Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament

Imagama, Shiro; Ando, Kei; Takeuchi, Kazuhiro; Kato, Satoshi; Murakami, Hideki; Aizawa, Tadanori; 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, Kota; Matsumoto, Morio; Yoshii, Toshitaka; Okawa, Atsushi

doi:10.1097/brs.0000000000002703

Cited by 63 publications

(56 citation statements)

References 35 publications

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“…To date, although the advance of instruments and technique, thoracic spinal decompression surgery is still of great challenging. Unfavorable outcomes and high incidence of complications were frequently reported [ 12 , 13 ]. To the best of our knowledge, few studies have described how to use UBS for thoracic spinal decompression [ 4 ], and no consistent surgical procedures have yet been established.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonic bone scalpel for thoracic spinal decompression: case series and technical note

et al. 2020

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Background Thoracic spinal stenosis (TSS) is a rare but intractable disease that fails to respond to conservative treatment. Thoracic spinal decompression, which is traditionally performed using high-speed drills and Kerrison rongeurs, is a time-consuming and technically challenging task. Unfavorable outcomes and high incidence of complications are the major concerns. The development and adaptation of ultrasonic bone scalpel (UBS) have promoted its application in various spinal operations, but its application and standard operating procedure in thoracic decompression have not been fully clarified. Therefore, the purpose of this study is to describe our experience and technique note of using UBS and come up with a standard surgical procedure for thoracic spinal decompression. Methods A consecutive of 28 patients with TSS who underwent posterior thoracic spinal decompression surgery with UBS between December 2014 and May 2015 was enrolled in this study. The demographic data, perioperative complications, operation time, estimated blood loss, and pre- and postoperative neurological statuses were recorded and analyzed. Neurological status was evaluated with a modified Japanese Orthopaedic Association (JOA) scale, and the neurological recovery rate was calculated using the Hirabayashi’s Method. Results Thoracic spinal decompression surgery was successfully carried out in all cases via a single posterior approach. The average age at surgery was 49.7 ± 8.5 years. The mean operative time of single-segment laminectomy was 3.0 ± 1.4 min, and the blood loss was 108.3 ± 47.3 ml. In circumferential decompression, the average blood loss was 513.8 ± 217.0 ml. Two cases of instrument-related nerve root injury occurred during operation and were cured by conservative treatment. Six patients experienced cerebrospinal fluid (CSF) leakage postoperatively, but no related complications were observed. The mean follow-up period was 39.7 ± 8.9 months, the average JOA score increased from 4.7 before surgery to 10.1 postoperatively, and the average recovery rate was 85.8%. Conclusions The UBS is an optimal instrument for thoracic spinal decompression, and its application enables surgeons to decompress the thoracic spinal cord safely and effectively. This standard operating procedure is expected to help achieve favorable outcomes and can be used to treat various pathologies leading to TSS.

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Section: Discussionmentioning

confidence: 99%

Ultrasonic bone scalpel for thoracic spinal decompression: case series and technical note

et al. 2020

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“…Compared with cervical myelopathy, neurological deterioration in thoracic myelopathy is rather concentrated in the lower limbs: lower limb numbness and weakness and an unsteady gait (28). Post-operative motor paralysis was observed in more than 30% of thoracic patients who underwent surgery for OPLL, more than 20% of whom underwent additional surgery to achieve recovery (29). Postoperative paralysis of thoracic OPLL patients tends to be severe, in accordance with the duration and severity of compression before surgery, even when enough decompression is obtained by surgery (30,31).…”

Section: Introductionmentioning

confidence: 99%

Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report

et al. 2020

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Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.

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“…The main disadvantages of this operation can be summarized as follows: i) The incidence of thoracic natural kyphosis may limit the positive effect of spinal cord retreat following posterior decompression; ii) the thoracic spinal cord is characterized by relatively low blood supply, leading to spinal cord ischemia and consequently spinal cord injury; and iii) OPLL with tight adhesion to the dural sac increases the difficulty of removing the ossified ligament and increases the risk of intraoperative spinal cord injury (3)(4)(5)(6)(7)(8). Therefore, patients with T-OPLL that proceed to surgical treatment often result in unsatisfactory prognosis (9,10).…”

Section: Introductionmentioning

confidence: 99%

The COL6A1 rs201153092 single nucleotide polymorphism, associates with thoracic ossification of the posterior longitudinal ligament

et al. 2019

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Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is one of the most common factors that causes thoracic spinal stenosis, resulting in intractable myelopathy and radiculopathy. Our previous study reported that the rs201153092 polymorphism present in the collagen 6A1 (COL6A1) gene was a potentially pathogenic locus for the development of T-OPLL. The present study aimed to determine whether the rs201153092 mutation causes abnormal expression of COL6A1 in Han Chinese patients with T-OPLL, and to examine the effects of this mutation on osteogenesis by establishing a model of osteogenic differentiation. COL6A1 gene mutant and wild-type mouse 3T3-E1 embryonic osteoblast models were constructed to induce the differentiation of these cells into osteoblasts. The potential of the mutation site to induce abnormal expression of the COL6A1 gene and osteogenic markers was assessed via reverse transcription-quantitative PCR and western blot analyses. The results demonstrated that the rs201153092A mutation site resulted in significantly increased COL6A1 gene expression levels in the OPLL tissues obtained following clinical surgery. This mutation was shown to play an important role in the development of T-OPLL by regulating the overexpression of the COL6A1 gene and significantly increasing the expression levels of osteogenic markers. The findings of the present study suggested that the rs201153092A mutant variant could increase the expression levels of COL6A1 and consequently play a role in the pathogenesis of T-OPLL.

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Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament

Abstract: 3.

Cited by 63 publications

References 35 publications

Ultrasonic bone scalpel for thoracic spinal decompression: case series and technical note

Ultrasonic bone scalpel for thoracic spinal decompression: case series and technical note

Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report

The COL6A1 rs201153092 single nucleotide polymorphism, associates with thoracic ossification of the posterior longitudinal ligament

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