Posterior Thoracic Antidisplacement and Fusion Surgery for a Special Type of Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine: Indications and Preliminary Clinical Results of 2-Year Follow-Up

Abstract

To describe a novel technique, posterior thoracic antidisplacement and fusion (PTAF), for a special type of ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL), and to evaluate its safety and efficacy. From July to December 2020, 5 consecutive patients with beak-type T-OPLL located at the thoracic vertebral body level underwent PTAF surgery. Their demographic data, radiological parameters, perioperative complications, and surgery-related findings were recorded and analyzed. The surgical outcomes were assessed using a modified Japanese Orthopedic Association scale, and the recovery rate was calculated using the Hirabayashi's method. All patients were followed up for at least two years. The mean thickness of OPLL was 9.4±1.0mm, and the OPLL spinal canal occupying ratio was 67.7%±8.5%. Postoperatively, the mean antidisplacement distance of OPLL was 8.1±1.8mm, and the average shortened distance of the spinal column was 6.0±1.13mm. The mean operation time and blood loss were 158.2±26.3minutes and 460±89.4mL, respectively. Perioperative complications were cerebrospinal fluid leakage and instrument failure, 2 cases each. The mean modified Japanese Orthopedic Association score was increased from 3.6±2.9 before surgery to 9.4±3.0 at the last follow-up, and the average recovery rate was 84.2±30.5%. The preliminary clinical outcomes indicate that PTAF is a safe and effective method for the treatment of beak-type T-OPLL, which has its apex located at the vertebral body level and has a high spinal canal occupation ratio.