Abstract / Summary
Abstract Background To characterize postoperative ambulatory recovery in non-ambulatory patients with thoracic ossification of the ligamentum flavum (TOLF) and identify factors associated with poor recovery. Methods We retrospectively reviewed 71 consecutive patients with TOLF who were unable to walk preoperatively and underwent posterior decompression and instrumented fusion between January 2012 and December 2023. Postoperative ambulatory recovery was assessed using the lower-extremity motor component of the modified Japanese Orthopaedic Association (mJOA) score. Patients with a postoperative motor score ≥ 3 were classified as having good recovery and those with a score ≤ 2 as having poor recovery. Clinical and radiographic variables were compared between groups, followed by univariable and multivariable logistic regression analyses. Results Sixty-one patients (85.9%) achieved some degree of ambulatory recovery, including 32 (45.1%) with good recovery. Compared with the good-recovery group, patients with poor recovery were older (59.9 ± 10.8 vs 52.3 ± 10.4 years, P = .005), had a longer duration of preoperative inability to walk (median, 3 vs 2 months, P = .005), more frequent thoracolumbar involvement (82.1% vs 37.5%, P < .001), and more frequent previous lumbar surgery (25.6% vs 6.2%, P = .030). Multivariable analysis identified thoracolumbar involvement (OR, 6.015; 95% CI, 1.791–21.044; P = .005) and previous lumbar surgery (OR, 6.442; 95% CI, 1.013–40.952; P = .048) as factors associated with poor recovery. Conclusion Thoracolumbar involvement and previous lumbar surgery were associated with poorer recovery, although the imprecision of these estimates warrants cautious interpretation and external validation.