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Multicenter Study
. 2018 Dec 1;43(23):E1389-E1397.
doi: 10.1097/BRS.0000000000002703.

Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament: A Nationwide Multicenter Prospective Study

Shiro Imagama  1   2 , Kei Ando  1   2 , Kazuhiro Takeuchi  3   2 , Satoshi Kato  4   2 , Hideki Murakami  4   2 , Toshimi Aizawa  5   2 , Hiroshi Ozawa  6   2 , Tomohiko Hasegawa  7   2 , Yukihiro Matsuyama  7   2 , Masao Koda  8   2 , Masashi Yamazaki  8   2 , Hirotaka Chikuda  9   2 , Shigeo Shindo  10   2 , Yukihiro Nakagawa  11   2 , Atsushi Kimura  12   2 , Katsushi Takeshita  12   2 , Kanichiro Wada  13   2 , Hiroyuki Katoh  14   2 , Masahiko Watanabe  14   2 , Kei Yamada  15   2 , Takeo Furuya  16   2 , Takashi Tsuji  17   2 , Shunsuke Fujibayashi  18   2 , Kanji Mori  19   2 , Yoshiharu Kawaguchi  20   2 , Kota Watanabe  21   2 , Morio Matsumoto  21   2 , Toshitaka Yoshii  22   2 , Atsushi Okawa  22   2
Affiliations
Multicenter Study

Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament: A Nationwide Multicenter Prospective Study

Shiro Imagama et al. Spine (Phila Pa 1976). .

Abstract

Study design: Prospective, multicenter, nationwide study.

Objective: To investigate perioperative complications and risk factors in surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) using data from the registry of the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament.

Summary of background data: There is no prospective multicenter study of surgical complications and risk factors for T-OPLL, and previous multicenter retrospective studies have lacked details.

Methods: Surgical methods, preoperative radiographic findings, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association [JOA] score), prone and supine position test (PST), intraoperative ultrasonography, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 115 cases (males: 55, females: 60, average age 53.1 y). Factors related to perioperative complications and risk factors for postoperative motor palsy were identified.

Results: Posterior decompression and fusion with instrumentation with or without dekyphosis was performed in 85 cases (74%). The JOA recovery rate at 1 year after surgery in all cases was 55%. Motor palsy occurred postoperatively in 37 cases (32.2%), with a mean recovery period of 2.7 months. A long recovery period for postoperative motor palsy was significantly associated with a high number of T-OPLL levels (P < 0.0001), lower preoperative JOA score (P < 0.05), and greater estimated blood loss (P < 0.05). Perioperative complications or postoperative motor palsy were significantly related to a higher number of T-OPLL levels, comorbid ossification of ligamentum flavum rate, lower preoperative JOA score, higher preoperative positive PST rate, more surgical invasiveness, a lower rate of intraoperative spinal cord floating in ultrasonography, and higher rate of deterioration of IONM.

Conclusion: This study firstly demonstrated the perioperative complications with high postoperative motor palsy rate in a nationwide multicenter prospective study. Surgical outcomes for T-OPLL should be improved by identifying and preventing perioperative complications with significant risk factors.

Level of evidence: 3.

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References

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    1. Fujimura Y, Nishi Y, Nakamura M, et al. Long-term follow-up study of anterior decompression and fusion for thoracic myelopathy resulting from ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 1997; 22:305–311.

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