A systematic review of complications in thoracic spine surgery for ossification of the posterior longitudinal ligament

To answer two questions: (1) what are the common complications associated with surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament, and (2) which surgical approach is safer with regard to the incidence of post-operative complications. Relevant literature searches were performed using the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, KoreaMed, and the Japan CentraRevuoMedicina. 15 studies met the inclusion criteria and were retrieved. They included a total of 595 patients, 39 % of whom were male and 61 % female. The mean patient age ranged from 52.6 to 60.9 years. The mean recovery rate from each individual study varied between 24.7 and 77.6 % and the pooled neurologic function recovery rate was 50.4 %. From these 15 studies, the mean complication rate was 39.4 %. By far, two complications were more common than the others: cerebrospinal fluid leakage (incidence rate 22.5 %) and post-operative neurologic deficit (incidence rate 13.9 %). 7.7 % of patients from the indirect decompression group experienced cerebrospinal fluid leakage, while it was reported in 25.6 % of those in the direct decompression group. Neurologic deficit was reported in 8.4 % of patients undergoing indirect decompression and 19.8 % of those undergoing direct decompression. Cerebrospinal fluid leakage and neurologic deficit were the two most common complications following surgical decompression of the thoracic spine with ossification of the posterior longitudinal ligament. Patients undergoing indirect decompression surgeries had significantly lower complication rates compared with those undergoing direct decompression surgeries.