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Chen G, Chen Z, Li W, Qi Q, Guo Z, Zhong W, Jiang Y, Wu F, Song C, Sun C. Posterior Thoracic Antidisplacement and Fusion Surgery for a Special Type of Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine: Indications and Preliminary Clinical Results of 2-Year Follow-Up. World Neurosurg 2024; 189:e932-e940. [PMID: 38992726 DOI: 10.1016/j.wneu.2024.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To describe a novel technique, posterior thoracic antidisplacement and fusion (PTAF), for a special type of ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL), and to evaluate its safety and efficacy. METHODS From July to December 2020, 5 consecutive patients with beak-type T-OPLL located at the thoracic vertebral body level underwent PTAF surgery. Their demographic data, radiological parameters, perioperative complications, and surgery-related findings were recorded and analyzed. The surgical outcomes were assessed using a modified Japanese Orthopedic Association scale, and the recovery rate was calculated using the Hirabayashi's method. RESULTS All patients were followed up for at least two years. The mean thickness of OPLL was 9.4 ± 1.0 mm, and the OPLL spinal canal occupying ratio was 67.7% ± 8.5%. Postoperatively, the mean antidisplacement distance of OPLL was 8.1 ± 1.8 mm, and the average shortened distance of the spinal column was 6.0 ± 1.13 mm. The mean operation time and blood loss were 158.2 ± 26.3 minutes and 460 ± 89.4 mL, respectively. Perioperative complications were cerebrospinal fluid leakage and instrument failure, 2 cases each. The mean modified Japanese Orthopedic Association score was increased from 3.6 ± 2.9 before surgery to 9.4 ± 3.0 at the last follow-up, and the average recovery rate was 84.2 ± 30.5%. CONCLUSIONS The preliminary clinical outcomes indicate that PTAF is a safe and effective method for the treatment of beak-type T-OPLL, which has its apex located at the vertebral body level and has a high spinal canal occupation ratio.
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Affiliation(s)
- Guanghui Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Qiang Qi
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Zhaoqing Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Woquan Zhong
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Yu Jiang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Fengliang Wu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Chunli Song
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
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Maruyama J, Furuya T, Maki S, Inoue T, Yunde A, Miura M, Shiratani Y, Nagashima Y, Shiga Y, Inage K, Eguchi Y, Orita S, Takahashi H, Koda M, Yamazaki M, Ohtori S. Posterior Decompression and Fixation for Thoracic Spine Ossification: A 10-Year Follow-Up Study. J Clin Med 2023; 12:5701. [PMID: 37685772 PMCID: PMC10488937 DOI: 10.3390/jcm12175701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Ossification of the posterior longitudinal ligament of the thoracic spine (T-OPLL) causes symptoms including leg and back pain, and motor and sensory deficits. This study retrospectively reviewed 32 patients who initially underwent posterior decompression with instrumented fusion (PDF) for T-OPLL between 2001 and 2012, with 20 qualifying for the final analysis after applying exclusion criteria. Exclusions included unknown preoperative neurological findings, follow-up less than 10 years, or prior spinal surgeries at other levels. Outcomes were assessed using the Japanese Orthopedic Association (JOA) score, recovery rate, and kyphotic angle. The average preoperative JOA score of 3.6 improved to 7.4 at 1 year post-surgery and remained at 7.4 at 10 years, with a recovery rate of 52%. The kyphotic angle at T4-12 increased from 26 degrees preoperatively to 29 degrees postoperatively and to 37 degrees at 10 years. At the fused levels, the angle remained at 26 degrees immediately post-operation and increased to 32 degrees at 10 years. Forty percent of patients required additional surgery, primarily for conditions related to cervical OPLL, such as myelopathy, or lumbar OPLL, such as radiculopathy, or cauda equina syndrome. In conclusion, PDF effectively reduces T-OPLL symptoms over the long term, but the high rate of additional surgeries calls for careful patient follow-up.
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Affiliation(s)
- Juntaro Maruyama
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Takeo Furuya
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Satoshi Maki
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Takaki Inoue
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Atsushi Yunde
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Masataka Miura
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Yuki Shiratani
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Yuki Nagashima
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Yasuhiro Shiga
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Kazuhide Inage
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Yawara Eguchi
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
| | - Sumihisa Orita
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Seiji Ohtori
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (J.M.)
