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Gatam AR, Noor EA, Gatam L. Unilateral biportal endoscopic surgical decompression for symptomatic ossification of the ligamentum flavum - Is it enough to improve the clinical outcome? A case-control study. J Orthop 2024; 53:150-155. [PMID: 38601893 PMCID: PMC11001628 DOI: 10.1016/j.jor.2024.03.037] [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: 03/19/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose Open decompression is currently the standard surgical procedure for symptomatic OLF. As the minimal invasive method gains popularity, UBE is considered a reliable technique with less complication. However, the outcome is still in question. This study aimed to evaluate and compare UBE versus open surgery in symptomatic OLF cases. Methods We evaluated 35 patients with single- or two-level thoracic OLF, underwent decompression by open or UBE. Surgery duration, estimated blood loss, and LOS were recorded as intraoperative parameters. Minimum follow-up was 1 year to evaluate clinical parameters based on the mJOA score, Frankel grade, and recovery rate (RR). Results The UBE procedure showed significant superiority with faster surgery (62.5 min vs. 180 min; p < 0.001), less blood loss (50 mL vs. 250 mL; p < 0.001), and shorter LOS (4 days vs. 6 days; p < 0,001). UBE patients showed notable clinical improvement on the mJOA score at 1 year (8.2 ± 0.18 vs. 6.8 ± 0.24; p = 0.015). Frankel grade improvements seen in both groups with 51.4% of subjects having at least a 1-point upgrade. RR in 1 year resulted in significant recovery in UBE group (RR-UBE 43.2 ± 17 vs. RR-open 26.3 ± 15.3; p < 0.05). No neurological deterioration or significant complication occurred after either procedure. Conclusion The UBE technique allows faster decompression with less blood loss and shorter LOS compared to open surgery. It was found to be a reliable treatment option in treating OLF with favorable clinical outcomes and improved patient neurological status.
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Affiliation(s)
- Asrafi Rizki Gatam
- Orthopedic Spine, Gatam Institute – Eka Hospital BSD, Banten, Indonesia
- Orthopedic Spine Division, Fatmawati General Hospital, Jakarta, Indonesia
| | - Erwin Ardian Noor
- Orthopedic Spine Division, Fatmawati General Hospital, Jakarta, Indonesia
| | - Luthfi Gatam
- Orthopedic Spine, Gatam Institute – Eka Hospital BSD, Banten, Indonesia
- Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
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Rujeedawa T, Mowforth OD, Davies BM, Yang C, Nouri A, Francis JJ, Aarabi B, Kwon BK, Harrop J, Wilson JR, Martin AR, Rahimi-Movaghar V, Guest JD, Fehlings MG, Kotter MR. Degenerative Thoracic Myelopathy: A Scoping Review of Epidemiology, Genetics, and Pathogenesis. Global Spine J 2024; 14:1664-1677. [PMID: 38146739 DOI: 10.1177/21925682231224768] [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] [Indexed: 12/27/2023] Open
Abstract
STUDY DESIGN Literature Review. OBJECTIVE Myelopathy affecting the thoracic spinal cord can arise secondary to several aetiologies which have similar presentation and management. Consequently, there are many uncertainties in this area, including optimal terminology and definitions. Recent collaborative cervical spinal research has led to the proposal and subsequent community adoption of the name degenerative cervical myelopathy(DCM), which has facilitated the establishment of internationally-agreed research priorities for DCM. We put forward the case for the introduction of the term degenerative thoracic myelopathy(DTM) and degenerative spinal myelopathy(DSM) as an umbrella term for both DCM and DTM. METHODS Following PRISMA guidelines, a systematic literature search was performed to identify degenerative thoracic myelopathy literature in Embase and MEDLINE. RESULTS Conditions encompassed within DTM include thoracic spondylotic myelopathy, ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, calcification of ligaments, hypertrophy of ligaments, degenerative disc disease, thoracic osteoarthritis, intervertebral disc herniation, and posterior osteophytosis. The classic presentation includes girdle pain, gait disturbance, leg weakness, sensory disturbance, and bladder or bowel dysfunction, often with associated back pain. Surgical management is typically favoured with post-surgical outcomes dependent on many factors, including the causative pathology, and presence of additional stenosis. CONCLUSION The clinical entities encompassed by the term DTM are interrelated, can manifest concurrently, and present similarly. Building on the consensus adoption of DCM in the cervical spine and the recent proposal of degenerative cervical radiculopathy(DCR), extending this common nomenclature framework to the terms degenerative spinal myelopathy and degenerative thoracic myelopathy will help improve recognition and communication.
