A new study offers hope for patients with thoracic ossification of the posterior longitudinal ligament (TOPLL), a rare spinal disorder. Researchers in Japan found that surgery to decompress and stabilize the spine led to significant and long-lasting improvements in patients with this condition. The findings, published in The Journal of Bone & Joint Surgery, suggest a promising treatment option for this often debilitating condition (1^✔ ✔Trusted Source
Ten-Year Follow-up of Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament

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“Surgical treatment of T-OPLL is effective in improving neurological function, quality of life, and pain management over an extended period,” according to the new research by Hiroaki Nakashima, MD, PhD, and colleagues of Nagoya University Graduate School of Medicine.

Understanding Ectopic Bone Growth

Patients with ossification of the posterior longitudinal ligament have ectopic bone growth in the spinal column, resulting in neurological signs and symptoms. Most cases involve the cervical spine. Although thoracic involvement is less common, it is prone to delayed diagnosis and often goes undetected until severe symptoms develop. Japan has the highest prevalence of T-OPLL.

Studies of operatively treated T-OPLL have reported better outcomes when spinal decompression is combined with fixation. To assess the long-term outcomes of this procedure, the researchers analyzed follow-up data on 51 patients undergoing posterior decompression and corrective fixation surgery for T-OPLL.

The patients, who had an average age of 51.6 years, underwent surgery at the study center between 2001 and 2014, with follow-up of at least 10 years. Severity was assessed using the Japanese Orthopedic Association (JOA) score. Other assessments included back and leg pain, quality of life (QoL), and radiographic outcomes.

The average JOA score improved significantly from 3.7 preoperatively to 7.9 at two years postoperatively, remaining stable thereafter. These scores indicated “sustained neurological and functional improvement from surgery over the long term,” the researchers write.

Decompression and fixation also yielded lasting improvement in patient-reported outcomes, including QoL (EQ-5D score). Numeric rating scale pain scores decreased from 5.4 preoperatively to 3.5 at 10 years for back pain and from 4.0 to 3.0 for leg pain. Radiographic outcomes included reduction in Cobb angles for T1-T12 in sagittal plane and kyphosis.

Eleven patients had progression of ossification, largely within the first five years. A total of 14 patients experienced postoperative complications, including six within the first 30 days postoperatively and eight thereafter. Perioperative complications included lower limb paralysis, infection, and hematoma, whereas later complications were mainly adjacent vertebral fractures. A total of four patients underwent an additional surgical procedure during follow-up.

The study provides new long-term follow-up data on the outcomes of decompression and fixation for T-OPLL, including persistent gains in clinical and patient-reported outcomes. Although some patients developed distal junctional failure or required reoperation, “these complications and interventions did not substantially detract from the overall QoL improvement,” Dr. Nakashima and coauthors conclude. “The imaging results showed minimal progression of ossification beyond two years postoperatively, contributing to the long-term stability and structural improvements observed in the patients.”

Reference:

1. Ten-Year Follow-up of Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament – (https://journals.lww.com/jbjsjournal/abstract/9900/ten_year_follow_up_of_posterior_decompression_and.1171.aspx)

Source-Eurekalert