学術雑誌論文 Resection of Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament from a Posterior Approach under Intraoperative Neurophysiological Monitoring for Paralysis after Posterior Decompression and Fusion Surgery

Imagama, Shiro  ,  Ando, Kei  ,  Ito, Zenya  ,  Kobayashi, Kazuyoshi  ,  Hida, Tetsuro  ,  Ito, Kenyu  ,  Ishikawa, Yoshimoto  ,  Tsushima, Mikito  ,  Matsumoto, Akiyuki  ,  Tanaka, Satoshi  ,  Morozumi, Masayoshi  ,  Machino, Masaaki  ,  Ota, Kyotaro  ,  Nakashima, Hiroaki  ,  Wakao, Norimitsu  ,  Nishida, Yoshihiro  ,  Matsuyama, Yukihiro  ,  Ishiguro, Naoki

6 ( 8 )  , pp.812 - 821 , 2016-12 , Georg Thieme Verlag
ISSN:2192-5682
内容記述
Study Design: Prospective clinical study. Objective: Posterior decompression and fusion surgery for beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) generally has a favorable outcome. However, some patients require additional surgery for postoperative severe paralysis, a condition that is inadequately discussed in the literature. The objective of this study was to describe the efficacy of a procedure we refer to as “resection at an anterior site of the spinal cord from a posterior approach” (RASPA) for severely paralyzed patients after posterior decompression and fusion surgery for beak-type T-OPLL. Methods: Among 58 consecutive patients who underwent posterior decompression and fusion surgery for beak-type T-OPLL since 1999, 3 with postoperative paralysis (5%) underwent RASPA in our institute. Clinical records, the Japanese Orthopaedic Association score, gait status, intraoperative neurophysiological monitoring (IONM) findings, and complications were evaluated in these cases. Results: All three patients experienced a postoperative decline in Manual Muscle Test (MMT) scores of 0 to 2 after the first surgery. RASPA was performed 3 weeks after the first surgery. All patients showed gradual improvements in MMT scores for the lower extremity and in ambulatory status; all could walk with a cane at an average of 4 months following RASPA surgery. There were no postoperative complications. Conclusions: RASPA surgery for beak-type T-OPLL after posterior decompression and fusion surgery resulted in good functional outcomes as a salvage surgery for patients with severe paralysis. Advantages of RASPA include a wide working space, no spinal cord retraction, and additional decompression at levels without T-OPLL resection and spinal cord shortening after additional dekyphosis and compression maneuvers. When used with IONM, this procedure may help avoid permanent postoperative paralysis.
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