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Affiliation(s)
- Tanzil Rujeedawa
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Cylene Yang
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Aria Nouri
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Jibin J Francis
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Brian K Kwon
- Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - James Harrop
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Allan R Martin
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - James D Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Michael G Fehlings
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mark R Kotter
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Sha Q, Huang Z, Liu J, Ge P, Zhang Y, Song E, Sun Z, Zhu T, Shen C, Qian J. Safety and efficacy of one-hole split endoscope technique for surgical treatment of thoracic ossification of the ligamentum flavum. Sci Rep 2024; 14:4342. [PMID: 38383583 PMCID: PMC10881547 DOI: 10.1038/s41598-024-55055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
Surgical intervention is typically recommended for thoracic ossification of the ligamentum flavum (TOLF). This study aimed to evaluate the efficacy and safety of a novel non-coaxial one-hole split endoscope (OSE) technique for treating TOLF. We performed OSE procedure on 13 patients with TOLF from June 2022 to July 2023. The mean operative time was 117.5 ± 15.4 min. VAS scores for lower limbs decreased from 6.5 ± 0.8 preoperative to 1.6 ± 0.4 at the last follow-up (P < 0.001). ODI scores improved from 62.4 ± 5.7 preoperative to 18.6 ± 2.2 at the last follow-up (P < 0.001), and mJOA scores increased from 5.1 ± 1.6 preoperative to 8.4 ± 1.5 at the latest follow-up (P < 0.001). All patients achieved ASIA scale grade D or E at the final follow-up, except for two patients remained residual limb numbness. None of the thirteen patients suffered from severe perioperative complications. The OSE technique proves to be a safe and effective procedure for treating TOLF or even with dura mater ossification, characterized by minimal surgical trauma, relatively smooth learning curve and flexible operation.
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Affiliation(s)
- Qi Sha
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Zhengdong Huang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jinhao Liu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Peng Ge
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yong Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - En Song
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Zhaozhong Sun
- Department of Spine, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China
| | - Tenyue Zhu
- Department of Orthopaedics, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, China
| | - Cailiang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jun Qian
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China.
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Ito S, Nakashima H, Segi N, Ouchida J, Oda M, Yamauchi I, Oishi R, Miyairi Y, Mori K, Imagama S. Automated Detection of the Thoracic Ossification of the Posterior Longitudinal Ligament Using Deep Learning and Plain Radiographs. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8495937. [PMID: 38054045 PMCID: PMC10695689 DOI: 10.1155/2023/8495937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
Ossification of the ligaments progresses slowly in the initial stages, and most patients are unaware of the disease until obvious myelopathy symptoms appear. Consequently, treatment and clinical outcomes are not satisfactory. This study is aimed at developing an automated system for the detection of the thoracic ossification of the posterior longitudinal ligament (OPLL) using deep learning and plain radiography. We retrospectively reviewed the data of 146 patients with thoracic OPLL and 150 control cases without thoracic OPLL. Plain lateral thoracic radiographs were used for object detection, training, and validation. Thereafter, an object detection system was developed, and its accuracy was calculated. The performance of the proposed system was compared with that of two spine surgeons. The accuracy of the proposed object detection model based on plain lateral thoracic radiographs was 83.4%, whereas the accuracies of spine surgeons 1 and 2 were 80.4% and 77.4%, respectively. Our findings indicate that our automated system, which uses a deep learning-based method based on plain radiographs, can accurately detect thoracic OPLL. This system has the potential to improve the diagnostic accuracy of thoracic OPLL.
