Surgical outcomes in non-ambulatory thoracic myelopathy: differences between ossification of the posterior longitudinal ligament and the ligamentum flavum.

BACKGROUND

Thoracic 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.

METHODS

A 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.

RESULTS

T-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).

CONCLUSIONS

Non-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.