{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:38:37Z","timestamp":1792543117197,"version":"4.5.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Thoracic ossification of the ligamentum flavum (T-OLF) may lead to severe thoracic myelopathy and loss of ambulation. Limited data are available regarding surgical outcomes in patients who are nonambulatory preoperatively. This study aimed to evaluate the surgical outcomes of posterior decompression in nonambulatory patients with T-OLF and to identify factors associated with failure to regain ambulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective study included consecutive patients with T-OLF who were nonambulatory before surgery and underwent posterior decompression with fusion (PDF) between July 2010 and July 2023. Preoperative nonambulatory status was defined as complete loss of walking ability, including inability to walk with assistive devices. Neurological function was assessed using the thoracic-adapted modified Japanese Orthopaedic Association (mJOA) score (maximum 11 points). Postoperative ambulation was defined as the ability to walk independently or with assistive devices. Patients were divided into ambulatory and nonambulatory groups based on walking status at the final follow-up. Multivariable logistic regression was performed to identify predictors associated with persistent nonambulation after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 72 patients with a minimum 2-year follow-up were included. At final follow-up, 58 patients (80.6%) regained ambulatory function, whereas 14 patients (19.4%) remained nonambulatory. The mean mJOA score improved significantly after surgery (p &lt; 0.001), with a median recovery rate of 47.2%. Female sex (OR 4.51, p = 0.032) and lower preoperative mJOA score (OR 0.46, p = 0.006) were independently associated with failure to regain ambulation after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In patients with T-OLF who were nonambulatory preoperatively, PDF resulted in recovery of ambulation in the majority of cases. Female sex and lower preoperative neurological function were associated with reduced likelihood of regaining ambulation. Even in severe thoracic myelopathy, meaningful functional improvement remains achievable following surgical decompression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.4.spine251040","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:58Z","timestamp":1791936058000},"page":"1-7","source":"Crossref","is-referenced-by-count":0,"title":["Clinical outcomes of nonambulatory patients caused by ossification of the ligamentum flavum in the thoracic spine"],"prefix":"10.3171","author":[{"given":"Juncai","family":"Lei","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing;"},{"name":"Beijing Key Laboratory of Spinal Diseases, Peking University, Beijing; and"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panpan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing;"},{"name":"Beijing Key Laboratory of Spinal Diseases, Peking University, Beijing; and"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing;"},{"name":"Beijing Key Laboratory of Spinal Diseases, Peking University, Beijing; and"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing;"},{"name":"Beijing Key Laboratory of Spinal Diseases, Peking University, Beijing; and"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanchao","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing;"},{"name":"Beijing Key Laboratory of Spinal Diseases, Peking University, Beijing; 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and"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing;"},{"name":"Beijing Key Laboratory of Spinal Diseases, Peking University, Beijing; and"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Dang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing;"},{"name":"Beijing Key Laboratory of Spinal Diseases, Peking University, Beijing; and"},{"name":"Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongjun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing;"},{"name":"Beijing Key Laboratory of Spinal Diseases, Peking University, Beijing; 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Thoracic myelopathy in ossified ligamentum flavum: surgical management and long-term outcome following 2 different techniques of surgical decompression. Global Spine J. 2023;13(3):659\u2013667. doi:10.1177\/21925682211003061"},{"issue":"5","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"394","article-title":"Prevalence, distribution, and morphology of thoracic ossification of the posterior longitudinal ligament in Japanese: results of CT-based cross-sectional study","volume":"39","author":"Mori K","year":"2014","unstructured":"Mori K, Imai S, Kasahara T, Nishizawa K, Mimura T, Matsusue Y. Prevalence, distribution, and morphology of thoracic ossification of the posterior longitudinal ligament in Japanese: results of CT-based cross-sectional study. Spine (Phila Pa 1976). 2014;39(5):394\u2013399. doi:10.1097\/BRS.0000000000000153"},{"issue":"9","key":"b3","series-title":"Eur Spine J","first-page":"2164","article-title":"The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review","volume":"29","author":"Chen G","year":"2020","unstructured":"Chen G, Fan T, Yang X, Sun C, Fan D, Chen Z. The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review. Eur Spine J. 2020;29(9):2164\u20132172. doi:10.1007\/s00586-020-06520-6"},{"issue":"2","key":"b4","series-title":"Orthop Surg","first-page":"87","article-title":"Progress on clinical characteristics and identification of location of thoracic ossification of the ligamentum flavum","volume":"7","author":"Feng F","year":"2015","unstructured":"Feng F, Bo Sun C, Guo Chen ZQ. Progress on clinical characteristics and identification of location of thoracic ossification of the ligamentum flavum. Orthop Surg. 2015;7(2):87\u201396. doi:10.1111\/os.12165"},{"key":"b5","series-title":"Front Surg","first-page":"1036253","article-title":"Analysis of the surgical strategy and postoperative clinical effect of thoracic ossification of ligament flavum with dural ossification","volume":"9","author":"Liu T","year":"2022","unstructured":"Liu T, Yang S, Tian S,  Analysis of the surgical strategy and postoperative clinical effect of thoracic ossification of ligament flavum with dural ossification. Front Surg. 2022;9:1036253. doi:10.3389\/fsurg.2022.1036253"},{"issue":"5","key":"b6","series-title":"J Neurosurg Spine","first-page":"348","article-title":"Clinical and prognostic analysis of ossified ligamentum flavum in a Chinese population","volume":"3","author":"He S","year":"2005","unstructured":"He S, Hussain N, Li S, Hou T. Clinical and prognostic analysis of ossified ligamentum flavum in a Chinese population. J Neurosurg Spine. 2005;3(5):348\u2013354. doi:10.3171\/spi.2005.3.5.0348"},{"issue":"3","key":"b7","series-title":"Spinal Cord","first-page":"188","article-title":"Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases","volume":"54","author":"Li Z","year":"2016","unstructured":"Li Z, Ren D, Zhao Y,  Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases. Spinal Cord. 2016;54(3):188\u2013196. doi:10.1038\/sc.2015.139"},{"issue":"9","key":"b8","series-title":"Spine J","first-page":"1032","article-title":"Clinical features and surgical outcomes of patients with thoracic myelopathy caused by multilevel ossification of the ligamentum flavum","volume":"13","author":"Gao R","year":"2013","unstructured":"Gao R, Yuan W, Yang L, Shi G, Jia L. 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Neurospine. 2018;15(3):269\u2013276. doi:10.14245\/ns.1836128.064"},{"issue":"3","key":"b10","series-title":"J Neurosurg Spine","first-page":"492","article-title":"Surgical results of nonambulatory patients caused by ossification of the posterior longitudinal ligaments in the thoracic spine: retrospective comparative study between posterior decompression and instrumented spinal fusion versus anterior decompression through a posterior approach","volume":"34","author":"Aizawa T","year":"2021","unstructured":"Aizawa T, Eto T, Hashimoto K, Kanno H, Itoi E, Ozawa H. Surgical results of nonambulatory patients caused by ossification of the posterior longitudinal ligaments in the thoracic spine: retrospective comparative study between posterior decompression and instrumented spinal fusion versus anterior decompression through a posterior approach. 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