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Liang H, Zhao X, Wang L, Li J, Shen Y. Risk factors for perioperative hidden blood loss after one-segment posterior circumferential decompression surgery on thoracic ossification of the posterior longitudinal ligament: a finding of the double-layer sign on CT. BMC Musculoskelet Disord 2023; 24:223. [PMID: 36964520 PMCID: PMC10037783 DOI: 10.1186/s12891-023-06352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Hidden blood loss (HBL) is of increasing interest to spine surgeons. This retrospective study aimed to evaluate perioperative HBL and its risk factors in patients undergoing one-segment posterior circumferential decompression surgery on thoracic ossification of the posterior longitudinal ligament (T-OPLL). METHOD We retrospectively studied 112 patients diagnosed with T-OPLL following posterior circumferential decompression surgery from August 2015 to June 2020. Patient demographics, blood loss-related parameters, surgery-related data and imaging parameters were extracted. Postoperative complications were also recorded. Pearson or Spearman correlation analysis was used to investigate the correlation between patient demographics and HBL. Multivariate linear regression analysis was performed to determine the independent risk factors associated with HBL. RESULTS Forty-five men and 67 women were involved in this research, with an average age of 56.4 ± 10.2 years. The mean HBL was 459.6 ± 275.4 ml, accounting for 56.5% of the total blood loss. Multiple linear regression analysis showed that double-layer sign (P = 0.000), ossification occupancy ratio (OOR) > 60% (P = 0.030), age (P = 0.010), hematocrit (Hct) loss (P = 0.034), and postoperative Hct (P = 0.016) were independent risk factors for HBL. However, OPLL morphology (P = 0.319), operation time (P = 0.587), hemoglobin (Hb) loss (P = 0.644), and postoperative Hb (P = 0.952) were not significantly different from HBL. CONCLUSION A high proportion of HBL was found after posterior circumferential decompression surgery on T-OPLL during the perioperative period, which should not be overlooked. Double-layer sign, OOR > 60%, age, Hct loss and postoperative Hct are independent risk factors for HBL.
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Affiliation(s)
- Huiqiang Liang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Xuan Zhao
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Jia Li
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
| | - Yong Shen
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
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Jing X, Gong Z, Qiu X, Zhong Z, Ping Z, Hu Q. "Cave-in" decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report. Front Surg 2023; 9:1030999. [PMID: 36684180 PMCID: PMC9852340 DOI: 10.3389/fsurg.2022.1030999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/08/2022] [Indexed: 01/09/2023] Open
Abstract
Background Thoracic ossification of the posterior longitudinal ligament (TOPLL) requires surgery for spinal cord decompression. Traditional open surgery is extremely invasive and has various complications. Unilateral biportal endoscopy (UBE) is a newly developed technique for spine surgery, especially in the lumbar region, but rare in the thoracic spine. In this study, we first used a different percutaneous UBE "cave-in" decompression technique for the treatment of beak-type TOPLL. Methods A 31-year-old female with distinct zonesthesia and numbness below the T3 dermatome caused by beak-type TOPLL (T2-T3) underwent a two-step UBE decompression procedure. In the first step, the ipsilateral lamina, left facet joint, partial transverse process, and pedicles of T2 and T3 were removed. In the second step, a cave was created by removing the posterior third of the vertebral body (T2-T3). The eggshell-like TOPLL was excised by forceps, and the dural sac was decompressed. All procedures are performed under endoscopic guidance. A drainage tube was inserted, and the incisions were closed after compliance with the decompression scope via a C-arm. The patient's preoperative and postoperative radiological and clinical results were evaluated. Results Postoperative CT and MR films conformed complete decompression of the spinal cord. The patient's lower extremity muscle strength was greatly improved, and no complications occurred. The mJOA score improved from 5 to 7, with a recovery rate of 33.3%. Conclusion UBE spinal decompression for TOPLL showed favorable clinical and radiological results and offers the advantages of minimal soft tissue dissection, shorter hospital stays, and a faster return to daily life activities.
