| アブストラクト | BACKGROUND: Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is a rare disease, which can cause spinal cord compression leading to various neurological symptoms. There are limited treatment options for T-OPLL, surgery is generally considered the only effective treatment. However, few studies have investigated surgical complications in patients with T-OPLL, and there are no data regarding surgical risks in anterior decompression with fusion (ADF) when compared with posterior decompression with fusion (PDF) for T-OPLL. METHODS: Patients who were diagnosed as T-OPLL and underwent ADF via the anterior approach and PDF via the posterior approach from April 1, 2012 to March 31, 2018, were extracted from the Diagnosis Procedure Combination (DPC) database. We analyzed perioperative systemic and local complication rates after ADF and PDF and compared them using propensity score matching (PSM) method. In each of the two groups, we investigated the details of length of stay, costs, mortality, and discharge destination. RESULTS: In total 1344 patients (ADF: 88 patients, PDF: 1256 patients), 176 patients were investigated after PSM (88 pairs). While the incidence of overall systemic complication was significantly higher in the ADF group (ADF/PDF: 25.0%/8.0%, P = 0.002), there was no significant difference in the overall local complication rate (15.9%/19.3%, P = 0.55). Specifically, respiratory complications were more frequently observed in the ADF group (9.1%/0%, P = 0.004), however, other systemic and local complications did not differ significantly between the two groups. The length of stay was 1.7 times longer (P < 0.001) and the medical costs were 1.4 times higher (P < 0.001) in patients with perioperative complications, compared to those without perioperative complications. CONCLUSION: We demonstrated the perioperative complications of ADF and PDF in patients with T-OPLL using a large national database. ADF showed a higher incidence of respiratory complications. Development of perioperative complications was associated with longer hospital stay and higher medical costs. |
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| 投稿日 | 2021/5/12 |
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| 投稿者 | Morishita, Shingo; Yoshii, Toshitaka; Inose, Hiroyuki; Hirai, Takashi; Yuasa, Masato; Matsukura, Yu; Ogawa, Takahisa; Fushimi, Kiyohide; Okawa, Atsushi; Fujiwara, Takeo |
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| ジャーナル名 | Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association |
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| 組織名 | Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate;School of Medicine, Tokyo, Japan.;School of Medicine, Tokyo, Japan. Electronic address: yoshii.orth@tmd.ac.jp.;Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School of Medicine, Tokyo, Japan.;Department of Global Health Promotion, Tokyo Medical and Dental University |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/33972149/ |
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