Abstract
The effectiveness and problems associated with the operation of anterior decompression and fusion using the manubrium splitting approach for thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL) of the upper thoracic spine carried out in nine patients was investigated. They were followed up for 1 year or more following the operation.
The severity of the thoracic myelopathy was evaluated using the Japanese Orthopaedic Association score, and the surgical outcome was evaluated using recovery rates. This study includes investigation of the surgical outcome and of any postoperative complications, and radiographie observation of bony union and the progression of OPLL within the area of the anterior decompression.
The caudal limit of the anterior decompression achieved by splitting the manubrium was the T3 vertebral body. A recovery rate of 71% was achieved during an average follow-up period of 35 months. Only one transient recurrent nerve palsy, and in another patient cerebrospinal fluid leakage occurred as postoperative complications. Radiographie examinations confirmed bony union in all of the patients, and there was no instance of spinal canal stenosis caused by progression of the OPLL within the area of the anterior decompression. Anterior decompression and fusion by splitting the manubrium was an effective surgical procedure for OPLL of the upper thoracic spine, to achieve a good outcome, however, the extent of anterior decompression was limited.
References
Terayama K . Ossification of the posterior longitudinal ligament of the spine. J Jpn Orthop Assoc 1976; 50: 415–442.
Tsuyama N, Kurokawa T . Statistical analysis of the patients with ossification of the posterior longitudinal ligament of the thoracic and lumbar spines. Rinsho Seikei Geka 1977; 12: 337–339.
Tsuyama N . Ossification of the posterior longitudinal ligament of the spine. Clin Orthop 1984; 184: 71–84.
Kurokawa T, et al. Diagnosis of the thoracic spinal canal stenosis and the evoked spinal cord action potential measurement. Rinsho Seikei Geka 1981; 16: 32–42.
Ohtani K, et al. Anterior decompression for ossification of the posterior longitudinal ligament of the thoracic spine. Rinsho Seikei Geka 1977; 12: 353–359.
Fujimura Y, et al. Surgical treatment for thoracic myelopathy due to spinal canal stenosis. Rinsho Seikei Geka 1981; 16: 51–62.
Ohtani K, et al. Anterior surgical decompression for thoracic myelopathy as a result of ossification of the posterior longitudinal ligament. Clin Orthop 1982; 166: 82–88.
Hanai K, et al. Decompression for ossification of the posterior longitudinal ligament in the thoracic spine using the lateral approach. Seikeigeka 1982; 33: 1059–1062.
Ohtsuka K, et al. A surgical procedure for the anterior decompression of the thoracic spinal cord through the posterior approach. Orthop Surg Traumatol 1983; 26: 1083–1090.
Yonenobu K, et al. Thoracic myelopathy secondary to ossification of the spinal ligament. J Neurosurg 1987; 66: 511–518.
Fujimura Y, Satomi K, Hirabayashi K . Anterior decompression for thoracic myelopathy due to ossification of the posterior longitudinal ligament. Spine Spinal Cord 1989; 2: 671–611.
Tomita K, et al. Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and ligamentum flavum. Spine 1990; 15: 1114–1120.
Yonenobu K, et al. Lateral rhachotomy for thoracic spinal lesions. Spine 1990; 15: 1121–1125.
Kataoka O, Sho T, Nishibayashi Y . A circumferential decompression of spinal cord through posterior approach for myelopathy due to ossification of the posterior longitudinal ligament on the upper thoracic spine. Seikeigeka 1989; 40: 669–675.
Imai K, et al. Clinical evaluation of ossification of the posterior longitudinal ligament of the thoracic spine. Rinsho Seikei Geka 1977; 12: 340–344.
Murakami Y, et al. Posterior decompression for thoracic myelopathy due to ossification of the posterior longitudinal ligament. Rinsho Seikei Geka 1977; 12: 345–352.
Miyazaki K, et al. Surgical treatment for ossification of the posterior longitudinal ligament of the thoracic spine. Rinsho Seikei Geka 1977; 12: 360–367.
Kaneda K, et al. Thoracic spinal canal stenosis due to ossification of the spinal canal ligament. Rinsho Seikei Geka 1981; 16: 63–74.
Sakou T, et al. Results of surgical treatment for the ossification of yellow ligament and posterior longitudinal ligament of the thoracic and thoracolumbar spine. Seikeigeka 1985; 36: 1367–1375.
Cauchoix J, Binet J P . Anterior surgical approaches to the spine. Ann R Coll Surg Engl 1957; 21: 237–243.
Hodgson A R, et al. Anterior spinal fusion: the operative approach and pathological findings in 412 patients with Pott's disease of the spine. Br J Surg 1960; 48: 172–178.
Fielding J W, Stillwell W T . Anterior cervical approach to the upper thoracic spine: a case repoprt. Spine 1976; 1: 158–161.
Yamaura I . Anterior floating method for ossification of the posterior longitudinal ligament. Rinso Seikei Geka 1983; 18: 855–868.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fujimura, Y., Nishi, Y., Nakamura, M. et al. Anterior decompression and fusion for ossification of the posterior longitudinal ligament of the upper thoracic spine causing myelopathy: using the manubrium splitting approach. Spinal Cord 34, 387–393 (1996). https://doi.org/10.1038/sc.1996.70
Issue Date:
DOI: https://doi.org/10.1038/sc.1996.70
Keywords
- ossification of the posterior longitudinal ligament (OPLL)
- thoracic myelopathy
- upper thoracic spine
- manubrium splitting approach
- anterior decompression and fusion
This article is cited by
-
Right infraaxillary thoracotomy approach for upper thoracic vertebral decompression and fusion at T2–T6 levels: a technical note
European Spine Journal (2019)
-
Sternum-splitting anterior approach following posterior decompression and fusion in patients with massive ossification of the posterior longitudinal ligament in the upper thoracic spine: report of 2 cases and literature review
European Spine Journal (2018)
-
Surgical outcomes of posterior thoracic interbody fusion for thoracic disc herniations
European Spine Journal (2013)