Management of ossification of the posterior longitudinal ligament of the thoracic spine

Abstract

<jats:p>The management of thoracic ossification of the posterior longitudinal ligament has been studied by many spinal surgeons. Indications for operative intervention include progressive radiculopathy, myelopathy, and neurological deterioration. The ideal surgery for decompression remains highly debatable as various methods of surgical treatment of ossification of the posterior longitudinal ligament have been devised. Although numerous modifications to the 3 main approaches have been identified (anterior, posterior, or lateral), the indication for each depends on the nature of compression, the morphology of the lesion, the level of the compression, the structural alignment of the spine, and the neurological status of the patient. The authors discuss treatment techniques for thoracic ossification of the posterior longitudinal ligament, cite case examples from a single institution, and review the literature.</jats:p>

Functional outcome of surgically treated patients of ossified posterior longitudinal ligament of cervical and dorsal spine in Indian population – A single center retrospective analysis of 40 patients

“…In their study, they found that many factors were accounting for poor outcome such as age, duration of symptoms, type of OPLL, location of OPLL, number of segments involved, coexistence of other degenerative conditions, comorbidities, preoperative neurology, type of approach used, and instrumented fusion. [24,25]…”

Use of an Ultrasonic Osteotome for Direct Removal of Beak-Type Ossification of Posterior Longitudinal Ligament in the Thoracic Spine

“…An anterior approach may be preferable to remove T-OPLL, but the transthoracic/extraplerual approach or trans-sternal approach is technically challenging and is associated with a higher complication rate 4 16 18) . A recent review on this subject has shown that neurological deficit occurred in 2.7-18.8% of patients after an anterior approach 5 17 18) . Direct removal of the ossified mass with a posterior only approach may be an alternative, but it has been traditionally challenging secondary to associated kyphotic deformities, adhesion of T-OPLL to the dura and a narrow/blind surgical field 3 16) .…”

“…Indirect decompression could be achieved with laminectomy, laminoplasty or posterior instrumented correction of thoracic kyphosis 5 8 11 12 13 14 15 18 26 27 28 30) . Although direct removal of T-OPLL is ideal for neural element decompression, complications associated with the anterior approach, e.g., neurologic deficit and dural tear/cerebrospinal fluid (CSF) leakage, leads us to explore other potential surgical options 5 13 14 17 18) . Because laminectomy had a poor outcome due to progression of thoracic kyphosis and persistent ventral compression, instrumented fusion with or without direct removal of T-OPLL mass with posterior approach was introduced with comparable recovery rate to anterior approach 5 9 11 12 13 14 18 19) .…”

A Single Stage Dorsal Corpectomy, Reconstruction and Stabilization; Can We Depend on the Costotransversectomy Approach?

“…The surgical field becomes wider as one chooses the approach from the former to the later, respectively, allowing better visualization, hence better ventral decompression, but with more tissue devitalization. [3][4][5][6][7][8] The transpedicular approach through a dorsal midline incision can achieve effective posterior decompression, posterolateral vertebrectomy, coupled with posterior transpedicular fixation even for multiple levels in a single session. This technique is familiar to many spine surgeons, and surely avoids the high morbidity complicating whether the anterior approach or the combined anterior and posterior approaches, hence it is considered an ideal approach for severely ill patients.…”