Onishi Eijiro, Sano Hirokazu, Matsushita Mutsumi
Department of Orthopaedic Surgery, Kurashiki Central Hospital, Okayama Prefecture, Japan.
Clin Spine Surg. 2016 Oct;29(8):E389-95. doi: 10.1097/BSD.0000000000000059.
Retrospective review.
The aim of this study was to assess the clinical outcomes of surgery in patients with simultaneous ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) at the same thoracic spine level and identify the risk factors for poor outcomes.
OPLL complicated with OLF in the thoracic spine is a rare condition. The optimal treatment option for thoracic myelopathy due to OPLL and OLF remains controversial, and high risk of postoperative paralysis remains a major complication.
We conducted a retrospective review of clinical and radiographic records of 15 patients who underwent surgery for simultaneous OPLL and OLF at the same level.
Simultaneous OPLL and OLF occurred in the upper thoracic spine in 3 patients (20%), mid-thoracic spine in 10 patients (67%), and lower thoracic spine in 2 patients (13%). Six, 4, 2, and 3 patients underwent posterior decompression, posterior decompression and fusion, posterior decompression and circumferential decompression through a posterior approach, and circumferential decompression and posterior fusion, respectively. The mean Japanese Orthopaedic Association score before surgery and at the final follow-up was 5.7±1.9 and 7.0±2.1 points, respectively, yielding a mean recovery rate of 16.5%. However, no significant difference was observed between preoperative and postoperative Japanese Orthopaedic Association scores. Two patients with mid-thoracic lesions reported postoperative lower extremity weakness. Mid-thoracic lesions and considerable blood loss were risk factors for poor surgical outcome.
Simultaneous OPLL and OLF in the mid-thoracic spine was observed in two thirds of the patients. We suggest that simultaneous OPLL and OLF in this area has a relatively poor recovery and may be very challenging and risky to treat, regardless of the surgical method selected, and recommend early surgery for OPLL and OLF in the mid-thoracic spine.
回顾性研究。
本研究旨在评估同一胸椎节段同时存在后纵韧带骨化（OPLL）和黄韧带骨化（OLF）患者的手术临床疗效，并确定预后不良的危险因素。
胸椎OPLL合并OLF是一种罕见情况。对于由OPLL和OLF引起的胸椎脊髓病的最佳治疗方案仍存在争议，术后瘫痪的高风险仍然是主要并发症。
我们对15例在同一节段同时进行OPLL和OLF手术的患者的临床和影像学记录进行了回顾性研究。
3例患者（20%）同时性OPLL和OLF发生在上胸椎，10例患者（67%）发生在中胸椎，2例患者（13%）发生在下胸椎。分别有6例、4例、2例和3例患者接受了后路减压、后路减压融合、后路经后路环周减压以及环周减压和后路融合手术。术前和末次随访时日本骨科协会评分的平均值分别为5.7±1.9分和7.0±2.1分，平均恢复率为16.5%。然而，术前和术后日本骨科协会评分之间未观察到显著差异。2例中胸椎病变患者术后报告下肢无力。中胸椎病变和大量失血是手术预后不良的危险因素。
三分之二的患者中胸椎同时存在OPLL和OLF。我们认为该区域同时存在OPLL和OLF恢复相对较差，无论选择何种手术方法治疗都可能极具挑战性和风险，建议对中胸椎OPLL和OLF尽早进行手术。
