Predictive Factors for a Poor Surgical Outcome With Thoracic Ossification of the Ligamentum Flavum by Multivariate Analysis

Ando, Kei; Imagama, Shiro; Ito, Zenya; Hirano, Ken‐ichi; Muramoto, Akio; Kato, Fumihiko; Yukawa, Yasutsugu; Kawakami, Noriaki; Sato, Koji; Matsubara, Yumiko; Kanemura, Tokumi; Matsuyama, Yukihiro; Ishiguro, Naoki

doi:10.1097/brs.0b013e31828ff736

Cited by 57 publications

(65 citation statements)

References 27 publications

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“…15,18,34,54,55 In our study, we also found similar results. In addition, it has been reported Clinical characteristics and surgical outcome of TM caused by OLF Z Li et al that the location of OLF is less vulnerable in mobile segments such as the cervical and lumbar vertebra than in the thoracic vertebrae.…”

Section: Discussionsupporting

confidence: 81%

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

Ren

Zhao

et al. 2015

Spinal Cord

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Study design: A retrospective comparative study. Objectives: To describe the clinical features and radiological findings, to assess the safety and effectiveness of posterior decompressive laminectomy and resection of the ossification of the ligamentum flavum (OLF), and to determine which presurgical and surgical variables were most closely related to postsurgical prognosis of thoracic myelopathy (TM) caused by OLF in China. Methods: Eighty-five patients with the diagnosis of TM caused by OLF received surgical treatment from July 1998 to May 2012. Clinical data were collected from medical and operative records. Correlations between the surgical outcome and various factors were also analyzed. Results: All cases were followed up for a mean of 49.2 months (range, 24-190 months) postoperatively. The mean Japanese Orthopaedic Association score was 3.8 points preoperatively and 8.2 points at the final follow-up, yielding a mean recovery rate of 63.0%. Postoperative complications included transient neurological deficits (9 cases), persistent neurological deficits (4 cases), dural tears (17 cases), cerebrospinal fluid leakage (9 cases), wound dehiscence (2 cases) and wound infection (3 cases). The OLF level (middle thoracic), preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were important predictors of surgical outcome. Conclusions: Biomechanical and anatomical factors may have a key role in thoracic OLF progression. Posterior decompressive laminectomy and resection of the OLF can be considered an effective, reliable and safe alternative procedure. The OLF level, preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were confirmed and significantly correlated with the surgical outcome.

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Section: Discussionsupporting

confidence: 81%

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

Ren

Zhao

et al. 2015

Spinal Cord

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“…However, surgical complications occurred such as dural tear in five patients and CSF leakage, immediate postoperative neurologic deterioration, epidural hematoma, and wound infection in one patient each, respectively 30) . Ando et al 31) reported that the risk factors related to surgical outcomes were duration of the disease, combined ossification of the dura mater, and the presence of discontinuous type ossification of the anterior longitudinal ligament (OALL). Aizawa et al 32) reported the surgical results of 72 patients and concluded that the preoperative results statistically depended on the preoperative severity of myelopathy.…”

Section: Surgical Resultsmentioning

confidence: 99%

“…The surgical methods include open-door type laminectomy, en bloc laminectomy, fenestration, and hemilaminectomy 22,[27][28][29][30][31][32] . In patients in whom the dura mater is ossified and adhered to the OLF, both the ossified dura mater and OLF are resected en bloc with preserving arachnoid.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Ossification of the ligamentum flavum

Hirabayashi

2017

Spine Surg Relat Res

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Abstract:Ossification of the ligamentum flavum (OLF or OYL: ossification of the yellow ligament) usually occurs at the lower thoracic level and causes various types of neurological symptoms in accordance with the compression level of the spinal cord, the nerve roots, the conus medullaris, and the cauda equina. Although the greatest compression level to the nerve tissues is thought to be the most pathognomonic one, it is difficult to diagnose it in some cases. The effectiveness of conservative treatment such as applying a corset is small. Early surgical treatment is strongly recommended for the patients with spastic gait, severe decrease of muscle power in the lower extremities, bladder-bowel disturbance, combined ossification of the posterior longitudinal ligament at the same level, and severe compression to the spinal cord due to thickly hypertrophied ossification. However, numbness of the lower extremities and spastic gait tend to remain even after surgery. . Some information is added here, especially concerning genetic studies, recent etiological studies, and surgical results. This article is being permitted to be published as an updated second version by the editors on both sides. ConceptThe ligamentum flavum locates within the spinal canal posterolaterally connecting two adjacent laminae and is divided into two portions: capsular portion and interlaminar portion 2) . It is composed of 80% elastic fiber and 20% collagen fiber 3) . OLF is a neurological disease in which the ligamentum flavum is chronically ossified and compresses the spinal cord, the nerve roots, the conus medullaris, and cauda equine to various degrees and extents. It can be said that it is a presentation of degenerative changes of the whole spinal column due to aging, and at the same time, it is one of the presentations of systematic ossification trait of the vertebral ligaments. It usually occurs at the lower thoracic level combined with ossification of the posterior longitudinal ligament (OPLL) at the cervical and/or thoracic levels. CauseAlthough the cause of the ossification of the vertebral ligaments is yet unclear, two factors are conjectured: systematic factors and local factors. The former includes heredity, abnormal metabolism of carbohydrate, abnormal metabolism of calcium, abnormal secretion of gender hormone, and degeneration of the ligament, and so on. The latter includes mechanical stress to the enthesis where the ligament attaches to the bone, especially at the capsular portion.The chondrocytes are activated by mechanical stress and produce high volume of type-II collagen, and that type-II collagen is then transformed into type-I collagen in the course of endochondral ossification, resulting in formation of bone within the vertebral ligament 4) . Concerning OPLL, it is reported that collagen 11A2 gene and collagen 6A1 gene are related to its formation 5) . It is also reported that in OPLL, growth factors and transcription factors such as cartilage-derived morphogenetic protein-1, promyelocytic leukemia zinc finger...

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“…The junction between the rigid thoracic spine and the mobile lumbar spine is exposed to concentrated stress levels, leading to a higher likelihood of injuries [4,5]. OLF is also frequently observed in the lower thoracic spine or the thoracolumbar junction [12,13]. In the present study, all patients showed OLF located in the lower thoracic spine.…”

Section: Discussionmentioning

confidence: 66%

Thoracic spinal cord injury without major bone injury associated with ossification of the ligamentum flavum

Machino

Imagama

Ito

et al. 2019

Journal of Orthopaedic Science

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Predictive Factors for a Poor Surgical Outcome With Thoracic Ossification of the Ligamentum Flavum by Multivariate Analysis

Abstract: 3.

Cited by 57 publications

References 27 publications

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

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

Ossification of the ligamentum flavum

Thoracic spinal cord injury without major bone injury associated with ossification of the ligamentum flavum

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