Neurological manifestations of thoracic myelopathy

• Published in: Archives of orthopaedic and trauma surgery 2014-07, Vol.134 (7), p.903-912
• Main Authors: Takenaka, Shota, Kaito, Takashi, Hosono, Noboru, Miwa, Toshitada, Oda, Takenori, Okuda, Shinya, Yamashita, Tomoya, Oshima, Kazuya, Ariga, Kenta, Asano, Masatoshi, Fuchiya, Tsuyoshi, Kuroda, Yusuke, Nagamoto, Yukitaka, Makino, Takahiro, Yamazaki, Ryoji, Yonenobu, Kazuo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Female; Humans; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neuromuscular Diseases - etiology; Orthopaedic Surgery; Orthopedics; Pathology; Retrospective Studies; Severity of Illness Index; Spinal Cord Compression - complications; Spinal Cord Diseases - complications; Thoracic Vertebrae; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-014-2000-1

Introduction Investigation of preoperative manifestations of thoracic myelopathy in a large population has not been reported. The aim of this study was to identify symptoms specific to anatomical pathology or compressed segments in thoracic myelopathy through investigation of preoperative manifestations. Materials and methods Subjects were 205 patients [143 men, 62 women; mean age, 62.2 (range 21–87 years)] with thoracic myelopathy who underwent surgery at our affiliate institutions from 2000 to 2011. The disease distribution included ossification of the ligamentum flavum (OLF) in 106 patients, ossification of the posterior longitudinal ligament (OPLL) in 17, OLF with OPLL in 17, intervertebral disc herniation (IDH) in 23, OLF with IDH in 3, and spondylosis in 39. We assessed (1) initial and preoperative complaints, (2) neurological findings, (3) Japanese Orthopaedic Association scores (JOA, full score, 11 points), (4) the compressed segments, and (5) preoperative duration. Multivariate analyses were performed to examine potential relationships between preoperative manifestations and anatomical pathology or compressed segments. Results The multivariate analyses revealed relationships between lower limb muscle weakness and T10/11 anterior compression; lower limb pain and T11/12 anterior compression; low back pain and T11/12 compression; and hyporeflexia in the patellar tendon reflex/foot drop and T12/L1 anterior compression. Conclusion This study elucidated symptoms specific to anatomical pathology or compressed segments in thoracic myelopathy. These relationships can be helpful in the initial investigation of thoracic diseases, although additional measures such as MRI or CT are necessary for definitive diagnosis.