Clinical outcomes after decompressive laminectomy for symptomatic ossification of ligamentum flavum at the thoracic spine

• OLF is a major cause of acquired thoracic spinal canal stenosis.
• Surgical intervention is generally necessary for symptomatic thoracic OLF.
• Posterior decompressive laminectomy is effective for symptomatic thoracic OLF.
• Surgery for thoracic OLF had a relatively high risk of complications.

Ossification of the ligamentum flavum (OLF) is a rare disease that causes acquired thoracic spinal canal stenosis and thoracic myelopathy. The aim of this study was to investigate clinical outcomes of symptomatic thoracic OLF treated using posterior decompressive laminectomy. We retrospectively analyzed the medical records of 22 patients who underwent posterior decompressive laminectomy for symptomatic thoracic OLF. The surgical results were evaluated using the modified Japanese Orthopaedic Association (JOA) scoring system and Hirabayashi recovery rate. The intensity of pain was evaluated using a visual analog scale (VAS). The mean duration of follow-up was 35.6 months. The mean JOA score was significantly improved at final follow-up (9.18 ± standard deviation of 1.53 points [range, 6–11 points]) compared with before surgery (5.64 ± 2.04 points [range, 3–9 points]) (P < 0.001). The mean Hirabayashi recovery rate was 65.49% (range, 20–100%). Recovery outcomes were excellent in nine patients, good in eight patients, fair in four patients and unchanged in one patient. No patient was classified as deteriorated. The VAS scores were 2.82 ± 3.08 before surgery and 0.59 ± 1.05 at final follow-up (P = 0.001). Surgical complications, which resolved after appropriate and prompt treatment, included dural tear in five patients, cerebrospinal fluid leakage in one patient, immediate postoperative neurologic deterioration in one patient, epidural hematoma in one patient, and wound infection in one patient. Our findings suggest that posterior decompressive laminectomy is an effective treatment for symptomatic thoracic OLF and provides satisfactory clinical improvement, but surgery for thoracic OLF is associated with a relatively high incidence of complications.