Indian Spine Journal (Jan 2025)

Does Long-Segment Involvement in Thoracic Ossified Ligamentum Flavum-Associated Compressive Myelopathy Portend a Poor Surgical Outcome?

  • Sam Scaria,
  • Ganesh Divakar,
  • Krishnakumar Kesavapisharady,
  • Easwer Harihara Venkat,
  • Antony Stanley

DOI
https://doi.org/10.4103/isj.isj_14_24
Journal volume & issue
Vol. 8, no. 1
pp. 43 – 50

Abstract

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Background: Compressive myelopathy due to thoracic ossified ligamentum flavum (TOLF) is a rare disorder of multifactorial etiology, and considerable ambiguity exists regarding several clinical and radiological indicators for prognosis following surgery. This study aims to analyze and compare the surgical outcomes from short-segment and long-segment involvement in patients with compressive myelopathy secondary to thoracic ossified ligamentum flavum and critically review the relevant literature. Materials and Methods: This is a retrospective, single-center study of 28 consecutive patients operated exclusively for TOLF divided into short-segment-TOLF (SSTOLF) (n = 15), having one or two contiguous levels of cord compression involvement, and long-segment-TOLF (LSTOLF) (n = 13), having three or more contiguous levels of involvement. The clinical features of these groups before and after surgery were analyzed and compared. Results: There were 20 males and eight females with a mean age of 53.2 years. Overall, there was a significant inverse correlation between the preoperative duration of symptoms and the Hirabayashi Recovery Rate (HRR) (r = -0.675, P = 0.001). The preoperative Japanese Orthopedic Association (JOA) score strongly correlated with the HRR (r = 0.715, P = 0.001). The mean preoperative JOA scores were 6.67 (0.72) and 4.08 (0.76), and the mean improvement in JOA scores for SSTOLF and LSTOLF following surgery were 2.26 (0.71) and 1.46 (1.13), respectively, which was statistically significant (P = 0.03). Conclusions: Patients with SSTOLF presented with symptoms relatively early, although with a better neurological profile and attained good functional status following surgical intervention. In contrast, patients with LSTOLF had a worse baseline clinical profile, and despite improvement with surgery, they had a poor functional status.

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