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‘Floating’ plaque technique can provide additional spinal cord decompression
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Surgical techniques to treat thoracic ossification of the posterior longitudinal ligament vary in their outcomes, but evidence from a recently published study showed a posterolateral approach-based floating plaque technique was safe and offered positive surgical outcomes in a small case series.
Researchers examined the outcomes of 12 patients with thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPPL) who were surgically treated at the researchers’ institution between 2011 and 2013. The cohort included in the study were six patients with beak-type OPLL who underwent anterior decompression and instrumented fusion via a posterolateral approach-based surgical technique. Three of the patients were treated with the removal of the ossified ligament, and the remaining three patients were treated by “floating” the OPLL plaques.
Investigators found recovery rates of 52.4% and 60% for the removal and floating groups, respectively.
No patients in the floating group had operative complications, while two patients in the removal group had operative complications. For all three patients in the floating group, the floating of the ossified ligament was achieved and the floated plaque gradually migrated to the ventral bone resection areas, according to the researchers.
The mean OPLL occupying ratio in the floating group was 85.3%, and a minimum concentric bone resection was observed in the posterior portion of the vertebral body for all of the floating patients. Researchers noted the mean migration of the plaques were 2.4 mm, 4.3 mm, 4.7 mm and 4.8 mm at 1 month, 3 months, 6 months and 12 months, respectively, after surgery.
“Floating of the ossified PLL via our posterolateral approach-based surgical technique was safe and effective in patients with beak-type OPLL in the thoracic spine,” the authors wrote. “Gradual migration of the floated plaques provided additional spinal cord decompression during the postoperative course.” – by Robert Linnehan
Disclosure: The study was supported by a Health Labour Sciences Research Grant.
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