Treatment for thoracic ossification of posterior longitudinal ligament with posterior circumferential decompression: complications and managements

BACKGROUND: The complications and corresponding managements for patients with thoracic ossification of posterior longitudinal ligament (TOPLL) who were treated with posterior circumferential decompression have not been systematically summarized yet. METHODS: Twenty-one patients with TOPLL who received posterior circumferential decompression between February 2010 and December 2014 were retrospectively reviewed. The patients’ basic characteristics, surgical duration, intraoperative blood loss, Japanese Orthopaedic Association (JOA) scores, and intraoperative and postoperative complications, and the adopted managements were summarized. RESULTS: The patients were averagely aged 52.1 ± 8.3 (range 32–67) years and included 10 males and 11 females. The mean operation time was 4.0 ± 0.9 (range 2.5–6) h and blood loss was 1619 ± 704 (range 800–4000) ml. Patients were followed up for 24.5 ± 1.2 (range 12–36) months. The average JOA score of patients was significantly elevated from 4.5 ± 1.4 (preoperative) to 7.4 ± 2.4 (P < 0.001, mean recovery rate 57.73%) on the second postoperative day and 7.8 ± 2.2 (P < 0.001, mean recovery rate 60.36%) at the final follow-up visit, respectively. There were 23 cases of complications that occurred in 12 patients, including 10 cases of intraoperative hemorrhage, 5 of cerebrospinal fluid leakage, 4 of intercostal nerve palsy, 3 of neurological deterioration, and 1 of superficial infection. After the corresponding treatment, these complications were recovered during the follow-up except 1 case of postoperative neurological deterioration did not exhibit improvement. CONCLUSIONS: Posterior circumferential decompression is effective for TOPLL but causes complications which need to be proactively prevented and treated. If treated properly, most complications can be recovered with satisfactory outcomes.