• Tang Chris Yuk Kwan CYK Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, H, Cheung Jason Pui Yin JPY Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, , Dino Samartzis, Ka Hei Leung, Yat Wa Wong, Luk Keith Dip Kei KDK Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, Hon, and Cheung Kenneth Man Chee KMC Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Roa.
• Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, Hong Kong, SAR, China.
• Eur Spine J. 2017 Oct 1; 26 (10): 2598-2605.

PurposeTo investigate the rate and predictive factors of post-operative neurological deterioration in ossified yellow ligament (OYL) surgery.MethodsA retrospective review was conducted for all patients with thoracic OYL causing myelopathy requiring surgical decompression from January 1998 to December 2012. Clinical parameters under study included clinical presentation, distribution of OYL, pre-operative walking score, pre- and post-operative neurological status, status of intra-operative neurophysiological monitoring, and modified Japanese Orthopaedic Association (mJOA) score. Any complications were also recorded. All outcomes were measured at post-operative 1 week and at 2 years.ResultsA total of 26 patients were included in this study. Most patients (92.3%) had Frankel grade D pre-operatively. The rate of neurological deterioration was 15.4% and was correlated with the presence of dural tear, extra-dural hematoma and spinal cord injury. Pre-operative walking score was prognostic of patients' walking ability in the post-operative period. Intra-operative monitoring of Somatosensory Evoked Potentials (SSEP) was found to be useful for monitoring spinal cord injury in OYL surgery, with a positive predictive value of 100% and a negative predictive value of 92.3%. The false negative rate of a SSEP signal drop was only 7.7% CONCLUSIONS: This is the first study exploring risk factors for post-operative neurological deterioration after surgery for thoracic OYL. The rate of neurological deficit is not small and prognostic factors for poor outcome include poor pre-operative walking score, presence of intra-operative dural tear, extra-dural hematoma and spinal cord injury, and intra-operative drop of SSEP signal.

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