TY - JOUR
T1 - Retrospective comparison of the surgical results for patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament
T2 - Posterior decompression with instrumented spinal fusion versus modified anterior decompression through a posterior approach
AU - Aizawa, Toshimi
AU - Hashimoto, Ko
AU - Kanno, Haruo
AU - Handa, Kyoichi
AU - Takahashi, Kohei
AU - Onoki, Takahiro
AU - Itoi, Eiji
AU - Ozawa, Hiroshi
N1 - Funding Information:
The preoperative and latest postoperative JOA scores and recovery rates are also shown in Table 3. The preoperative JOA score was significantly better in the PDF group than in the modified Ohtsuka group. However, the latest JOA score and recovery rate were significantly better in the modified Ohtsuka group than in the PDF group. The recovery rate in the modified Ohtsuka group reached to 70.8%. Using the modified Frankel scale before surgery, the modified Ohtsuka group had significantly more severe patients than the PDF group; non-ambulatory patients accounted for 50% in the modified Ohtsuka group while only 15% in the PDF group (Table 1). By contrast, both groups showed no significant difference at the final follow-up (Table 3). Compared the preoperative modified Frankel scale to the postoperative scale, in the PDF group, six patients showed two grade-ups and seven patients demonstrated one grade-up, while five patients maintained the same grade and two patients showed deterioration (Fig. 3A). In the modified Ohtsuka group, three patients showed three grade-ups, two patients showed two grade-ups, and seven patients demonstrated one grade-up (Fig. 3B). At the latest follow-up, all non-ambulatory patients before surgery in the PDF group used a wheelchair or a cane, however, half of those patients in the modified Ohtsuka group could walk without any support.
Publisher Copyright:
© 2021 The Japanese Orthopaedic Association
PY - 2022/3
Y1 - 2022/3
N2 - Background: In Japan, approximately 75% of patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) are treated by posterior decompression with instrumented spinal fusion (PDF) because of its efficacy and safety. To achieve more effective decompression of the spinal cord using a posterior approach, anterior decompression through a posterior approach was developed. However, this technique has a high risk of postoperative paralysis. We have added a couple of ingenuities to this procedure (modified Ohtsuka procedure). This study was performed to report the surgical results of our modified Ohtsuka procedure and to compare them with the results of PDF. Methods: This was a retrospective case series. From 2008 to 2018, we surgically treated 32 patients: 20 patients treated by PDF (PDF group) and 12 patients by our modified Ohtsuka procedure (modified Ohtsuka group) as the initial surgery. All patients were followed up for at least 12 months. The degree of surgical invasion and patients’ neurological condition were assessed. Results: The operative duration and intraoperative blood loss indicated no significant differences (PDF vs. Ohtuska: 507 ± 103 vs. 534 ± 99 min, 1022 ± 675 vs. 1160 ± 685 ml, respectively). The preoperative Japanese Orthopaedic Association (JOA) score was 4.5 ± 2.0 in the PDF group and 3.3 ± 1.4 in the modified Ohtsuka group (p < 0.05). However, the latest JOA score and recovery rate were significantly better in the modified Ohtsuka group than in the PDF group (8.9 ± 1.2 vs. 7.4 ± 2.5 and 70.8 ± 17.6% vs. 44.5 ± 40.2%, respectively). Postoperative paralysis did not occur in the modified Ohtsuka group while four patients had it in the PDF group. Conclusions: The present study clearly indicated the modified Ohtsuka group showed significantly better surgical outcomes than the PDF group with the recovery rate ≥70%.
AB - Background: In Japan, approximately 75% of patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) are treated by posterior decompression with instrumented spinal fusion (PDF) because of its efficacy and safety. To achieve more effective decompression of the spinal cord using a posterior approach, anterior decompression through a posterior approach was developed. However, this technique has a high risk of postoperative paralysis. We have added a couple of ingenuities to this procedure (modified Ohtsuka procedure). This study was performed to report the surgical results of our modified Ohtsuka procedure and to compare them with the results of PDF. Methods: This was a retrospective case series. From 2008 to 2018, we surgically treated 32 patients: 20 patients treated by PDF (PDF group) and 12 patients by our modified Ohtsuka procedure (modified Ohtsuka group) as the initial surgery. All patients were followed up for at least 12 months. The degree of surgical invasion and patients’ neurological condition were assessed. Results: The operative duration and intraoperative blood loss indicated no significant differences (PDF vs. Ohtuska: 507 ± 103 vs. 534 ± 99 min, 1022 ± 675 vs. 1160 ± 685 ml, respectively). The preoperative Japanese Orthopaedic Association (JOA) score was 4.5 ± 2.0 in the PDF group and 3.3 ± 1.4 in the modified Ohtsuka group (p < 0.05). However, the latest JOA score and recovery rate were significantly better in the modified Ohtsuka group than in the PDF group (8.9 ± 1.2 vs. 7.4 ± 2.5 and 70.8 ± 17.6% vs. 44.5 ± 40.2%, respectively). Postoperative paralysis did not occur in the modified Ohtsuka group while four patients had it in the PDF group. Conclusions: The present study clearly indicated the modified Ohtsuka group showed significantly better surgical outcomes than the PDF group with the recovery rate ≥70%.
UR - http://www.scopus.com/inward/record.url?scp=85100477377&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85100477377&partnerID=8YFLogxK
U2 - 10.1016/j.jos.2021.01.001
DO - 10.1016/j.jos.2021.01.001
M3 - Article
C2 - 33568316
AN - SCOPUS:85100477377
SN - 0949-2658
VL - 27
SP - 323
EP - 329
JO - Journal of Orthopaedic Science
JF - Journal of Orthopaedic Science
IS - 2
ER -