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Takahashi K, Hashimoto K, Onoki T, Kanno H, Ozawa H, Aizawa T. Anterior shift of the ventral dura mater: A novel concept of the posterior surgery for ossification of the posterior longitudinal ligament in thoracic spine. Front Surg 2023; 10:1120069. [PMID: 37114152 PMCID: PMC10128993 DOI: 10.3389/fsurg.2023.1120069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
Background Thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) remains one of the most difficult disorders to treat. The Ohtsuka procedure, extirpation, or anterior floating of the OPLL through a posterior approach, has shown great surgical outcomes after several modifications. However, these procedures are technically demanding and pose a significant risk of neurological deterioration. We have developed a novel modified Ohtsuka procedure in which removal or minimization of the OPLL mass is unnecessary; instead, the ventral dura mater is shifted anteriorly with the posterior part of the vertebral bodies and targeted OPLL. Surgical Procedure First, pedicle screws were inserted at more than three spinal levels above and below the spinal level where pediculectomies were performed. After laminectomies and total pediculectomies, partial osteotomy of the posterior vertebra adjacent to the targeted OPLL was performed by using a curved air drill. Then, the PLL is completely resected at the cranial and caudal sites of the OPLL using special rongeurs or a threadwire saw with a diameter of 0.36 mm. The nerve roots were not resected during surgery. Methods Eighteen patients (follow-up ≥1 year) treated with our modified Ohtsuka procedure were assessed clinically, including the Japanese Orthopaedic Association (JOA) score for thoracic myelopathy and radiographically. Results The average follow-up period was 3.2 years (range, 1.3-6.1 years). The preoperative JOA score was 2.7 ± 1.7, which improved to 8.2 ± 1.8 at 1 year postoperatively; therefore, the recovery rate was 65.8 ± 19.8%. The CT scan at 1 year after surgery revealed the anterior shift of the OPLL averaged 3.1 ± 1.7 mm and the ossification-kyphosis angle of the anterior decompression site decreased at an average of 7.2 ± 6.8 degrees. Three patients demonstrated temporary neurological deterioration, all of whom completely recovered within 4 weeks postoperatively. Discussion The concept of our modified Ohtsuka procedure is 1) not OPLL extirpation or minimization but only the creation of space between the OPLL and spinal cord by an anterior shift of the ventral dura mater, which is achieved by complete resection of the PLL at the cranial and caudal sites of the OPLL; and 2) no nerve roots are sacrificed to prevent ischemic spinal cord injury. This procedure is not technically demanding and safe and provides secure decompression for thoracic OPLL. The anterior shift of the OPLL was smaller than expected, but it resulted in a relatively good surgical outcome with a recovery rate ≥65%. Conclusion Our modified Ohtsuka procedure is quite secure and is not technically demanding, with a recovery rate of 65.8%.
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Affiliation(s)
- Kohei Takahashi
- Department of Orthopaedic Surgery, Schoolof Medicine, Tohoku University, Sendai, Japan
- Correspondence: Kohei Takahashi
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Schoolof Medicine, Tohoku University, Sendai, Japan
| | - Takahiro Onoki
- Department of Orthopaedic Surgery, Schoolof Medicine, Tohoku University, Sendai, Japan
| | - Haruo Kanno
- Department of Orthopaedic Surgery, School of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, School of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Schoolof Medicine, Tohoku University, Sendai, Japan
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Sun C, Chen Z, Chen G, Li W, Qi Q, Guo Z, Zhong W. A new "de-tension"-guided surgical strategy for multilevel ossification of posterior longitudinal ligament in thoracic spine: a prospective observational study with at least 3-year follow-up. Spine J 2022; 22:1388-1398. [PMID: 35351669 DOI: 10.1016/j.spinee.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT Multilevel ossification of the posterior longitudinal ligament in thoracic spine (mT-OPLL) is a rare but clinically significant spinal condition. Various surgical methods have been developed to address this disease. However, the outcomes are commonly unfavorable, and no standard surgical strategy has been established. To solve this problem, we introduced a new surgical strategy based on an innovative decompression concept, namely "de-tension." PURPOSE This study aimed to investigate the safety and efficacy of this new treatment, and to establish an improved surgical strategy. STUDY DESIGN A prospective observational study with at least 3 years of follow-up. PATIENT SAMPLE Fifty-one patients with consecutive mT-OPLL who were treated between August-2012 and June-2018 were enrolled in this study. OUTCOME MEASURES A modified Japanese Orthopedic Association (mJOA) scale assessing thoracic