Surgical Outcome of Ossification of the Posterior Longitudinal Ligament (OPLL) of the Thoracic Spine

Matsuyama, Yukihiro; Yoshihara, Hisatake; Tsuji, Taichi; Sakai, Yoshihito; Yukawa, Yasutsugu; Nakamura, Hiroshi; Ito, Keigo; Ishiguro, Naoki

doi:10.1097/01.bsd.0000155033.63557.9c

Cited by 103 publications

(74 citation statements)

References 6 publications

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“…Beak-type OPLL has higher risk of neurological deterioration after posterior approach surgery than flat-type OPLL. 80 Beak-type and flat-type OPLL are shown in Fig. 5.…”

Section: Surgical Treatment Of Thoracic Opllmentioning

confidence: 99%

Ossification of the posterior longitudinal ligament: a review

Saetia

Cho

Lee

et al. 2011

FOC

119

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Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, the elderly, and Asian patients. There are many diseases associated with OPLL, such as diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and other spondyloarthropathies. Several factors have been reported to be associated with OPLL formation and progression, including genetic, hormonal, environmental, and lifestyle factors. However, the pathogenesis of OPLL is still unclear. Most symptomatic patients with OPLL present with neurological deficits such as myelopathy, radiculopathy, and/or bowel and bladder symptoms. There are some reports of asymptomatic OPLL. Both static and dynamic factors are related to the development of myelopathy. Plain radiography, CT, and MR imaging are used to evaluate OPLL extension and the area of spinal cord compression. Management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be made case by case, depending on the patient's condition, level of pathology, type of OPLL, and the surgeon's experience. In this paper, the authors attempt to review the incidence, pathology, pathogenesis, natural history, clinical presentation, classification, radiological evaluation, and management of OPLL.

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“…Beak-type OPLL has higher risk of neurological deterioration after posterior approach surgery than flat-type OPLL. 80 Beak-type and flat-type OPLL are shown in Fig. 5.…”

Section: Surgical Treatment Of Thoracic Opllmentioning

confidence: 99%

Ossification of the posterior longitudinal ligament: a review

Saetia

Cho

Lee

et al. 2011

FOC

119

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“…6 Matsuyama et al 7 reported posterior displacement of the spinal cord after laminectomy and concluded that destruction of the posterior spinal structures, such as occurs during a laminectomy procedure, may increase spinal kyphosis, leading to the spinal cord deterioration, in the beak type of thoracic OPLL. CT myelogram demonstrated a beak-type OPLL at the T7-8 level in the present case.…”

Section: Discussionmentioning

confidence: 99%

Resection of spinous processes can cause spinal cord injury in patient with ossification of the posterior longitudinal ligament in the thoracic spine

et al. 2014

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Study design: Case report. Objective: To report intraoperative spinal cord injury by resection of spinous processes in a 73-year-old man with ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Methods: A 73-year-old man presented with cervicothoracic OPLL with bilateral numbness and clumsiness of his hand, weakness of his lower extremities and severe gait disturbance. His Japanese Orthopaedic Association (JOA) score was 7.5 out of 17. Cervical laminoplasty (C2-6), cervicothoracic laminectomy (C7-T10) and posterior fusion (C7-T10) were performed in the prone position with electrophysiologic monitoring of the spinal cord-evoked potentials (SCEPs). Results: The spinal processes with supra-and interspinous ligaments between C7 and T10 were resected. After resection, the amplitude of SCEP waveforms decreased rapidly to o10% of control levels. Laminectomy was performed, and, after 80 min of SCEP deterioration, an instrumented fusion with correction for kyphosis was completed. The SCEP amplitude recovered gradually. Immediately after surgery, the patient suffered severe motor loss in both lower limbs. His neurological recovery progressed gradually from 2 days after surgery, and he was able to walk at 3 months after surgery. At 6 years after surgery, the JOA score was 11. Conclusion: Our results suggest that intraoperative spinal cord injury can occur before posterior decompression by resection of spinal processes with supra-and interspinous ligaments. The timing of the instrumented stabilization using a temporary rod is important and should be considered immediately after posterior exposure of the spine. Spinal Cord (2014) 52, S19-S21; doi:10.1038/sc.2014.151 INTRODUCTIONIn treatment for thoracic ossification of the posterior longitudinal ligament (OPLL), postoperative paraplegia is a major risk. 1,2 To avoid the postoperative paraplegia, posterior decompression with instrumented fusion (PDF) has been reported. 3 However, postoperative paraplegia remains a risk and the causes are controversial. We present a case of cervicothoracic OPLL suggesting that electrophysiologic monitoring can be used to document the occurrence of paralysis with resection of spinous processes. CASE REPORTA 73-year-old man presented with cervicothoracic OPLL, a Japanese Orthopaedic Association (JOA) score for cervical myelopathy of 7.5 (17 points is full points) and JOA score for thoracic myelopathy of 5.5 (11 points is full points). The patient complained of bilateral numbness, clumsiness of his hands, bilateral motor weakness of his lower extremities (manual muscle testing: MMT at grade 4 out of 5), hypoesthesia in both lower limbs (Grade 1-5 out of 10) and inability to walk without a handrail. Reconstructed images from a computerized tomography (CT) myelogram showed extensive segmental OPLL, in particular at C4-5 (Figure 1a), T2-3 and T7-8 levels (Figure 1b). Thoracic MRI showed severe compression of the spinal cord at T2-3 and T7-8 (Figure 1c). The kyphotic Cobb's angle between the upper endplate of the C7 an...

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“…1 The surgical management of thoracic OPLL consists of a multitude of options: posterior decompressive laminectomy, posterior decompressive laminectomy with fusion, anterior decompression through an anterior or lateral approach, anterior decompression through a posterior approach, posterior decompression with fusion followed by anterior or lateral decompression, and laminoplasty. 1,3,4,6,8,9,12,16,20,21,25,[28][29][30][31]34,36,40 Many studies have highlighted the various approaches, but no protocol, paradigm, or definite standard has been identified. 5,36 The optimal objective of surgery for OPLL of the thoracic spine is to completely decompress the spinal cord.…”

Section: Advantages and Disadvantages With Indications And Limitationmentioning

confidence: 99%

“…A classification based on form and morphology includes a continuous or mixed type with a flat shape ("flattype") and a segmental type with sharp protrusions located behind the disc spaces ("beak-type"). 16 Ossification of the posterior longitudinal ligament can also be described morphologically as linear, beaked, continuous waveform, continuous cylindrical, segmental, continuous, or mixed. 15,24 Patterns of ossification can be divided into 4 major subgroups as follows: 1) focal ossification at the posterior margin of the vertebral body; 2) segmental ossification in which each change does not extend beyond the adjacent intervertebral disc level; 3) continuous ossification over multiple levels; and 4) mixed ossification.…”

Section: Anatomical Considerationsmentioning

confidence: 99%

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

McClendon

Sugrue

Ganju

et al. 2011

FOC

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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.

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Surgical Outcome of Ossification of the Posterior Longitudinal Ligament (OPLL) of the Thoracic Spine

Cited by 103 publications

References 6 publications

Ossification of the posterior longitudinal ligament: a review

Ossification of the posterior longitudinal ligament: a review

Resection of spinous processes can cause spinal cord injury in patient with ossification of the posterior longitudinal ligament in the thoracic spine

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

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