Postoperative ossification progression after decompression for thoracic ossification of the ligamentum flavum: associated factors identified by serial CT analysis.
- 1Department of Orthopaedic Surgery, Spinal Injuries Center, Japan Organization of Occupational Health and Safety, Fukuoka, Japan. [email protected].
- 2Department of Orthopaedic Surgery, Spinal Injuries Center, Japan Organization of Occupational Health and Safety, Fukuoka, Japan.
Abstract
Introduction
Postoperative ossification progression after decompression for thoracic ossification of the ligamentum flavum (T-OLF) has been reported, but factors associated with its progression remain poorly understood. The role of additional instrumentation in preventing postoperative ossification progression also remains controversial.Methods
We retrospectively reviewed 65 patients who underwent primary surgery for T-OLF between 2007 and 2024. Clinical characteristics and surgical outcomes were compared between patients treated with decompression alone and those treated with decompression and instrumentation. Detailed CT analysis was performed in 31 patients who underwent serial CT examinations before surgery, immediately after surgery, and at the final follow-up with at least 2 years of radiological follow-up. Residual ossification and postoperative ossification progression were evaluated using CT imaging.Results
Among the 65 patients, postoperative ossification progression occurred in five patients (7.6%), and two patients required revision surgery. No significant differences in postoperative ossification progression or reoperation were observed between the decompression-alone and instrumentation groups. In the detailed CT cohort, postoperative ossification progression was significantly associated with a greater preoperative ossification occupying ratio (p = 0.02) and residual ossification on immediate postoperative CT (p < 0.01). Instrumentation was not significantly associated with postoperative ossification progression.Conclusions
Additional instrumentation was not significantly associated with postoperative ossification progression in this cohort. However, detailed CT analysis demonstrated that a greater preoperative ossification occupying ratio and residual ossification were associated with postoperative ossification progression. These findings suggest that minimizing residual ossification during decompression may be important for reducing postoperative ossification progression. Larger multicenter studies are warranted to clarify the role of instrumentation in selected high-risk patients.
Related
- Clinical Outcomes and Feasibility of Unilateral Biportal Endoscopic Decompression for Thoracic Ossification of the Ligamentum Flavum: A Retrospective Single-Center Study
- Neurological and Functional Outcomes After Decompression With or Without Fusion for Thoracic Ossification of the Ligamentum Flavum: A Systematic Review and Evidence Synthesis.
- Current progress and controversies in thoracic ossification of the ligamentum flavum: pathogenesis, diagnosis and surgical management
- Posterior circumferential decompression for multilevel thoracic ossification of the posterior longitudinal ligament: a case report and literature review.
- Atraumatic iliopsoas heterotopic ossification with postoperative atypical haemolytic uraemic syndrome
BibTeX
@article{kai2026postoperative,
title = {{Postoperative ossification progression after decompression for thoracic ossification of the ligamentum flavum: associated factors identified by serial CT analysis.}},
author = {Kazuhiro Kai and Osamu Kawano and Hirokazu Saiwai and Muneaki Masuda and Kensuke Kubota and Kazuhiro Hata and Momo Irie and Sei Kuroishi and Kazuhiro Murotani and Takeshi Maeda},
journal = {BMC musculoskeletal disorders},
year = {2026},
month = jul,
doi = {10.1186/s12891-026-10245-w},
url = {https://europepmc.org/article/MED/42897602},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Postoperative ossification progression after decompression for thoracic ossification of the ligamentum flavum: associated factors identified by serial CT analysis.
AU - Kazuhiro Kai
AU - Osamu Kawano
AU - Hirokazu Saiwai
AU - Muneaki Masuda
AU - Kensuke Kubota
AU - Kazuhiro Hata
AU - Momo Irie
AU - Sei Kuroishi
AU - Kazuhiro Murotani
AU - Takeshi Maeda
PY - 2026
DA - 2026/07/01
JO - BMC musculoskeletal disorders
DO - 10.1186/s12891-026-10245-w
UR - https://europepmc.org/article/MED/42897602
AB - Introduction Postoperative ossification progression after decompression for thoracic ossification of the ligamentum flavum (T-OLF) has been reported, but factors associated with its progression remain poorly understood. The role of additional instrumentation in preventing postoperative ossification progression also remains controversial.Methods We retrospectively reviewed 65 patients who underwent primary surgery for T-OLF between 2007 and 2024. Clinical characteristics and surgical outcomes were compared between patients treated with decompression alone and those treated with decompression and instrumentation. Detailed CT analysis was performed in 31 patients who underwent serial CT examinations before surgery, immediately after surgery, and at the final follow-up with at least 2 years of radiological follow-up. Residual ossification and postoperative ossification progression were evaluated using CT imaging.Results Among the 65 patients, postoperative ossification progression occurred in five patients (7.6%), and two patients required revision surgery. No significant differences in postoperative ossification progression or reoperation were observed between the decompression-alone and instrumentation groups. In the detailed CT cohort, postoperative ossification progression was significantly associated with a greater preoperative ossification occupying ratio (p = 0.02) and residual ossification on immediate postoperative CT (p < 0.01). Instrumentation was not significantly associated with postoperative ossification progression.Conclusions Additional instrumentation was not significantly associated with postoperative ossification progression in this cohort. However, detailed CT analysis demonstrated that a greater preoperative ossification occupying ratio and residual ossification were associated with postoperative ossification progression. These findings suggest that minimizing residual ossification during decompression may be important for reducing postoperative ossification progression. Larger multicenter studies are warranted to clarify the role of instrumentation in selected high-risk patients.
SN - 1471-2474
ER -