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Predicting the Results of Surgery for Ossification of the Ligamentum Flavum

Posted on: 08/31/2006
In this review, doctors from the University of South Florida School of Medicine look over the results of 10 years worth of studies. The topic is the results of surgery for patients with thoracic ossification of the ligamentum flavum (OLF). They hoped to find a way to predict results of the surgery.

OLF is a condition in which the ligamentum along the back of the spine thickens and hardens. Bony splinters may replace the fibers of the ligament. The thicker ligament decreases the size of the opening of the spinal canal. These changes can put pressure on the spinal cord causing paralysis. This condition is called myeloradiculopathy. The part of the spine affected most often is T9 to T12.

Surgery may be the only treatment that helps with myeloradiculopathy. By comparing patient factors with outcomes of treatment, researcher may uncover who can be helped the most with surgery for OLF. Here's what they found so far.

Although men are affected more often, being male doesn't mean a better or worse outcome after surgery. Increasing age may be linked with worse results but this wasn't true for every patient. It doesn't appear that the level of OLF (higher or lower in the spine) makes any difference either.

More recent studies suggest two factors that may have the most predictive value. These include: 1) duration of symptoms and 2) presence of neurologic symptoms. Patients who wait the longest to have surgery may have the worst results. There were different results from study to study when looking at this factor so it wasn't 100 per cent fool proof.

Patients with a delayed diagnosis and advanced disease were more likely to have irreversible spinal cord damage. In these cases, the presence of neurologic symptoms was a negative predictor of outcome.

OLF is rare but the number of people affected by this condition is increasing. Guidelines for treatment are needed. Surgeons still don't know if the OLF should be removed completely or just the affected segments. Most experts advise early surgery even in patients with only mild to moderate symptoms.

Johi Inamasu, MD, PhD, and Bernard H. Guiot, MD, FRSC(C). A Review of Factors Predictive of Surgical Outcome for Ossification of the Ligamentum Flavus of the Thoracic Spine. In Journal of Neurosurgery: Spine. August 2006. Vol. 5. No. 2. Pp. 133-139.

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