3区 · 医学
ArticleOA
作者: Matsumoto, Akiyuki ; Tanaka, Satoshi ; Ishikawa, Yoshimoto ; Hida, Tetsuro ; Nishida, Yoshihiro ; Morozumi, Masayoshi ; Machino, Masaaki ; Nakashima, Hiroaki ; Ota, Kyotaro ; Ito, Kenyu ; Wakao, Norimitsu ; Matsuyama, Yukihiro ; Ishiguro, Naoki ; Ito, Zenya ; Ando, Kei ; Imagama, Shiro ; Kobayashi, Kazuyoshi ; Tsushima, Mikito
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.
