Abstract | STUDY DESIGN: A retrospective review. OBJECTIVE: SUMMARY OF BACKGROUND DATA: Since posterior decompressive laminectomy is not always effective in the treatment of thoracic myelopathy caused by OPLL, circumferential spinal cord decompression through a single posterior approach seems to offer an effective treatment option. However, this procedure is technically demanding and has a high risk of postoperative neurologic deterioration. Long-term clinical outcome data and complication rates of this procedure are not well covered in the literature. METHODS: Medical records of sequentially treated 30 patients, who had undergone circumferential spinal cord decompression through a single posterior approach, were reviewed to determine demographic data, neurologic examination, imaging findings, surgical procedure, and follow-up data. The Japanese Orthopedic Association (JOA) score was used to assess physical dysfunction and neurologic impairment. RESULTS: The mean follow-up period was 8 years; the average operative time was 389 minutes; the mean blood loss was 1883 mL. An average of 4-level spinal cord decompression was performed on all 30 patients. Posterior spinal fusion was performed on 26 of the 30 patients. The mean preoperative JOA score was 3.4/11, and it improved to an average of 7.1/11 at final evaluation. Clinical symptoms and the JOA score improved in 24 patients, but were unchanged or worsened in the other 6 patients compared to the preoperative conditions. Surgical complications included dural tear in 12 patients (40%), deep infection in 3 (10%), and postoperative neurologic deterioration in 10 (33%). Statistical analysis showed that a risk factor associated with the unfavorable surgical outcomes was multiple level circumferential spinal cord decompression of 5 or more vertebral levels. CONCLUSION: Despite circumferential spinal cord decompression through posterior approach for thoracic OPLL providing effective neurologic recovery, there was a high rate of complications such as postoperative neurologic deterioration. Risk factor analysis shows that multiple level circumferential decompression of 5 or more vertebral levels to be associated with unfavorable surgical outcome.
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Authors | Masahiko Takahata, Manabu Ito, Kuniyoshi Abumi, Yoshihisa Kotani, Hideki Sudo, Akio Minami |
Journal | Spine
(Spine (Phila Pa 1976))
Vol. 33
Issue 11
Pg. 1199-208
(May 15 2008)
ISSN: 1528-1159 [Electronic] United States |
PMID | 18469693
(Publication Type: Comparative Study, Journal Article)
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Topics |
- Adult
- Aged
- Decompression, Surgical
(adverse effects, methods)
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Ossification of Posterior Longitudinal Ligament
(pathology, surgery)
- Postoperative Complications
(diagnosis, pathology)
- Retrospective Studies
- Spinal Cord Compression
(pathology, surgery)
- Spinal Cord Diseases
(pathology, surgery)
- Thoracic Vertebrae
(pathology, surgery)
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