Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamam-atsu, Japan.
Oper Neurosurg (Hagerstown). 2017 Dec 1;13(6):661-669. doi: 10.1093/ons/opx043.
Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown.
To identify factors for good surgical outcomes with prospective and comparative study.
Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on ≥50% and <50% recovery rates for the Japanese Orthopaedic Association score. Preoperative, intraoperative, and postoperative findings were compared in the 2 groups, and significant factors for a good outcome were analyzed.
Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively; lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging; lower estimated blood loss; higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring; and lower rates of postoperative complications (P < .0005). In multivariate logistic regression analysis, negative prone and supine position test (odds ratio [OR]: 17.00), preoperative ambulatory status (OR: 6.05), absence of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level (OR: 5.84), intraoperative spinal cord floating (OR: 4.98), and lower estimated blood loss (OR: 1.01) were significant factors for a good surgical outcome.
This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes.
胸段后纵韧带骨化（T-OPLL）的手术仍然具有挑战性，良好手术效果的因素尚不清楚。
通过前瞻性和对照研究确定良好手术效果的因素。
71 例连续接受后路减压和器械融合的患者根据日本矫形协会评分（JOA 评分）≥50%和<50%的恢复率分为良好或不良预后组。比较两组患者的术前、术中、术后发现，并分析良好预后的显著因素。
良好预后（76%）患者术前非步行率和正、仰卧位试验阳性率显著较低；T-OPLL、黄韧带骨化、同一水平高信号区、胸段脊髓对线差异和椎管狭窄的发生率较低；术中出血量较低；脊髓漂浮和术中神经生理监测恶化的发生率较高；术后并发症发生率较低（P<0.0005）。多变量逻辑回归分析显示，仰卧位和俯卧位试验阴性（优势比 [OR]：17.00）、术前活动能力（OR：6.05）、无 T-OPLL、黄韧带骨化、同一水平高信号区（OR：5.84）、术中脊髓漂浮（OR：4.98）和术中出血量较低（OR：1.01）是良好手术效果的显著因素。
本研究表明，在这些积极因素下，建议早期手术。根据术前胸段脊髓对线差异进行适当的手术规划，以及使用术中超声和术中神经生理监测充分减压脊髓和减少并发症，可能会改善手术效果。
