Miyakoshi Naohisa, Shimada Yoichi, Suzuki Tetsuya, Hongo Michio, Kasukawa Yuji, Okada Kyoji, Itoi Eiji
Department of Orthopedic Surgery, Akita University School of Medicine, Akita, Japan.
J Neurosurg. 2003 Oct;99(3 Suppl):251-6. doi: 10.3171/spi.2003.99.3.0251.
Factors related to long-term surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) have not been fully investigated. To evaluate these factors, the authors reviewed medical records obtained in patients who had undergone decompressive surgery for thoracic OLF.
Thirty-four patients in whom decompressive surgery was performed for thoracic OLF (mean follow-up period 8 years) were recruited. Fourteen patients underwent simultaneous decompressive surgery for cervical or lumbar lesions. Patient age, duration of symptoms, OLF type, dural adhesion, neurological status classified by the Japanese Orthopaedic Association (JOA) scale before and after surgery (1 month postoperatively and at final follow up), and recovery rate were reviewed. The ossified ligamentum flavum was classified into five types according to Sato's classification by assessing preoperative computerized tomography scans. The mean preoperative JOA score (5) was significantly improved at 1 month after surgery (7.1) and at final follow up (7.9) (p < 0.05). Recovery rates at 1 month and at final follow up were 34.6 and 44.2%, respectively. No significant correlations were found between age, OLF type, and neurological status before and after surgery. In patients with dural adhesion, which was observed in cases of larger-type OLF (p < 0.02), lower JOA scores were observed compared with those in patients without dural adhesion both preoperatively and at 1 month after surgery (p < 0.05) but not at the final follow-up examination. Higher JOA scores and recovery rates were demonstrated in patients who had undergone simultaneous surgery than in those who had not undergone simultaneous surgery at 1 month (p < 0.05) but not at the final follow up. Using multiple regression analysis, the authors identified the duration of preoperative symptoms as the most important predictor of a high JOA score and recovery rate at the final follow up.
Duration of preoperative symptoms represents the most important predictor of long-term surgery-related outcome in patients treated for thoracic OLF. The type of ossified ligamentum flavum, dural adhesion, and simultaneous surgery for coexistent cervical or lumbar lesions do not appear to influence the long-term postoperative prognosis.
黄韧带骨化（OLF）所致胸段脊髓病的长期手术效果相关因素尚未得到充分研究。为评估这些因素，作者回顾了接受胸段OLF减压手术患者的病历资料。
招募了34例行胸段OLF减压手术的患者（平均随访期8年）。其中14例患者同时接受了颈椎或腰椎病变的减压手术。回顾了患者的年龄、症状持续时间、OLF类型、硬脊膜粘连情况、术前及术后（术后1个月和末次随访时）根据日本骨科协会（JOA）量表分类的神经功能状态以及恢复率。通过评估术前计算机断层扫描，根据佐藤分类法将骨化的黄韧带分为五种类型。术前JOA平均评分（5分）在术后1个月（7.1分）和末次随访时（7.9分）显著改善（p < 0.05）。术后1个月和末次随访时的恢复率分别为34.6%和44.2%。年龄、OLF类型与手术前后神经功能状态之间未发现显著相关性。在大型OLF病例中观察到硬脊膜粘连（p < 0.02），与无硬脊膜粘连的患者相比，术前及术后1个月JOA评分较低（p < 0.05），但在末次随访检查时无差异。与未同时手术的患者相比，同时手术的患者在术后1个月时JOA评分和恢复率更高（p < 0.05），但在末次随访时无差异。通过多元回归分析，作者确定术前症状持续时间是末次随访时JOA高分和高恢复率的最重要预测因素。
术前症状持续时间是胸段OLF治疗患者长期手术相关结局的最重要预测因素。骨化黄韧带的类型、硬脊膜粘连以及同时存在的颈椎或腰椎病变的手术似乎不影响术后长期预后。
