Perioperative complications after surgery for thoracic ossification of posterior longitudinal ligament

Shiro Imagama, Kei Ando, Kazuhiro Takeuchi, Satoshi Kato, Hideki Murakami, Toshimi Aizawa, Hiroshi Ozawa, Tomohiko Hasegawa, Yukihiro Matsuyama, Masao Koda, Masashi Yamazaki, Hirotaka Chikuda, Shigeo Shindo, Yukihiro Nakagawa, Atsushi Kimura, Katsushi Takeshita, Kanichiro Wada, Hiroyuki Katoh, Masahiko Watanabe, Kei YamadaTakeo Furuya, Takashi Tsuji, Shunsuke Fujibayashi, Kanji Mori, Yoshiharu Kawaguchi, Kota Watanabe, Morio Matsumoto, Toshitaka Yoshii, Atsushi Okawa

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59 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)E1389-E1397
Issue number23
Publication statusPublished - 2018


  • Amount of spinal cord decompression
  • Intraoperative neurophysiological monitoring
  • Intraoperative ultrasonography
  • Nationwide multicenter prospective study
  • Perioperative complication
  • Preoperative prone and supine position test
  • Preoperative severe myelopathy
  • Recovery period of postoperative motor palsy
  • Risk factors for postoperative motor palsy
  • Thoracic ossification of posterior longitudinal ligament.


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