Treatment for Thoracic Ossification of Posterior Longitudinal Ligament with Posterior Circumferential Decompression

Xu, Zhaowan; Hu, Yongcheng; Sun, Chuiguo; Shang, Xiaopeng; Lun, Dengxing; Feng, Li; Ji, Xubin; Liu, Da‐yong; Chen, Nai‐wang; Zhuang, Qingshan

doi:10.1111/os.12331

Cited by 12 publications

(13 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The cases enrolled in this study were patients who were diagnosed with OPLL in thoracic spine from August 2015 to June 2020 in our hospital. The inclusion criteria included: (1) Age ≥ 18 years old; (2) The surgery plan was a simple posterior approach to transarticular osteotomy and circumferential decompression; (3) The cases underwent complete preoperative CT examination to determine the type of OPLL and whether there was ossi cation of the ligamentum avum (OLF); (4) The surgery was done by the same team. The exclusion criteria included: (1) Age 18 years old; (2) Patients with congenital or acquired deformities of thoracic spine, such as congenital thoracic scoliosis, ankylosing spondylitis, and kyphosis secondary to spinal tuberculosis; (3) Thoracic infectious diseases; (4) Primary or metastatic spinal tumors; (5) Previous history of thoracic surgery.…”

Section: Methods Patient Screening and Selectionmentioning

confidence: 99%

“…(2) Once the patient has symptoms of low intracranial pressure such as headache, the bed tail would be raised for 10 cm, or the trendelenburg position would be adopted to alleviate the symptoms. (3) Water and electrolyte should be taken on a regular basis to strengthen nutritional support. For patients with low intracranial pressure symptoms, intravenous infusion of concentrated sodium chloride was conducted to alleviate the symptoms.…”

Section: Diagnostic Criteria For Csflmentioning

confidence: 99%

See 1 more Smart Citation

Predictive Model of Cerebrospinal Fluid Leakage After Posterior Circumferential Decompression for Thoracic Ossification of Posterior Longitudinal Ligament

Zhong

Wen

Chen

2021

Preprint

View full text Add to dashboard Cite

Background: Cerebrospinal fluid leakage(CSFL) is one of the most common complications after posterior transarticular osteotomy and circumferential decompression for thoracic ossification of posterior longitudinal ligament(OPLL). It is of great usefulness If the cerebrospinal fluid leakage can be predicted preoperatively. These predictors help to attract the attention of the surgeon in advance and warn the patient. Therefore, the aim of this study is to find out the factors that can predict the CSFL prior to operation and try to build a predictive model.Methods: A total of 61 patients with thoracic OPLL underwent posterior transarticular osteotomy and circumferential decompression from August 2015 to June 2020 in our hospital were included in this study, including 29 males and 32 females. The patients were divided into CSLF group and non-CSFL group according to whether they suffered cerebrospinal fluid leakage. Univariate analysis was used to identify possible predictors in Demographic characteristics, clinical and radiological data. A logistic regression model was developed by multivariate analyses to predict probability of CSFL. Model validation was done using the receiver operating characteristic(ROC) curve.Results: The incidence of CSFL was 31.1%, including 7 males and 12 females, with an average age of 49.8 ±11.4 years. The mean drainage indwelling time in CSFL group was 5.6±1.0 days, which was significantly higher than that in non-CSFL group (4.2±1.3 days, P < 0.001). The mean length of hospital stay was 16.3±6.3 days, slightly higher than that of the non-CSF group (15.8±6.7 days), but there was no statistical difference (P=0.77). Among them, 12 patients (63.2%) suffered low intracranial pressure manifested as headache; 1 patient (5.3%) had cerebrospinal fluid outflow from the incision, and the wound healed successfully after debridement.1 patient (5.3%) was re-admitted to the hospital due to fever after 3 weeks, considering deep wound effusion and pleural effusion. The wound effusion was found to be cured after 2 weeks of anti-infective treatment. Univariate regression analysis showed statistical differences (P<0.05) in smoking history, segment of circumferential decompression, combined with ossification of the ligamentum flavum (OLF), number of laminectomy, occupying ratio and OPLL base ratio. Multivariate regression model showed smoking history (OR=30.1, P=0.003), the upper thoracic segment (OR= 188.0, P= 0.002), the middle thoracic segment (OR= 57.4, P= 0.005) and OPLL base ratio (OR=1.3, P=0.007) were the predictors of CSFL. The ROC curve was in the upper left corner (area under the curve = 0.955, 95% CI 0.91-1.00, P< 0.001), indicating good predictability of the model.Conclusion: The predictive model established in this study has a high predictive effect. When the patients with thoracic OPLL have smoking history or the segment of circumferential decompression is located in the upper or middle thoracic spine or the OPLL has a wide base, the operator should be highly alert to the possibility of postoperative CSFL and warn the patient before surgery. Evidence level: level II-2

show abstract

Section: Methods Patient Screening and Selectionmentioning

confidence: 99%

Section: Diagnostic Criteria For Csflmentioning

confidence: 99%

Predictive Model of Cerebrospinal Fluid Leakage After Posterior Circumferential Decompression for Thoracic Ossification of Posterior Longitudinal Ligament

Zhong

Wen

Chen

2021

Preprint

View full text Add to dashboard Cite

show abstract

“…The occurrence of ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine is about 0.8% (1), which is lower than that of OPLL in the cervical spine. However, due to the limited activity of thoracic spine as well as poor compensatory effect of thoracic spinal cord, bone compression often requires static compression (2,3). Therefore, once clinical symptoms of OPLL occur in the thoracic spine, they progress rapidly and can cause severe spinal cord injury or even paraplegia in a short time.…”

Section: Introductionmentioning

confidence: 99%

“…Circumferential decompression (CD) has been widely used due to its effectiveness in removing the compression around the spinal cord even postoperative complication rate was relative higher. Many scholars have confirmed that the posterior approach can achieve satisfactory surgical results (2,3). Nevertheless, the operation is highly difficult and can result in many complications, with cerebrospinal fluid leakage (CSFL) being one of the most common (4).…”

Section: Introductionmentioning

confidence: 99%

Predicting cerebrospinal fluid leakage prior to posterior circumferential decompression for the ossification of the posterior longitudinal ligament in the thoracic spine

2021

View full text Add to dashboard Cite

“…It is considered one of the most challenging spinal surgeries, mainly owing to its unique anatomy and pathophysiological factors. 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

View full text Add to dashboard Cite

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.

show abstract

Treatment for Thoracic Ossification of Posterior Longitudinal Ligament with Posterior Circumferential Decompression

Abstract: Treatment with posterior transpedicular osteotomy and circumferential decompression was found to be safe, effective, reliable, and technically feasible, and keeping the thoracic cavity intact avoids many shortcomings of anterior surgery and results in a satisfactory spinal decompression.

Cited by 12 publications

References 23 publications

Predictive Model of Cerebrospinal Fluid Leakage After Posterior Circumferential Decompression for Thoracic Ossification of Posterior Longitudinal Ligament

Predictive Model of Cerebrospinal Fluid Leakage After Posterior Circumferential Decompression for Thoracic Ossification of Posterior Longitudinal Ligament

Predicting cerebrospinal fluid leakage prior to posterior circumferential decompression for the ossification of the posterior longitudinal ligament in the thoracic spine

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

Contact Info

Product

Resources

About