What question did this study set out to answer?

This research aims to compare clinical features and surgical outcomes of non-ambulatory patients with T-OPLL and T-OLF.

March 18, 2026Journal of Orthopaedic Surgery and Research0 citationsOpen Access

Surgical outcomes in non-ambulatory thoracic myelopathy: differences between ossification of the posterior longitudinal ligament and the ligamentum flavum

JLJuncai LeiMinistry of Education of the People's Republic of China PHPan HuMinistry of Education of the People's Republic of China YTYanchao TangMinistry of Education of the People's Republic of China

Key Points

This research aims to compare clinical features and surgical outcomes of non-ambulatory patients with T-OPLL and T-OLF.
Retrospective analysis of 126 non-ambulatory patients undergoing decompression surgery (2012-2023)
Comparison of demographic data, surgical details, perioperative complications, and neurological outcomes between T-OPLL and T-OLF groups
T-OPLL patients were younger (51.3 vs. 58.2 years, P < 0.001) and had a higher female prevalence (74.3% vs. 48.2%, P = 0.003)
Despite similar preoperative mJOA scores, T-OPLL patients had better recovery rates (62.5% vs. 50.0%, P = 0.042)
T-OPLL surgeries had longer operative times (134.5 vs. 111.0 min, P = 0.02) and higher transient neurological deterioration rates (22.9% vs. 5.4%, P = 0.006)

Abstract

Thoracic spinal stenosis (TSS) is a severe spinal disorder that can lead to thoracic myelopathy, particularly in non-ambulatory patients. Thoracic ossification of the posterior longitudinal ligament (T-OPLL) and thoracic ossification of the ligamentum flavum (T-OLF) are the primary etiologies, but their differences in clinical characteristics and surgical outcomes remain unclear. This study aimed to compare the clinical features and surgical efficacy between non-ambulatory T-OPLL and T-OLF patients. A retrospective analysis was conducted on 126 non-ambulatory patients (70 in T-OPLL group, 56 in T-OLF group) who underwent decompression surgery between 2012 and 2023. Demographic data, surgical details, perioperative complications, and neurological outcomes were compared between groups. T-OPLL patients were younger (51.3 vs. 58.2 years, P < 0.001) and more frequently female (74.3% vs. 48.2%, P = 0.003). Despite worse preoperative mJOA scores (median 3.0 vs. 3.0, P = 0.03), T-OPLL patients achieved higher recovery rates (62.5% vs. 50.0%, P = 0.042) at final follow-up. T-OPLL surgeries required more decompressed segments (4.5 vs. 4.0, P = 0.02) and longer operative times (134.5 vs. 111.0 min, P = 0.02), with higher rates of transient neurological deterioration (22.9% vs. 5.4%, P = 0.006). Non-ambulatory T-OPLL patients exhibit distinct demographic profiles and more severe preoperative deficits but demonstrate better postoperative recovery than T-OLF patients. These findings underscore the need for tailored surgical approaches and highlight the potential for neurological improvement even in advanced TSS.

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