Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Value of Additional Instrumented Fusion in the Treatment of Thoracic Ossification of the Ligamentum Flavum

  • Hwang, Sung Hwan (Department of Neurosurgery, The Armed Forces Capital Hospital of Korea) ;
  • Chung, Chun Kee (Human Brain Function Laboratory, Department of Neurosurgery, Seoul National University Hospital) ;
  • Kim, Chi Heon (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Yang, Seung Heon (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Choi, Yunhee (Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Yoon, Joonho (Department of Neurosurgery, The Armed Forces Capital Hospital of Korea)
  • Received : 2021.07.07
  • Accepted : 2021.12.29
  • Published : 2022.09.01
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Abstract

Objective : The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group). Methods : A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model. Results : After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the F-group than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months. Conclusion : Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.

Keywords

Acknowledgement

The study was supported by a grant of the Seoul National University Hospital (Nos. 3020210070 & 3020220200).

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