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Affiliation(s)
- Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Oda
- Information Strategy Office, Information and Communications, Nagoya University Nagoya, Japan
| | - Ippei Yamauchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryotaro Oishi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Miyairi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kensaku Mori
- Information Strategy Office, Information and Communications, Nagoya University Nagoya, Japan
- Department of Intelligent Systems, Nagoya University Graduate School of Informatics, Nagoya, Japan
- Research Center for Medical Bigdata, National Institute of Informatics, Tokyo, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Zhang C, Yang S, Wang L, Wang N, Ke Z, Liu P, Zhang C, Xiong C, Zhao R, Liang H, Luo X. Preoperative Magnetic Resonance Imaging Signal Intensity Classification Is Associated With Clinical Presentation and Surgical Outcomes in Myelopathy Caused by Thoracic Ossification of Ligamentum Flavum: A Multicenter Study. Global Spine J 2023; 13:1971-1980. [PMID: 34911374 PMCID: PMC10556922 DOI: 10.1177/21925682211067752] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To explore whether classification of the increased signal intensity (ISI) on magnetic resonance imaging (MRI) correlates with clinical presentations and outcomes in symptomatic thoracic ossification of ligamentum flavum (T-OLF) patients. METHODS All patients with symptomatic T-OLF who underwent laminectomy at four institutions were reviewed. The ISI on preoperative T2-weighted MRI was divided into 3 groups, Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). Neurological function before surgery and at follow-up was evaluated by the revised Japanese Orthopedic Association (JOA) score. Patients' demographics, clinical manifestations, and surgical outcomes were compared. RESULTS A total of 94 patients were involved. Preoperative MRI showed 32 patients in Grade 0, 39 patients in Grade 1, and 23 patients in Grade 2. Low extremities numbness, weakness, and clinical signs were less frequent in Grade 0 patients. The grade of ISI was correlated with the duration of symptoms and cord compression. Grade 0 patients had a better preoperative JOA score than those with ISI changes, while Grade 2 patients showed worse neurological recovery, longer duration of operation, more intraoperative blood loss, and a higher incidence of perioperative complications. CONCLUSION The classification of ISI is an effective parameter for preoperatively assessing cord compression, clinical severity, and surgical outcomes in T-OLF patients. Grade 0 patients have relatively mild neurological impairment but are more likely to be misdiagnosed. Grade 2 indicates the worst clinical impairment and neurological recovery, and implies a risky and challenging surgery.
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Affiliation(s)
- Chao Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shengdong Yang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Wang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nan Wang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenyong Ke
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Liu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengmin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuang Xiong
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Runhan Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Liang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoji Luo
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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6
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He JL, Du Q, Hu WD, Xin ZJ, Shao XX, Liao WB. CT-based radiographic measurements and effectiveness estimates of full-endoscopic surgery in thoracic myelopathy caused by ossification of ligamentum flavum. BMC Surg 2023; 23:84. [PMID: 37041487 PMCID: PMC10091596 DOI: 10.1186/s12893-023-01989-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Evaluate the effectiveness of posterior percutaneous full-endoscopic technique for patients with thoracic myelopathy caused by ossification of ligamentum flavum (TOLF). METHODS A prospective study was conducted for 16 patients with TOLF, who were treated with posterior endoscopic technique from 2017 to 2019. The sagittal and cross-sectional CT images are used to measure the area of ossified ligamentum and evaluate the decompression of surgery, respectively. The effectiveness was evaluated with visual analog scale (VAS), modified Japanese Orthopedic Association scale (mJOA), The Oswestry Disability Index (ODI), and Macnab efficacy evaluation. RESULTS The average area of TOLF on sagittal and cross-sectional CT images in the 16 patients was (116.62 ± 32.72) mm2 and (141.59 ± 27.25) mm2 preoperatively, (15.99 ± 12.54) mm2 and (11.72 ± 8.64) mm2 at 3 days after the operation, (16.78 ± 11.49) mm2 and (10.82 ± 7.57) mm2 postoperative 1 year, respectively. The invasive proportion of spinal canal at preoperative sagittal and cross-sectional CT images was (48.10 ± 10.04) % and (57.58 ± 11.37) %, which decreased to (6.83 ± 4.48) % and (4.40 ± 3.01) % at the final follow-up. The average score of mJOA, VAS and ODI improved. The excellent and good rate was 87.50% according to Macnab evaluation. Compared with preoperative, differences in areas of TOLF, proportions of spinal canal, and clinical assessments of postoperative 3 days and 1 year were all statistically significant. Two cases of dural tear were observed. CONCLUSION Endoscopic surgery has a good clinical effect on TOLF, which has the advantage of less trauma to the paraspinal muscles and no impact on the spinal structure. The CT-based radiographic measurements can quantitatively evaluate the degree of spinal canal stenosis in TOLF.
