Clinical Features of Thoracic Myelopathy: A Single-Center Study

Thoracic myelopathy is relatively uncommon because few degenerative changes occur as a result of the restricted range of motion surrounding the rib cage.

A retrospective study was performed in 300 consecutive surgical cases of thoracic disorders with myelopathy treated in our department from 2000 to 2015. Girdle pain, back pain, low back pain, leg numbness, leg pain, gait disturbance, leg paresis, and bowel bladder disturbance as initial and preoperative symptoms; patellar tendon reflex, ankle tendon reflex, and ankle clonus as preoperative neurologic findings; MRI and CT findings; and surgical procedure, intraoperative findings, and postoperative recovery were investigated.

The disease distribution included ossification of the ligamentum flavum (OLF) (n = 48), ossification of the posterior longitudinal ligament (OPLL) (n = 30), OPLL with OLF (n = 27), intradural extramedullary tumor (n = 98), intramedullary spinal cord tumor (n = 64), vertebral tumor (n = 17), spinal cord herniation (n = 7), vertebral fracture (n = 4), and thoracic disk herniation (n = 5). There were notable associations of gait disturbance with OPLL and OPLL + OLF; back pain at initial diagnosis with disease at upper levels; and low back pain with disease at a lower level.

These findings suggest that patients with gait disturbance, back pain, and low back pain on physical examination may have thoracic disease that results in myelopathy.