ArticleJournal of orthopaedic surgery and research2026
Surgical outcomes in non-ambulatory thoracic myelopathy: differences between ossification of the posterior longitudinal ligament and the ligamentum flavum.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThoracic spinal stenosis (TSS) is a severe spinal disorder that can lead to thoracic myelopathy, particularly in non-ambulatory patients. Thoracic ossification of the posterior longitudinal ligament (T-OPLL) and thoracic ossification of the ligamentum flavum (T-OLF) are the primary etiologies, but their differences in clinical characteristics and surgical outcomes remain unclear. This study aimed to compare the clinical features and surgical efficacy between non-ambulatory T-OPLL and T-OLF patients.
methodsA retrospective analysis was conducted on 126 non-ambulatory patients (70 in T-OPLL group, 56 in T-OLF group) who underwent decompression surgery between 2012 and 2023. Demographic data, surgical details, perioperative complications, and neurological outcomes were compared between groups.
resultsT-OPLL patients were younger (51.3 vs. 58.2 years, P < 0.001) and more frequently female (74.3% vs. 48.2%, P = 0.003). Despite worse preoperative mJOA scores (median 3.0 vs. 3.0, P = 0.03), T-OPLL patients achieved higher recovery rates (62.5% vs. 50.0%, P = 0.042) at final follow-up. T-OPLL surgeries required more decompressed segments (4.5 vs. 4.0, P = 0.02) and longer operative times (134.5 vs. 111.0 min, P = 0.02), with higher rates of transient neurological deterioration (22.9% vs. 5.4%, P = 0.006).
conclusionsNon-ambulatory T-OPLL patients exhibit distinct demographic profiles and more severe preoperative deficits but demonstrate better postoperative recovery than T-OLF patients. These findings underscore the need for tailored surgical approaches and highlight the potential for neurological improvement even in advanced TSS.
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