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Affiliation(s)
- Jia-Lin He
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563006, Guizhou, China
| | - Qian Du
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563006, Guizhou, China
| | - Wan-Dong Hu
- Guizhou Aerospace Hospital, Zunyi, Guizhou, 563099, China
| | - Zhi-Jun Xin
- Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Xin-Xin Shao
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563006, Guizhou, China
| | - Wen-Bo Liao
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563006, Guizhou, China.
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Bagga RS, Shetty AP, Viswanathan VK, Reddy GJ, Kanna RM, Rajasekaran S. Thoracic Myelopathy in Ossified Ligamentum Flavum: Surgical Management and Long-Term Outcome Following 2 Different Techniques of Surgical Decompression. Global Spine J 2023; 13:659-667. [PMID: 33840238 DOI: 10.1177/21925682211003061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Thoracic ossified ligamentum flavum (TOLF) has been reported to present with varying degrees of neuro-deficit and multiple factors have been purported to affect its outcome. Purpose of study was to analyze factors affecting outcome and impact of ultrasonic osteotome (UO). METHODS We retrospectively reviewed patients treated for thoracic myelopathy secondary to OLF between 2010 and 2017. 77 patients with complete clinico-radiological records and 2 years follow-up were included. Initial 45 patients, conventional high-speed burr (HSB-group A) was used for decompression. In others, UO was used in combination with HSB (group B). Myelopathy was graded using modified Japanese orthopaedic association grading pre-operatively and each postoperative visit. At final follow-up, recovery rate was calculated. Radiological details including location, morphology, dural ossification, signal change and spinal ossifications were recorded. RESULTS Mean mJOA at presentation and final follow-up were 4.3±1.8 and 7.6±1.9 respectively (p = 0.001). HRR was 49.9±23 at final follow-up. A significant reduction in dural tear (12.5%; 29%) and surgical time (125.8±49.5; 189.4±52.5) were observed in group B (p = 0.00). However, there was no statistically significant difference (p = 0.18) in recovery rates between groups A (44.8±26.1) and B (52.8±24.3). Symptom duration (p = 0.00), severity of myelopathy (p = 0.04) and cord signal changes on MRI (p = 0.02) were important predictors of outcome. CONCLUSION Use of UO significantly reduced operative time and dural tears, although resulted in similar recovery rate as compared with HSB. Pre-operative severity of myelopathy, symptom duration and presence of cord signal change were the most significant predictors of outcome.
