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Spine (Phila Pa 1976). 2008 May 15;33(11):1199-208. doi: 10.1097/BRS.0b013e3181714515.

Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament.

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1
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

Abstract

STUDY DESIGN:

A retrospective review.

OBJECTIVE:

This study examined the clinical outcomes of circumferential spinal cord decompression through a posterior approach for thoracic ossification of posterior longitudinal ligament (OPLL), to determine the efficacy of this procedure and the incidence of complications.

SUMMARY OF BACKGROUND DATA:

Since posterior decompressive laminectomy is not always effective in the treatment of thoracic myelopathy caused by OPLL, circumferential spinal cord decompression through a single posterior approach seems to offer an effective treatment option. However, this procedure is technically demanding and has a high risk of postoperative neurologic deterioration. Long-term clinical outcome data and complication rates of this procedure are not well covered in the literature.

METHODS:

Medical records of sequentially treated 30 patients, who had undergone circumferential spinal cord decompression through a single posterior approach, were reviewed to determine demographic data, neurologic examination, imaging findings, surgical procedure, and follow-up data. The Japanese Orthopedic Association (JOA) score was used to assess physical dysfunction and neurologic impairment.

RESULTS:

The mean follow-up period was 8 years; the average operative time was 389 minutes; the mean blood loss was 1883 mL. An average of 4-level spinal cord decompression was performed on all 30 patients. Posterior spinal fusion was performed on 26 of the 30 patients. The mean preoperative JOA score was 3.4/11, and it improved to an average of 7.1/11 at final evaluation. Clinical symptoms and the JOA score improved in 24 patients, but were unchanged or worsened in the other 6 patients compared to the preoperative conditions. Surgical complications included dural tear in 12 patients (40%), deep infection in 3 (10%), and postoperative neurologic deterioration in 10 (33%). Statistical analysis showed that a risk factor associated with the unfavorable surgical outcomes was multiple level circumferential spinal cord decompression of 5 or more vertebral levels.

CONCLUSION:

Despite circumferential spinal cord decompression through posterior approach for thoracic OPLL providing effective neurologic recovery, there was a high rate of complications such as postoperative neurologic deterioration. Risk factor analysis shows that multiple level circumferential decompression of 5 or more vertebral levels to be associated with unfavorable surgical outcome.

PMID:
18469693
DOI:
10.1097/BRS.0b013e3181714515
[Indexed for MEDLINE]
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