@article{oai:nagoya.repo.nii.ac.jp:00023221,
 author = {Imagama, Shiro and Ando, Kei and Ito, Zenya and Kobayashi, Kazuyoshi and Hida, Tetsuro and Ito, Kenyu and Ishikawa, Yoshimoto and Tsushima, Mikito and Matsumoto, Akiyuki and Tanaka, Satoshi and Morozumi, Masayoshi and Machino, Masaaki and Ota, Kyotaro and Nakashima, Hiroaki and Wakao, Norimitsu and Nishida, Yoshihiro and Matsuyama, Yukihiro and Ishiguro, Naoki},
 issue = {8},
 journal = {Global Spine Journal},
 month = {Dec},
 note = {Study Design: Prospective clinical study. Objective: Posterior decompression and fusion surgery for beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) generally has a favorable outcome. However, some patients require additional surgery for postoperative severe paralysis, a condition that is inadequately discussed in the literature. The objective of this study was to describe the efficacy of a procedure we refer to as “resection at an anterior site of the spinal cord from a posterior approach” (RASPA) for severely paralyzed patients after posterior decompression and fusion surgery for beak-type T-OPLL. Methods: Among 58 consecutive patients who underwent posterior decompression and fusion surgery for beak-type T-OPLL since 1999, 3 with postoperative paralysis (5%) underwent RASPA in our institute. Clinical records, the Japanese Orthopaedic Association score, gait status, intraoperative neurophysiological monitoring (IONM) findings, and complications were evaluated in these cases. Results: All three patients experienced a postoperative decline in Manual Muscle Test (MMT) scores of 0 to 2 after the first surgery. RASPA was performed 3 weeks after the first surgery. All patients showed gradual improvements in MMT scores for the lower extremity and in ambulatory status; all could walk with a cane at an average of 4 months following RASPA surgery. There were no postoperative complications. Conclusions: RASPA surgery for beak-type T-OPLL after posterior decompression and fusion surgery resulted in good functional outcomes as a salvage surgery for patients with severe paralysis. Advantages of RASPA include a wide working space, no spinal cord retraction, and additional decompression at levels without T-OPLL resection and spinal cord shortening after additional dekyphosis and compression maneuvers. When used with IONM, this procedure may help avoid permanent postoperative paralysis.},
 pages = {812--821},
 title = {Resection of Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament from a Posterior Approach under Intraoperative Neurophysiological Monitoring for Paralysis after Posterior Decompression and Fusion Surgery},
 volume = {6},
 year = {2016}
}