Predictors of good outcome after anterior decompression and fusion in patients with ossification of the posterior longitudinal ligament of the thoracic spine

Abstract

Background: There are few reports concerning determinants of the surgical outcome of anterior decompression and fusion (ADF) when performed for ossification of the posterior longitudinal ligament of the thoracic spine (T-OPLL). We investigated prognostic factors associated with neurological recovery in the patients with T-OPLL.

Methods: This retrospective study included consecutive cases of T-OPLL patients from January 2002 to January 2020 and minimum one-year follow-up. Data were collected for sex, age, body mass index, preoperative manual muscle test score for the weakest muscle, surgical data, and preoperative and postoperative findings on radiographs, magnetic resonance images, and computed tomography scans. Imaging data were also collected, including preoperative kyphotic angles, canal occupancy ratio, type of OPLL, and high-intensity areas on T2-weighted images. The Japanese Orthopaedic Association score for thoracic myelopathy (T-JOA) was used to evaluate the recovery of the thoracic myelopathy. The patients were categorized according to whether the improvement in T-JOA score was >50% or ≤50%.

Results: Forty-six patients who underwent anterior procedures for T-OPLL were included in the study. Preoperative and postoperative T-JOA scores were 4.2 ± 2.3 and 7.9 ± 2.1, respectively. The improvement in the T-JOA score was 54.5 ± 25.6%. The proportion of patients with beak-type OPLL was significantly higher in the >50% JOA improvement group (23/27) than in the ≤50% group (9/19) (p = 0.009) and the canal occupancy ratio was significantly lower in the >50% group (56.3 ± 12.2% vs 64.4 ± 8.73%; p = 0.0163). There were no significant between-group differences in other factors.

Conclusions: Beak-type ossification and a low canal occupancy ratio are predictors of good outcome after ADF in patients with T-OPLL. ADF should be considered in patients with either or both of these features.