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Review
. 2025 Sep 24:142:111649.
doi: 10.1016/j.jocn.2025.111649. Online ahead of print.

Factors predicting the outcome of thoracic ossification of ligamentum flavum (OLF) surgery: A systematic review and meta-analysis

Anish Tayal  1 , Pragya Mitra  1 , Aneeket Modak  1 , Sucharu Asri  2 , Kanwaljeet Garg  3
Affiliations
Review

Factors predicting the outcome of thoracic ossification of ligamentum flavum (OLF) surgery: A systematic review and meta-analysis

Anish Tayal et al. J Clin Neurosci. .

Abstract

Background: The study aimed to determine the association between demographics, clinical presentation, radiological findings, and intraoperative characteristics of patients with thoracic ossification of ligamentum flavum (OLF) surgery and their postoperative outcomes.

Methods: PubMed, Ovid, Embase, and Web of Sciences databases were searched until July 2023 to include articles regarding the prognostic factors for thoracic OLF surgery. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool. The outcome of surgery was evaluated by calculating the recovery rate (RR), as follows: RR = (postoperative Japanese Orthopedic Association (JOA) score - preoperative JOA score)/(11 - preoperative JOA score). Meta-analyses Of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Furthermore, factors associated with outcome were assessed separately within open and minimally invasive surgery (MIS) subgroups.

Results: Thirty-six studies with 1,511 patients were included. RR was associated with age (p-value = 0.012), JOA score (p-value < 0.001), ossified region (middle vs. lower thoracic spine: p-value = 0.042), intramedullary signal intensity change on T2-weighted magnetic resonance imaging (p-value < 0.001), and occurrence of dural ossification (p-value = 0.006). On subgroup analysis, JOA score (p-value < 0.001) and operation time (p-value = 0.014) were associated with outcomes for patients managed with an open surgical approach, while none for those operated with the MIS technique.

Conclusion: Although surgery is the cornerstone of the management of OLF, careful patient prognostication should be performed considering the aforementioned factors. Further, high-quality research is warranted to confirm the findings of this study.

Keywords: Ligamentum flavum; Prognosis; Recovery rate; Thoracic spine.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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