Surgical Treatment of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum

Abstract

Objectives We retrospectively studied the risk factors, clinicalmanifestations, radiological aspects, surgical treatment, and prognosticfactors in 143 patients of thoracic ossification of ligamentum flavum(OLF).Methods A total of 143 patients who underwent surgical treatment forthoracic myelopathy secondary to OLF between 1989 and 2010 were studiedretrospectively. Preoperative and postoperative neurological data werereviewed and the correlation between the variables of patientcharacteristics, preoperative duration of symptoms, preoperativeneurological status, and the functional outcome were analyzed. The maleto female ratio was 1.5:1. In total, 114 patients (79.72%) were in the4th to 6th decade of life. Only two cases (1.4%) were of less than20-year age group. The lower thoracic region (D9-D12) was most commonlyaffected (61.5%). Four patients had long segment involvement (>= 7levels) and eight patients had two separate levels of involvement.Associated fluorosis was observed in 32 patients (22.37%). All patientsunderwent wide decompressive laminectomy with medial one-thirdfacetectomy and OLF was resected. The part of dura adherent to OLF orcalcified is also removed with it and duroplasty done if required. Theaverage follow-up was 5 years.Outcome In all, 86 patients (60.13%) were able to do their job withmild neurological deficit such as spasticity and impairment of jointposition sense. Twenty-eight patients (19.58%) were back to some jobwith limitation but were independent for their routine work. Sixteenpatients (11.18%) improved but still required help for their routinework while thirteen patients (9.09%) were bed-ridden at last follow-up.Most common complications observed were cerebrospinal fluid leak(7.69%), neurological deterioration (8.39%), and infection (4.89%).Five (3.4%) patients required second surgery for ossification at otherlevel during follow-up.