Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior Approach

Various methods via anterior or posterior approach with or without spinal stabilization have been performed in accordance with the level and configuration of ossification of the posterior longitudinal ligament (OPLL) as the decompression surgery for thoracic myelopathy due to OPLL. Among them, anter...

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Main Authors: Shigeru Hirabayashi, Tomoaki Kitagawa, Iwao Yamamoto, Kazuaki Yamada, Hirotaka Kawano
Format: Article
Language:English
Published: The Japanese Society for Spine Surgery and Related Research 2018-07-01
Series:Spine Surgery and Related Research
Subjects:
Online Access:https://www.jstage.jst.go.jp/article/ssrr/2/3/2_2017-0044/_pdf/-char/en
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author Shigeru Hirabayashi
Tomoaki Kitagawa
Iwao Yamamoto
Kazuaki Yamada
Hirotaka Kawano
author_facet Shigeru Hirabayashi
Tomoaki Kitagawa
Iwao Yamamoto
Kazuaki Yamada
Hirotaka Kawano
author_sort Shigeru Hirabayashi
collection DOAJ
description Various methods via anterior or posterior approach with or without spinal stabilization have been performed in accordance with the level and configuration of ossification of the posterior longitudinal ligament (OPLL) as the decompression surgery for thoracic myelopathy due to OPLL. Among them, anterior decompression at the middle thoracic level (T4/T5-T7/T8) is especially difficult to perform because of the special anatomical structures, where the spinal alignment is kyphotic and the thoracic cage containing circulatory-respiratory organs exist nearby. Of the anterior decompression procedures at this level, the posterior approach has various advantages compared to the anterior one. In the anterior approach, the procedure is complicated and the effect of decompression of the spinal cord can be obtained only by direct resection or anterior floating of the OPLL. However, complications such as spinal cord injury and dural tear are most likely to occur at that time. On the contrary, in the posterior approach, the procedure is simple, and various options to obtain decompression can be selected from, these are, laminectomy, laminoplasty, dekyphosis surgery, staged decompression surgery (Tsuzuki's method), circumferential decompression via posterior approach alone (Ohtsuka's method), and circumferential decompression via combined posterior and anterior approaches (Tomita's method). Among them, in laminectomy, laminoplasty, and dekyphosis surgery, anterior decompression can be obtained to some extent without performing direct procedure on the OPLL. In Ohtsuka's method, complete decompression can be obtained via posterior approach alone, although it is somewhat technically demanding. It is preferable to drop the shaved down and separated OPLL anteriorly instead of trying to remove it completely to avoid complications, especially in patients with severe adhesion between the dura mater and OPLL.
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spelling doaj.art-09e1b18582254449bfb43145fa3d4dc02022-12-22T01:57:49ZengThe Japanese Society for Spine Surgery and Related ResearchSpine Surgery and Related Research2432-261X2018-07-012316917610.22603/ssrr.2017-00442017-0044Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior ApproachShigeru Hirabayashi0Tomoaki Kitagawa1Iwao Yamamoto2Kazuaki Yamada3Hirotaka Kawano4Department of Orthopaedic Surgery, Teikyo University HospitalDepartment of Orthopaedic Surgery, Teikyo University HospitalDepartment of Orthopaedic Surgery, Teikyo University HospitalDepartment of Orthopaedic Surgery, Teikyo University HospitalDepartment of Orthopaedic Surgery, Teikyo University HospitalVarious methods via anterior or posterior approach with or without spinal stabilization have been performed in accordance with the level and configuration of ossification of the posterior longitudinal ligament (OPLL) as the decompression surgery for thoracic myelopathy due to OPLL. Among them, anterior decompression at the middle thoracic level (T4/T5-T7/T8) is especially difficult to perform because of the special anatomical structures, where the spinal alignment is kyphotic and the thoracic cage containing circulatory-respiratory organs exist nearby. Of the anterior decompression procedures at this level, the posterior approach has various advantages compared to the anterior one. In the anterior approach, the procedure is complicated and the effect of decompression of the spinal cord can be obtained only by direct resection or anterior floating of the OPLL. However, complications such as spinal cord injury and dural tear are most likely to occur at that time. On the contrary, in the posterior approach, the procedure is simple, and various options to obtain decompression can be selected from, these are, laminectomy, laminoplasty, dekyphosis surgery, staged decompression surgery (Tsuzuki's method), circumferential decompression via posterior approach alone (Ohtsuka's method), and circumferential decompression via combined posterior and anterior approaches (Tomita's method). Among them, in laminectomy, laminoplasty, and dekyphosis surgery, anterior decompression can be obtained to some extent without performing direct procedure on the OPLL. In Ohtsuka's method, complete decompression can be obtained via posterior approach alone, although it is somewhat technically demanding. It is preferable to drop the shaved down and separated OPLL anteriorly instead of trying to remove it completely to avoid complications, especially in patients with severe adhesion between the dura mater and OPLL.https://www.jstage.jst.go.jp/article/ssrr/2/3/2_2017-0044/_pdf/-char/enossification of the posterior longitudinal ligament (OPLL)thoracic spinesurgical treatmentposterior approach
spellingShingle Shigeru Hirabayashi
Tomoaki Kitagawa
Iwao Yamamoto
Kazuaki Yamada
Hirotaka Kawano
Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior Approach
Spine Surgery and Related Research
ossification of the posterior longitudinal ligament (OPLL)
thoracic spine
surgical treatment
posterior approach
title Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior Approach
title_full Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior Approach
title_fullStr Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior Approach
title_full_unstemmed Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior Approach
title_short Surgical Treatment for Ossification of the Posterior Longitudinal Ligament (OPLL) at the Thoracic Spine: Usefulness of the Posterior Approach
title_sort surgical treatment for ossification of the posterior longitudinal ligament opll at the thoracic spine usefulness of the posterior approach
topic ossification of the posterior longitudinal ligament (OPLL)
thoracic spine
surgical treatment
posterior approach
url https://www.jstage.jst.go.jp/article/ssrr/2/3/2_2017-0044/_pdf/-char/en
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