Differences in the Demographics and Clinical Characteristics between the Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum in Patients Who Underwent Thoracic Spinal Surgery for Compressive Myelopathy

Neurol Med Chir (Tokyo), 2024 · DOI: 10.2176/jns-nmc.2023-0137 · Published: February 26, 2024

Simple Explanation

This study compares patients who underwent thoracic spinal surgeries for ossification of the posterior longitudinal ligament (TOPLL) and those with thoracic ossification of the ligamentum flavum (TOLF). The aim was to identify clinical differences between these two conditions. The study found that TOPLL patients were significantly younger, more often female, and had a higher body mass index (BMI) compared to TOLF patients. TOPLL patients also more frequently required instrumented fusion and repetitive surgical intervention. While neurological deterioration was more common immediately after surgery in TOPLL patients, there was no significant difference in long-term functional recovery between the two groups.

Study Duration

July 2010 and June 2022

Participants

34 patients who underwent thoracic spinal surgeries

Evidence Level

Not specified

Key Findings

1
TOPLL patients were significantly younger than TOLF patients (53.7 vs. 68.4 years).
2
The TOPLL group exhibited a greater female predominance than the TOLF group (58.3% vs. 18.2%).
3
The median body mass index of the TOPLL group was significantly higher than that of the TOLF group (33.0 vs. 26.0 kg/m2).

Research Summary

This retrospective study analyzed 34 patients who underwent thoracic spinal surgeries for OPLL and/or OLF between July 2010 and June 2022. Data were compared between patients with thoracic OPLL (TOPLL; n = 12) and those with thoracic OLF (TOLF; n = 22). The TOPLL group had a younger onset, female dominance, and a greater degree of obesity when compared with the TOLF group. Patients with TOPLL significantly required instrumented fusion and repetitive surgical intervention more than those with TOLF. The surgery for TOPLL is challenging, considering that it requires long-range decompression and fusion, subsequent operations, careful management, and long-term follow-up, when compared to TOLF, which necessitates only simple decompression.

Practical Implications

Surgical Planning

Surgeons should anticipate more complex procedures, longer operative times, and potentially higher complication rates when treating TOPLL compared to TOLF.

Patient Counseling

Patients with TOPLL should be informed about the increased likelihood of needing instrumented fusion, revision surgeries, and the potential for postoperative neurological decline.

Long-term Monitoring

Given the tendency for TOPLL to develop in younger patients, long-term follow-up is crucial to manage disease progression and potential complications.

Study Limitations

1
The sample size was relatively small.
2
The study analysis was retrospective and observational.
3
This study was conducted only on eligible candidates who had surgical treatment, excluding subclinical patients receiving conservative treatment.

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