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Differences in the Demographics and Clinical Characteristics between the Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum in Patients Who Underwent Thoracic Spinal Surgery for Compressive Myelopathy

Summary

This study compared two spinal conditions that cause nerve compression in the upper back: ossification of the posterior longitudinal ligament (TOPLL) and ossification of the ligamentum flavum (TOLF). Researchers found that TOPLL patients tend to be younger, more often female, and more obese than TOLF patients. Surgery for TOPLL is more complex and requires more extensive procedures with longer recovery times compared to TOLF surgery.

Background

Ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) are related diseases causing spinal ligament ossification that can lead to thoracic myelopathy. Understanding clinical differences between these conditions is important for surgical management.

Objective

To retrospectively compare demographic and clinical characteristics between patients with thoracic OPLL (TOPLL) and thoracic OLF (TOLF) who underwent surgical treatment for compressive myelopathy between July 2010 and June 2022.

Results

TOPLL group had significantly lower mean age (53.7 vs 68.4 years), greater female predominance (58.3% vs 18.2%), and higher median BMI (33.0 vs 26.0 kg/m²) compared to TOLF. TOPLL required more instrumented fusion (83.3% vs 9.1%) and repetitive surgery (50.0% vs 0.0%). Operating time and blood loss were significantly higher in TOPLL despite similar functional recovery rates between groups.

Conclusion

TOPLL is characterized by younger age of onset, female predominance, and obesity, suggesting associations with genetic and environmental factors. TOPLL requires more complex surgical management with long-range decompression and fusion, while TOLF achieves good outcomes with simple ossified ligament removal.
  • Published in:Neurological Medicine and Surgery (Neurol Med Chir Tokyo),
  • Study Type:Retrospective Comparative Study,
  • Source: 10.2176/jns-nmc.2023-0137, PMID: 38403719
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