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

Sanghvi, Amish V.; Chhabra, Harvinder Singh; Mascarenhas, Amrithlal A; Mittal, Vivek; Sangondimath, Gururaj

doi:10.1007/s00586-010-1423-9

Cited by 54 publications

(63 citation statements)

References 29 publications

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“…41 A recent study evaluating the effect of intramedullary signal changes on recovery suggested that the presence or absence of signal changes did not correlate with postoperative recovery; but whenever present, intramedullary signal size (ISS) greater than 15 mm significantly compromised recovery. 39 The results of our study match with other studies 39,42 ; however, we did not evaluate the effect of ISS with recovery.…”

Section: Discussionsupporting

confidence: 85%

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Surgical Treatment of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum

Arora

Jaiswal

Mittal

et al. 2016

IJNS

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Objectives We retrospectively studied the risk factors, clinical manifestations, radiological aspects, surgical treatment, and prognostic factors in 143 patients of thoracic ossification of ligamentum flavum (OLF). Methods A total of 143 patients who underwent surgical treatment for thoracic myelopathy secondary to OLF between 1989 and 2010 were studied retrospectively. Preoperative and postoperative neurological data were reviewed and the correlation between the variables of patient characteristics, preoperative duration of symptoms, preoperative neurological status, and the functional outcome were analyzed. The male to female ratio was 1.5:1. In total, 114 patients (79.72%) were in the 4th to 6th decade of life. Only two cases (1.4%) were of less than 20-year age group. The lower thoracic region (D9-D12) was most commonly affected (61.5%). Four patients had long segment involvement (7 levels) and eight patients had two separate levels of involvement. Associated fluorosis was observed in 32 patients (22.37%). All patients underwent wide decompressive laminectomy with medial one-third facetectomy and OLF was resected. The part of dura adherent to OLF or calcified is also removed with it and duroplasty done if required. The average follow-up was 5 years. Outcome In all, 86 patients (60.13%) were able to do their job with mild neurological deficit such as spasticity and impairment of joint position sense. Twenty-eight patients (19.58%) were back to some job with limitation but were independent for their routine work. Sixteen patients (11.18%) improved but still required help for their routine work while thirteen patients (9.09%) were bed-ridden at last follow-up. Most common complications observed were cerebrospinal fluid leak (7.69%), neurological deterioration (8.39%), and infection (4.89%). Five (3.4%) patients required second surgery for ossification at other level during follow-up.

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Section: Discussionsupporting

confidence: 85%

“…Despite good posterior decompression of thoracic myelopathy due to OLF, recovery varies widely from 25 to 100%. 39 We had improvement in over 90% of our patients at their respective last follow-up.…”

Section: Discussionmentioning

confidence: 63%

Surgical Treatment of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum

Arora

Jaiswal

Mittal

et al. 2016

IJNS

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“…However, outcomes after surgery may depend on the involvement of the spinal cord, irreversible changes, and duration of symptoms [29]. Sanghvi et al [31] reported that the predictors of postoperative recovery are preoperative symptom duration and intramedullary signal size. In the present study, all six patients who had undergone surgical decompression showed JOA score improvement and an average recovery rate of 58.9 %.…”

Section: Discussionmentioning

confidence: 99%

Thoracic myelopathy caused by ossification of the yellow ligament in patients with posterior instrumented lumbar fusion

Ha¹,

Seo²,

Son³

et al. 2012

Eur Spine J

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“…Many factors influence the neurological recovery after decompressive surgery for cervical and thoracic myelopathy. Previous studies have suggested that the surgical outcome and prognostic factors include patient clinical characteristics (age at surgery, sex, duration of symptoms, preoperative JOA score, type of myelopathy, radiological findings, spinal cord evoked potentials type, surgical procedure, and follow-up period duration), intramedullary signal change on MRI, and outcomes of the 15-second grip-and-release test and the 10-second step test [15][16][17][18][19][20]. However, the prognostic guidelines are not clear, thus, making it difficult for the surgeon to predict neurological recovery and outcome.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Improved Intraoperative Neurophysiological Monitoring Signal during Spine Surgery: A Retrospective Study of a Single-Institution Prospective Cohort

Lee

Kang

et al. 2020

Asian Spine J

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Study Design: Retrospective case series. Purpose: We reviewed the cases that showed significant improvement of intraoperative neurophysiological monitoring (IONM) signals during spine surgery to assess whether there is a correlation with signal improvement and postoperative clinical status and its clinical significance. Overview of Literature: To reduce the risk of neural injury, many spine surgeons are using multimodality IONM. Although many studies attempted to identify valid alarm criteria for predicting postoperative neurologic deterioration, studies concerning the improvement of IONM signals are rare. Methods: We reviewed all spine surgery cases with IONM data treated at our department between January 2013 and May 2017. We found cases showing significant IONM signal improvements. We prospectively analyzed the neurological and clinical outcomes of these patients and compared outcomes pre-and postoperatively. Results: Among 317 cases with the IONM data, we found 29 cases that showed IONM signal improvement compared with baseline. There were 27 cases of compressive myelopathy: 22 had a degenerative cause at the cervical spine, and five, at the thoracic spine. There were two cases of huge neurogenic tumor each at the craniovertebral junction and at the lumbar spine. Both motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) signals were improved in six cases, only the MEPs signal improved in 10, and only SSEP signal improved in 13 cases. All cases showed the IONM signal improvement consistently after the decompression procedure during surgery. All patients had a significant improvement in neurological function and subjective symptoms, and none had neurologic deterioration postoperatively. Conclusions: Improvement of IONM signals during surgery may indicate that no unrecognized neural injury occurred during surgery and a favorable postoperative neurological outcome can be expected.

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

Cited by 54 publications

References 29 publications

Surgical Treatment of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum

Surgical Treatment of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum

Thoracic myelopathy caused by ossification of the yellow ligament in patients with posterior instrumented lumbar fusion

Clinical Significance of Improved Intraoperative Neurophysiological Monitoring Signal during Spine Surgery: A Retrospective Study of a Single-Institution Prospective Cohort

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