications and risk factors for postoperative motor palsy were identified. RESULTS: Posterior decompression and fusion with instrumentation with or without dekyphosis was performed in 85 cases (74{\%}). The JOA recovery rate at 1 year after surgery in all cases was 55{\%}. Motor palsy occurred postoperatively in 37 cases (32.2{\%}), with a mean recovery period of 2.7 months. A long recovery period for postoperative motor palsy was significantly associated with a high number of T-OPLL levels (P < 0.0001), lower preoperative JOA score (P < 0.05), and greater estimated blood loss (P < 0.05). Perioperative complications or postoperative motor palsy were significantly related to a higher number of T-OPLL levels, comorbid ossification of ligamentum flavum rate, lower preoperative JOA score, higher preoperative positive PST rate, more surgical invasiveness, a lower rate of intraoperative spinal cord floating in ultrasonography, and higher rate of deterioration of IONM. CONCLUSION: This study firstly demonstrated the perioperative complications with high postoperative motor palsy rate in a nationwide multicenter prospective study. Surgical outcomes for T-OPLL should be improved by identifying and preventing perioperative complications with significant risk factors.3.",
author = "Shiro Imagama and Kei Ando and Kazuhiro Takeuchi and Satoshi Kato and Hideki Murakami and Toshimi Aizawa and Hiroshi Ozawa and Tomohiko Hasegawa and Yukihiro Matsuyama and Masao Koda and Masashi Yamazaki and Hirotaka Chikuda and Shigeo Shindo and Yukihiro Nakagawa and Atsushi Kimura and Katsushi Takeshita and Kanichiro Wada and Hiroyuki Katoh and Masahiko Watanabe and Kei Yamada and Takeo Furuya and Takashi Tsuji and Shunsuke Fujibayashi and Kanji Mori and Yoshiharu Kawaguchi and Koota Watanabe and Morio Matsumoto and Toshitaka Yoshii and Atsushi Okawa",
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T1 - Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament

T2 - A Nationwide Multicenter Prospective Study

AU - Imagama, Shiro

AU - Ando, Kei

AU - Takeuchi, Kazuhiro

AU - Kato, Satoshi

AU - Murakami, Hideki

AU - Aizawa, Toshimi

AU - Ozawa, Hiroshi

AU - Hasegawa, Tomohiko

AU - Matsuyama, Yukihiro

AU - Koda, Masao

AU - Yamazaki, Masashi

AU - Chikuda, Hirotaka

AU - Shindo, Shigeo

AU - Nakagawa, Yukihiro

AU - Kimura, Atsushi

AU - Takeshita, Katsushi

AU - Wada, Kanichiro

AU - Katoh, Hiroyuki

AU - Watanabe, Masahiko

AU - Yamada, Kei

AU - Furuya, Takeo

AU - Tsuji, Takashi

AU - Fujibayashi, Shunsuke

AU - Mori, Kanji

AU - Kawaguchi, Yoshiharu

AU - Watanabe, Koota

AU - Matsumoto, Morio

AU - Yoshii, Toshitaka

AU - Okawa, Atsushi

PY - 2018/12/1

Y1 - 2018/12/1

N2 - STUDY DESIGN: Prospective, multicenter, nationwide study. OBJECTIVE: To investigate perioperative complications and risk factors in surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) using data from the registry of the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. SUMMARY OF BACKGROUND DATA: There is no prospective multicenter study of surgical complications and risk factors for T-OPLL, and previous multicenter retrospective studies have lacked details. METHODS: Surgical methods, preoperative radiographic findings, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association [JOA] score), prone and supine position test (PST), intraoperative ultrasonography, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 115 cases (males: 55, females: 60, average age 53.1 y). Factors related to perioperative complications and risk factors for postoperative motor palsy were identified. RESULTS: Posterior decompression and fusion with instrumentation with or without dekyphosis was performed in 85 cases (74%). The JOA recovery rate at 1 year after surgery in all cases was 55%. Motor palsy occurred postoperatively in 37 cases (32.2%), with a mean recovery period of 2.7 months. A long recovery period for postoperative motor palsy was significantly associated with a high number of T-OPLL levels (P < 0.0001), lower preoperative JOA score (P < 0.05), and greater estimated blood loss (P < 0.05). Perioperative complications or postoperative motor palsy were significantly related to a higher number of T-OPLL levels, comorbid ossification of ligamentum flavum rate, lower preoperative JOA score, higher preoperative positive PST rate, more surgical invasiveness, a lower rate of intraoperative spinal cord floating in ultrasonography, and higher rate of deterioration of IONM. CONCLUSION: This study firstly demonstrated the perioperative complications with high postoperative motor palsy rate in a nationwide multicenter prospective study. Surgical outcomes for T-OPLL should be improved by identifying and preventing perioperative complications with significant risk factors.3.

AB - STUDY DESIGN: Prospective, multicenter, nationwide study. OBJECTIVE: To investigate perioperative complications and risk factors in surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) using data from the registry of the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. SUMMARY OF BACKGROUND DATA: There is no prospective multicenter study of surgical complications and risk factors for T-OPLL, and previous multicenter retrospective studies have lacked details. METHODS: Surgical methods, preoperative radiographic findings, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association [JOA] score), prone and supine position test (PST), intraoperative ultrasonography, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 115 cases (males: 55, females: 60, average age 53.1 y). Factors related to perioperative complications and risk factors for postoperative motor palsy were identified. RESULTS: Posterior decompression and fusion with instrumentation with or without dekyphosis was performed in 85 cases (74%). The JOA recovery rate at 1 year after surgery in all cases was 55%. Motor palsy occurred postoperatively in 37 cases (32.2%), with a mean recovery period of 2.7 months. A long recovery period for postoperative motor palsy was significantly associated with a high number of T-OPLL levels (P < 0.0001), lower preoperative JOA score (P < 0.05), and greater estimated blood loss (P < 0.05). Perioperative complications or postoperative motor palsy were significantly related to a higher number of T-OPLL levels, comorbid ossification of ligamentum flavum rate, lower preoperative JOA score, higher preoperative positive PST rate, more surgical invasiveness, a lower rate of intraoperative spinal cord floating in ultrasonography, and higher rate of deterioration of IONM. CONCLUSION: This study firstly demonstrated the perioperative complications with high postoperative motor palsy rate in a nationwide multicenter prospective study. Surgical outcomes for T-OPLL should be improved by identifying and preventing perioperative complications with significant risk factors.3.

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