{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T22:56:01Z","timestamp":1761519361336,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,4,6]]},"abstract":"<jats:p>Revision spine surgery is extremely challenging in super-super obese patients (body mass index (BMI) \u226560\u2009kg\/m<jats:sup>2<\/jats:sup>). This is the first report describing how bariatric surgery was useful for a super-super obese patient with progressing myelopathy. A 44-year-old man with a BMI of 62.9\u2009kg\/m<jats:sup>2<\/jats:sup> presented with an ambulatory disorder caused by thoracic ossification of the posterior longitudinal ligament (T7\u20138). Before this paraparesis, he had undergone four spinal operations, and was not considered a good candidate for a fifth spine surgery. At the time of the fourth operation, he had reached a maximum weight of 205\u2009kg (BMI 69.3\u2009kg\/m<jats:sup>2<\/jats:sup>). Instead, he underwent a laparoscopic sleeve gastrectomy. Sixteen months later, his body weight had decreased to BMI 35.2\u2009kg\/m<jats:sup>2<\/jats:sup>, and he could walk without a walker. In addition to reducing our patient\u2019s load, a \u2018non-operative\u2019 form of dekyphosis due to altered thoracic spinal alignment secondary to weight loss may explain the improvement in his myelopathy.<\/jats:p>","DOI":"10.1136\/bcr-2017-223629","type":"journal-article","created":{"date-parts":[[2018,4,11]],"date-time":"2018-04-11T13:29:09Z","timestamp":1523453349000},"page":"bcr-2017-223629","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Improvement of thoracic myelopathy following bariatric surgery in an obese patient"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-5914","authenticated-orcid":false,"given":"Shota","family":"Takenaka","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihiro","family":"Mukai","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noboru","family":"Hosono","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Kaito","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,4,11]]},"reference":[{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.soard.2014.04.031","article-title":"Five-year outcomes of gastric bypass for super-super-obesity (BMI\u226560 kg\/m\u00b2): a case matched study","volume":"11","author":"Thereaux","year":"2015","journal-title":"Surg Obes Relat Dis"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.2","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3171\/2013.4.SPINE12876","article-title":"Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series","volume":"19","author":"Rosenfeld","year":"2013","journal-title":"J Neurosurg Spine"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.3","first-page":"20","article-title":"Spine surgery in morbidly obese patients","volume":"97","author":"Telfeian","year":"2002","journal-title":"J Neurosurg"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.4","first-page":"490","article-title":"Scoring system for cervical myelopathy","volume":"68","author":"Japanese Orthopaedic Association","year":"1994","journal-title":"J Jpn Orthop Assoc"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.5","unstructured":"Campbell WW . DeJong\u2019s The Neurologic Examination. 7th ed: Philadelphia, PA: Lippincott Williams & Wilkins, 2012."},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.6","first-page":"1088","article-title":"Spine Surgery for Patients over 100 kg in Weight","volume":"1","author":"Katayama","year":"2010","journal-title":"J Spine Res"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.7","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/350195"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.8","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1097\/BRS.0b013e31825fab16","article-title":"Intervertebral disc height changes after weight reduction in morbidly obese patients and its effect on quality of life and radicular and low back pain","volume":"37","author":"Lidar","year":"2012","journal-title":"Spine"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.9","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s00586-009-0956-2","article-title":"Indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine: is it possible to predict the surgical results?","volume":"18","author":"Matsuyama","year":"2009","journal-title":"Eur Spine J"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.10","doi-asserted-by":"crossref","first-page":"116","DOI":"10.3171\/2010.3.SPINE09237","article-title":"Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level","volume":"13","author":"Zhang","year":"2010","journal-title":"J Neurosurg Spine"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.11","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-011-0574-z"},{"key":"2025082707341113000_2018.apr10_2.bcr-2017-223629.12","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1381\/096089206778026389","article-title":"Gastric bypass surgery in a paraplegic morbidly obese patient","volume":"16","author":"Alaedeen","year":"2006","journal-title":"Obes Surg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-223629","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:34:19Z","timestamp":1756305259000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-223629"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,11]]},"references-count":12,"alternative-id":["10.1136\/bcr-2017-223629"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-223629","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,4,11]]}}}