Neurological and Functional Outcomes After Decompression With or Without Fusion for Thoracic Ossification of the Ligamentum Flavum: A Systematic Review and Evidence Synthesis.
- 1Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, IND.
- 2Department of Pathology, District Hospital, Faridkot, IND.
Abstract
Thoracic ossification of the ligamentum flavum (TOLF) is an important cause of thoracic myelopathy. This systematic review evaluated neurological and functional outcomes after posterior decompression with or without fusion for TOLF and assessed perioperative safety. An electronic search of PubMed/MEDLINE was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Studies published up to December 2024 that reported adult patients undergoing posterior decompression with or without fusion for TOLF were included. Neurological recovery was assessed using the modified Japanese Orthopaedic Association score and recovery rate. Perioperative outcomes included cerebrospinal fluid leakage, blood loss, infection, and operative time. Owing to clinical and methodological heterogeneity, a narrative synthesis was performed using the Synthesis Without Meta-analysis framework. Risk of bias was assessed using ROBINS-I, and the certainty of evidence was evaluated using the GRADE approach. Ten retrospective cohort studies including 846 patients were included. Regarding the primary neurological outcomes and perioperative safety, the use of an ultrasonic osteotome reduced operative time, blood loss, and dural tear rates compared with a high-speed burr, without significant differences in long-term neurological outcomes. Dural ossification was the strongest predictor of cerebrospinal fluid leakage. Regarding secondary prognostic factors, longer symptom duration, preoperative intramedullary T2 hyperintensity, and lower baseline modified Japanese Orthopaedic Association scores were associated with poorer neurological recovery. Furthermore, a signal change ratio ≥1.54 on quantitative magnetic resonance imaging and sagittal beak-type ossification were associated with unfavorable prognosis. Overall certainty of evidence was low to very low. Outcomes after surgery for TOLF are primarily determined by preoperative neurological status and magnetic resonance imaging features. These findings may help guide surgical timing and selective fusion, while operative technique appears to mainly influence perioperative safety.
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BibTeX
@article{singh2026neurological,
title = {{Neurological and Functional Outcomes After Decompression With or Without Fusion for Thoracic Ossification of the Ligamentum Flavum: A Systematic Review and Evidence Synthesis.}},
author = {Ajaybir Singh and Amanpreet Singh and Supreet Kaur and Jagdeep Singh and Kapil Bansal},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116563},
url = {https://europepmc.org/article/MED/42903226},
note = {CC BY},
}
RIS
TY - JOUR
TI - Neurological and Functional Outcomes After Decompression With or Without Fusion for Thoracic Ossification of the Ligamentum Flavum: A Systematic Review and Evidence Synthesis.
AU - Ajaybir Singh
AU - Amanpreet Singh
AU - Supreet Kaur
AU - Jagdeep Singh
AU - Kapil Bansal
PY - 2026
DA - 2026/09/19
JO - Cureus
DO - 10.7759/cureus.116563
UR - https://europepmc.org/article/MED/42903226
AB - Thoracic ossification of the ligamentum flavum (TOLF) is an important cause of thoracic myelopathy. This systematic review evaluated neurological and functional outcomes after posterior decompression with or without fusion for TOLF and assessed perioperative safety. An electronic search of PubMed/MEDLINE was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Studies published up to December 2024 that reported adult patients undergoing posterior decompression with or without fusion for TOLF were included. Neurological recovery was assessed using the modified Japanese Orthopaedic Association score and recovery rate. Perioperative outcomes included cerebrospinal fluid leakage, blood loss, infection, and operative time. Owing to clinical and methodological heterogeneity, a narrative synthesis was performed using the Synthesis Without Meta-analysis framework. Risk of bias was assessed using ROBINS-I, and the certainty of evidence was evaluated using the GRADE approach. Ten retrospective cohort studies including 846 patients were included. Regarding the primary neurological outcomes and perioperative safety, the use of an ultrasonic osteotome reduced operative time, blood loss, and dural tear rates compared with a high-speed burr, without significant differences in long-term neurological outcomes. Dural ossification was the strongest predictor of cerebrospinal fluid leakage. Regarding secondary prognostic factors, longer symptom duration, preoperative intramedullary T2 hyperintensity, and lower baseline modified Japanese Orthopaedic Association scores were associated with poorer neurological recovery. Furthermore, a signal change ratio ≥1.54 on quantitative magnetic resonance imaging and sagittal beak-type ossification were associated with unfavorable prognosis. Overall certainty of evidence was low to very low. Outcomes after surgery for TOLF are primarily determined by preoperative neurological status and magnetic resonance imaging features. These findings may help guide surgical timing and selective fusion, while operative technique appears to mainly influence perioperative safety.
SN - 2168-8184
ER -