spine, recovery rate (RR), and surgical complications. METHODS All patients underwent 1-stage thoracic posterior laminectomy, selective OPLL resection, and spinal column shortening with/without reduction of kyphosis (dekyphosis). Initially, we recommended that when thoracic kyphosis of T1-T12 in sagittal reconstruction CT (TK) was less than 20°, no dekyphosis should be performed; when this angle was greater than 20°, dekyphosis could be conducted. Patients' demographic data, radiological findings, and intra/postoperative complications were recorded and analyzed. Neurological status was evaluated with mJOA score and RR. The correlation of preoperative TK or kyphosis angle in fusion area (FSK) with postoperative dekyphosis angle and spinal column shortening distance (SD) were respectively evaluated by Pearson correlation analysis. RESULTS Cerebrospinal fluid leakage (58.8%) and neurological deterioration (15.7%) were the most common complications. Average mJOA score was improved from preoperative 4.0±2.1 to 8.9±2.4 at the last follow-up, and the mean RR was 71.3±33.7%. There was no correlation between preoperative TK and SD (p=.56) or between preoperative FSK and SD (p=.21), but dekyphosis angle was significantly correlated with TK (r=0.504, p<.01) and FSK (r=0.5734, p<.01). TK of 24.6° and FSK of 23.0° were determined as the critical angles for dekyphosis, and a modified surgical strategy was formulated. CONCLUSIONS This new strategy provided a novel solution for mT-OPLL, and was proved to be safe and effective during long-term follow-up. Further rigorously designed large-scale prospective studies are needed to validate our findings.
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Affiliation(s)
- Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China.
| | - Guanghui Chen
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Qiang Qi
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
| | - Zhaoqing Guo
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
| | - Woquan Zhong
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
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Wu X, Lin R, Ding D, Ding X, Fan Z, Wang T, Chen G, Sun Y, Lin Y, Wang H, Yin M, Yan Y. Global Trends Of The Researches On Ossification Of Posterior Longitudinal Ligament In Thoracic Spine: A Bibliometric And Visualization Study. World Neurosurg 2022; 168:e1-e11. [PMID: 35817352 DOI: 10.1016/j.wneu.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022]
Abstract
STUDY DESIGN Bibliometric analysis OBJECTIVE: Thoracic ossification of the posterior longitudinal ligament (TOPLL) was a rare but intractable disease, and was the second leading cause of thoracic myelopathy. This study aimed to illustrate the overall knowledge structure, and development trends of TOPLL, using a bibliometric analysis and newly developed visualization tools. METHODS Research datasets were acquired from the Web of Science. The literature search was also limited to articles that were published until Oct 30, 2021. VOS viewer and Citespace software was provided to analyze the data and generate visualization knowledge maps. Annual trend of publications, distribution, H-Index status, co-authorship status and research hotspots were analyzed. RESULTS 206 publications met the requirement. Japan published most papers (92), both total citations (1574) and H-index (24) ranked first of all the countries. The most productive organizations were Peking University (22). The most productive authors were Yamazaki M (18). The most productive journals were Spine (33). Diagnosis and treatment on the accuracy of surgical segments, prognosis of patients, and gene research were the research hotspots in the recent years. CONCLUSION The study showed an upward trend with a stable rise in recent years. Japan is country with the highest productivity, not only in quality, but also in quantity. Peking University and Spine have been the largest contributor. Indeed, this study provides great insights to the growth and development of TOPLL. Moreover, it will contribute to the growth of the international frontier.
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Affiliation(s)
- Xifa Wu
- Department of Spine, Shandong Zibo Central Hospital, Shandong, China
| | - Rui Lin
- Department of Spine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Ding Ding
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xing Ding
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhaoxiang Fan
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tao Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guanghui Chen
- Department of Orthopaedics, Third Affiliated Hospital of Peking University, Beijing, China
| | - Yueli Sun
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongpeng Lin
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Hongshen Wang
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Mengchen Yin
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yinjie Yan
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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