Global Spine J 2016; 06(08): 812-821
DOI: 10.1055/s-0036-1579662
Technical Report
Georg Thieme Verlag KG Stuttgart · New York

Resection of Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament from a Posterior Approach under Intraoperative Neurophysiological Monitoring for Paralysis after Posterior Decompression and Fusion Surgery

Shiro Imagama1, Kei Ando1, Zenya Ito1, Kazuyoshi Kobayashi1, Tetsuro Hida1, Kenyu Ito1, Yoshimoto Ishikawa1, Mikito Tsushima1, Akiyuki Matsumoto1, Satoshi Tanaka1, Masayoshi Morozumi1, Masaaki Machino1, Kyotaro Ota1, Hiroaki Nakashima1, Norimitsu Wakao2, Yoshihiro Nishida1, Yukihiro Matsuyama3, Naoki Ishiguro1
  • 1Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
  • 2Department of Orthopaedic Surgery, Aichi Medical University, Aichigun, Aichi-Ken, Japan
  • 3Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
Further Information

Publication History

09 November 2015

04 January 2016

Publication Date:
24 February 2016 (eFirst)

Abstract

Study Design Prospective clinical study.

Objective Posterior decompression and fusion surgery for beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) generally has a favorable outcome. However, some patients require additional surgery for postoperative severe paralysis, a condition that is inadequately discussed in the literature. The objective of this study was to describe the efficacy of a procedure we refer to as “resection at an anterior site of the spinal cord from a posterior approach” (RASPA) for severely paralyzed patients after posterior decompression and fusion surgery for beak-type T-OPLL.

Methods Among 58 consecutive patients who underwent posterior decompression and fusion surgery for beak-type T-OPLL since 1999, 3 with postoperative paralysis (5%) underwent RASPA in our institute. Clinical records, the Japanese Orthopaedic Association score, gait status, intraoperative neurophysiological monitoring (IONM) findings, and complications were evaluated in these cases.

Results All three patients experienced a postoperative decline in Manual Muscle Test (MMT) scores of 0 to 2 after the first surgery. RASPA was performed 3 weeks after the first surgery. All patients showed gradual improvements in MMT scores for the lower extremity and in ambulatory status; all could walk with a cane at an average of 4 months following RASPA surgery. There were no postoperative complications.

Conclusions RASPA surgery for beak-type T-OPLL after posterior decompression and fusion surgery resulted in good functional outcomes as a salvage surgery for patients with severe paralysis. Advantages of RASPA include a wide working space, no spinal cord retraction, and additional decompression at levels without T-OPLL resection and spinal cord shortening after additional dekyphosis and compression maneuvers. When used with IONM, this procedure may help avoid permanent postoperative paralysis.