Contributing factors affecting the prognosis surgical outcome for thoracic OLF

Abstract

The thoracic ossification of ligamentum flavum (OLF) is a disease that produces spastic paraparesis, and there are various factors that may affect the surgical outcome of thoracic OLF patients. The authors of this study treated 19 of these thoracic OLF patients from 1998 to 2002, and retrospectively reviewed the patients¢ age, sex, symptom duration, involved disease level, preoperative clinical features, neurological findings, radiological findings, the other combined spinal diseases and the surgical outcomes. There were excellent or good surgical outcomes in 16 patients, but 3 patients did not improve after thoracic OLF surgery: this included 1 patient, whose motor function worsened after decompressive thoracic OLF surgery. The favorable contributing factors of surgical outcome in thoracic OLF are a short preoperative symptom duration, single-level lesion, and unilateral lesion type on CT axial scan. On the contrary, the poor prognostic factors are beak type lesion and intramedullary signal changes on T 2 -weighted sagittal MRI. The complete preoperative evaluation including radiologic findings will provide valuable aid in presuming the surgical outcome for the thoracic OLF patients.Keywords Thoracic Spine AE Stenosis AE Ossification of ligament flavum AE Myelopathy AE Surgical Outcome Eur Spine J (2006) 15: 485-491

Thoracic myelopathy due to ossification of ligamentum flavum: a retrospective analysis of predictors of surgical outcome and factors affecting preoperative neurological status

“…He et al [16] also differentiated between operated and unoperated lesions and found no differences in recovery. Others [11,14,17] observed that associated stenosis has no impact on recovery, but they did not differentiate them failing to uncover the finding reported by us. Better recovery is seen in decompressed lesions, though the finding was statistically insignificant; Miyokashi et al [10] statistically support same at 1 month after surgery.…”

“…We had patients operated as early as 1 week to 84 months after onset of symptoms, encompassing a wider range and hence were successful in discovering this correlation. Chang et al [12] reported a threshold preoperative duration of symptoms of 2 years as having significant influence on recovery, whereas Kuh et al [14] reported the same as 6 months. However, we do not find any threshold in our study.…”

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

“…13,19,20,22,33,34,56 Preoperative severity of myelopathy was considered as the most important predictor of the postoperative outcome. 19,20,22,56 In accordance with this finding, our research confirmed that preoperative severity of myelopathy was the most important predictor of the highest postoperative JOA score and the lowest percentage RR in multiple linear regression analyses.…”

“…The new categorization of the axial configuration of OLF is by unilateral, bilateral and bridged type (Figure 1), and the categorization of the sagittal configuration of OLF is by beak type and round type ( Figure 2) according to previous reports with some modifications. 33,34 To evaluate the effect of the thoracic OLF purely, OLF should be apparent and the direct cause of myelopathy. Patients were excluded on the basis of the following criteria: diagnosis of OLF occurring with concurrent ventral compressive lesion, such as thoracic disc herniation or ossification of posterior longitudinal ligament at the same level or cervical compressive myelopathy such as ossification of posterior longitudinal ligament or cervical spondylosis; receipt of surgery using an anterior approach or circumferential spinal cord decompression through a posterior approach; history of spinal tumor; or previous spinal surgery.…”

Diffüz İdiopatik İskeletal Hiperostozlu (DİSH) Hastada Posterior Vertebral Osteofit ve Ligamentum Flavum Ossifikasyonuna Bağlı Üst Torakal Miyelopati Gelişimi

“…Ancak torakal LFO cerrahi tedavisinin, yüksek riskli ve gidişatı öngörülemeyen bir durum yaratabildiği de bildirilmektedir (7). Bu nedenle erken teşhis edilen, miyelopatinin ilerlemediği, cerrahi risklerinin yüksek olduğu ve operasyonun hasta tarafından tercih edilmediği, bizim olgumuzdaki gibi nadir durumlarda da rehabilitasyon yaklaşımını içeren konservatif tedavi düşünülebilir.…”