Peer-reviewedCC BY-NC-ND 4.0BMC Surgery1 Aug 2026

Development of a treatment classification system and treatment strategy for ligamentous ossification disease-traditional and innovative surgical strategies

Shunmin Wang¹
Yong Huang²
Tiefeng Li¹
Jingchuan Sun¹
Jiangang Shi¹
Yu Chen¹

¹Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, P. R. China, No. 415 Fengyang Road, Shanghai, 200003 People’s Republic of China
²Department of Orthopedics, Taihe Hospital, Hubei University of Medicine, Shiyan, China

Abstract

Background: Ligamentous ossification diseases like OPLL and OLF can cause severe neurological compromise. While whole-spine CT identifies ossified segments and MRI reveals cord compression/signal changes, treatment guidelines—especially for multi-level involvement—remain undefined, particularly with advancing anterior surgical techniques.

Methods: In this retrospective study of 168 patients with ≥ 2-year follow-up, we classified cases into: Cervicothoracic (CT), Cervicolumbar (CL), Thoracolumbar (TL), and Cervicothoracolumbar (CTL) types. Diagnosis required CT-confirmed ossification plus cord compression/T2 signal change (cervical/thoracic) or OLF with Schizas grade ≥ C lumbar stenosis. Surgical prioritization emphasized clinical symptoms over signs, myelopathy over radiculopathy, and proximal over distal compression.

Results: Type-specific strategies included anterior/posterior decompression (ACAF/TACAF for CT-type), selective approaches (CL-type), and level-specific decompression (TL/CTL-types). All subtypes showed significant improvement in JOA (e.g., CT-subtype: 10.54 ± 2.19 to 15.15 ± 0.78), Nurick (e.g., 3.52 ± 1.24 to 1.48 ± 0.96), and ODI scores (e.g., 31.75 ± 8.50 to 16.50 ± 1.29).

Conclusion: This strategy integrates clinical presentation with imaging criteria to guide level-specific surgical planning. Beyond radiological findings, symptomatology critically informs decision-making, enabling tailored decompression with validated functional outcomes across all ligamentous ossification subtypes.

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BibTeX RIS

BibTeX

@article{wang2026development,
  title = {{Development of a treatment classification system and treatment strategy for ligamentous ossification disease-traditional and innovative surgical strategies}},
  author = {Shunmin Wang and Yong Huang and Tiefeng Li and Jingchuan Sun and Jiangang Shi and Yu Chen},
  journal = {BMC Surgery},
  year = {2026},
  month = aug,
  doi = {10.1186/s12893-026-03994-x},
  url = {https://doi.org/10.1186/s12893-026-03994-x},
  note = {CC BY-NC-ND 4.0},
}

RIS

TY  - JOUR
TI  - Development of a treatment classification system and treatment strategy for ligamentous ossification disease-traditional and innovative surgical strategies
AU  - Shunmin Wang
AU  - Yong Huang
AU  - Tiefeng Li
AU  - Jingchuan Sun
AU  - Jiangang Shi
AU  - Yu Chen
PY  - 2026
DA  - 2026/08/01
JO  - BMC Surgery
DO  - 10.1186/s12893-026-03994-x
UR  - https://doi.org/10.1186/s12893-026-03994-x
AB  - Background: Ligamentous ossification diseases like OPLL and OLF can cause severe neurological compromise. While whole-spine CT identifies ossified segments and MRI reveals cord compression/signal changes, treatment guidelines—especially for multi-level involvement—remain undefined, particularly with advancing anterior surgical techniques.  Methods: In this retrospective study of 168 patients with ≥ 2-year follow-up, we classified cases into: Cervicothoracic (CT), Cervicolumbar (CL), Thoracolumbar (TL), and Cervicothoracolumbar (CTL) types. Diagnosis required CT-confirmed ossification plus cord compression/T2 signal change (cervical/thoracic) or OLF with Schizas grade ≥ C lumbar stenosis. Surgical prioritization emphasized clinical symptoms over signs, myelopathy over radiculopathy, and proximal over distal compression.  Results: Type-specific strategies included anterior/posterior decompression (ACAF/TACAF for CT-type), selective approaches (CL-type), and level-specific decompression (TL/CTL-types). All subtypes showed significant improvement in JOA (e.g., CT-subtype: 10.54 ± 2.19 to 15.15 ± 0.78), Nurick (e.g., 3.52 ± 1.24 to 1.48 ± 0.96), and ODI scores (e.g., 31.75 ± 8.50 to 16.50 ± 1.29).  Conclusion: This strategy integrates clinical presentation with imaging criteria to guide level-specific surgical planning. Beyond radiological findings, symptomatology critically informs decision-making, enabling tailored decompression with validated functional outcomes across all ligamentous ossification subtypes.
SN  - 1471-2482
ER  -

Abstract

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