A long-term follow-up study from Japan has shown that decompression and fixation surgery yields long-term benefits, and significant improvement, in T-OPLL – Thoracic ossification of the posterior longitudinal ligament, the rare condition associated with ectopic bone formation in the thoracic spine.
Their findings are published in the Journal of Bone & Joint Surgery.
“Surgical treatment of T-OPLL is effective in improving neurological function, quality of life, and pain management over an extended period,” wrote Hiroaki Nakashima, MD, PhD, and colleagues of Nagoya University Graduate School of Medicine.
New evidence
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 analysed follow-up data on 51 patients undergoing posterior decompression and corrective fixation surgery for T-OPLL.
With an average age of 51.6 years, they underwent surgery at the study centre between 2001 and 2014, with follow-up of at least 10 years. Severity was assessed using the Japanese Orthopaedic 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 pre-operatively to 7.9 at two years post-operatively, remaining stable thereafter. “These scores indicated sustained neurological and functional improvement from surgery over the long term,” the researchers wrote.
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 post-operative complications, including six within the first 30 days post-operatively and eight thereafter.
Peri-operative complications included lower limb paralysis, infection, and haematoma, whereas later complications were mainly adjacent vertebral fractures. Four patients had 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, the researchers concluded.
“The imaging results showed minimal progression of ossification beyond two years post-operatively, contributing to the long-term stability and structural improvements observed in the patients."
Study details
Ten-year follow-up of posterior decompression and fusion surgery for thoracic ossification of the posterior longitudinal ligament
Ito, Sadayuki; Nakashima, Hiroak; Segi Imagama, Shiro et al.
Published in Journal of Bone & Joint Surgery on 5 August 2024
Abstract
Background
We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL).
Methods
We retrospectively evaluated 51 patients followed for ≥10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression.
Results
A significant improvement was observed in the JOA score from pre-operatively (3.7) to 2 years post-operatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 pre-operatively to 0.68 at 10 years post-operatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from pre-operatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after two years. Fourteen (27.5%) of the patients experienced post-operative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade.
Conclusions
Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years.
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