• Morio Matsumoto, Kazuhiro Chiba, Yoshiaki Toyama, Katsushi Takeshita, Atsushi Seichi, Kozo Nakamura, Jun Arimizu, Shunsuke Fujibayashi, Shigeru Hirabayashi, Toru Hirano, Motoki Iwasaki, Kouji Kaneoka, Yoshiharu Kawaguchi, Kosei Ijiri, Takeshi Maeda, Yukihiro Matsuyama, Yasuo Mikami, Hideki Murakami, Hideki Nagashima, Kensei Nagata, Shinnosuke Nakahara, Yutaka Nohara, Shiro Oka, Keizo Sakamoto, Yasuo Saruhashi, Yutaka Sasao, Katsuji Shimizu, Toshihiko Taguchi, Makoto Takahashi, Yasuhisa Tanaka, Toshikazu Tani, Yasuaki Tokuhashi, Kenzo Uchida, Kengo Yamamoto, Masashi Yamazaki, Toru Yokoyama, Munehito Yoshida, and Yuji Nishiwaki.
• Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University, Department of Orthopedic Surgery, Tokyo, Japan. morio@sc.itc.keio.ac.jp
• Spine. 2008 Apr 20; 33 (9): 1034-41.

Study DesignRetrospective multi-institutional studyObjectiveTo describe the surgical outcomes in patients with ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) and to clarify factors related to the surgical outcomes.Summary Of Background DataDetailed analyses of surgical outcomes of T-OPLL have been difficult because of the rarity of this disease.MethodsThe subjects were 154 patients with T-OPLL who were surgically treated at 34 institutions between 1998 and 2002. The surgical procedures were laminectomy in 36, laminoplasty in 51, anterior decompression via anterior approach in 25 and via posterior approach in 29, combined anterior and posterior fusion in 8, and sternum splitting approach in 5 patients. Instrumentation was conducted in 52 patients. Assessments were made on (1) The Japanese Orthopedic Association (JOA) scores (full score, 11 points), its recovery rates, (2) factors related to surgical results, and (3) complications and their consequences.Results(1) The mean JOA score before surgery was 4.6 +/- 2.0 and, 7.1 +/- 2.5 after surgery. The mean recovery rate was 36.8% +/- 47.4%. (2) The recovery rate was 50% or higher in 72 patients (46.8%). Factors significantly related to this were location of the maximum ossification (T1-T4) (odds ratio, 2.43-4.17) and the use of instrumentation (odds ratio, 3.37). (3) The frequent complications were deterioration of myelopathy immediately after surgery in 18 (11.7%) and dural injury in 34 (22.1%) patients.ConclusionThe factors significantly associated with favorable surgical results were maximum ossification located at the upper thoracic spine and use of instrumentation. T-OPLL at the nonkyphotic upper thoracic spine can be treated by laminoplasty that is relatively a safe surgical procedure for neural elements. The use of instrumentation allows correction of kyphosis or prevention of progression of kyphosis, thereby, enhancing and maintaining decompression effect, and its use should be considered with posterior decompression.

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