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Affiliation(s)
| | - Ajoy P Shetty
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
| | | | | | | | - S Rajasekaran
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
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8
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Zhao Y, Xiang Q, Jiang S, Wang L, Lin J, Sun C, Li W. Prevalence, diagnosis, and impact on clinical outcomes of dural ossification in the thoracic ossification of the ligamentum flavum: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1245-1253. [PMID: 36877368 DOI: 10.1007/s00586-023-07625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
STUDY DESIGN Systematic review. BACKGROUND CONTEXT Thoracic ossification of the ligamentum flavum (TOLF) has become the principal cause of thoracic spinal stenosis. Dural ossification (DO) was a common clinical feature accompanying with TOLF. However, on account of the rarity, we know little about the DO in TOLF so far. PURPOSE This study was conducted to elucidate the prevalence, diagnostic measures, and impact on the clinical outcomes of DO in TOLF by integrating the existing evidence. METHODS PubMed, Embase, and Cochrane Database were comprehensively searched for studies relevant to the prevalence, diagnostic measures, or impact on the clinical outcomes of DO in TOLF. All retrieved studies meeting the inclusion and criterion were included into this systematic review. RESULTS The prevalence of DO in TOLF treated surgically was 27% (281/1046), ranging from 11 to 67%. Eight diagnostic measures have been put forward to predict the DO in TOLF using the CT or MRI modalities, including "tram track sign", "comma sign", "bridge sign", "banner cloud sign", "T2 ring sign", TOLF-DO grading system, CSAOR grading system, and CCAR grading system. DO did not affect the neurological recovery of TOLF patients treated with the laminectomy. The rate of dural tear or CSF leakage in TOLF patients with DO was approximately 83% (149/180). CONCLUSION The prevalence of DO in TOLF treated surgically was 27%. Eight diagnostic measures have been put forward to predict the DO in TOLF. DO did not affect the neurological recovery of TOLF treated with laminectomy but was associated with high risk of complications.
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Affiliation(s)
- Yongzhao Zhao
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Qian Xiang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Shuai Jiang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Longjie Wang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Jialiang Lin
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China. .,Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China. .,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China.
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9
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Novel therapeutic strategy in the treatment of ossification of the ligamentum flavum associated with dural ossification. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1068-1076. [PMID: 36717400 DOI: 10.1007/s00586-023-07549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE To investigate the imaging characteristics of thoracic ossification of ligamentum flavum (OLF) combined with dural ossification (DO) and the clinical efficacy of zoning laminectomy. METHOD The clinical data of 48 patients with thoracic OLF combined with DO who underwent zoning laminectomy between June 2016 and May 2020 were retrospectively analyzed. The modified Japanese Orthopedic Association (mJOA) score was used to evaluate neurological function before and after surgery, and the clinical efficacy was evaluated according to the improvement rate. RESULTS The symptoms of all patients significantly improved after the operation, and the average follow-up time was 27.8 (10-47) months. In addition, the average mJOA score had increased from 5.0 (2-8) preoperatively to 8.7 (6-11) postoperatively (t = 18.880, P < 0.05). The average improvement rate was 62.6% (25-100%), with 16 patients graded as excellent, 21 as good, and 11 as fair. Cerebrospinal fluid leakage occurred in 12 cases (25.0%), and all of them healed well after treatment. No postoperative aggravation of neurological dysfunction, wound infection or hematoma occurred. At the last follow-up, there was no recurrence of symptoms and kyphosis. CONCLUSION The Zoning laminectomy described here is both safe and effective.
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Zhu J, Luo X, Sun K, Sun J, Wang Y, Xu X, Shi J. The Gantry Crane Technique: A Novel Technique for Treating Severe Thoracic Spinal Stenosis and Myelopathy Caused by Ossification of the Ligamentum Flavum and Preliminary Clinical Results. Global Spine J 2023; 13:400-408. [PMID: 33663242 PMCID: PMC9972271 DOI: 10.1177/2192568221996693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective single-arm study. OBJECTIVE To propose a novel technique named the gantry crane technique for treating severe thoracic spinal stenosis and myelopathy caused by thoracic ossification of the ligamentum flavum (TOLF) and investigate its clinical results. METHODS From June 2017 to January 2019, 18 patients presenting with severe spinal stenosis and myelopathy caused by TOLF were included in our study. All patients were treated with gantry crane technique, pre-operative JOA score, as well as 3 days-, 3 months-, 6 months-, 12 months-, 24 months after operation, and Hirabayashi recovery rate were reported. Pre- and post-operative image were utilized for the assessment of post-operative effect. Peri-operative complications were recorded to assess the safety of the gantry crane technique. RESULTS The JOA score increased from 10.56 ± 3.76 preoperatively to 12.94 ± 3.33, 13.56 ± 3.48, 13.94 ± 3.32, 14.17 ± 3.70 and 14.06 ± 3.54 in 3 days, 3 months, 6 months, 12 months and 24 months after surgery, respectively. The post-operative JOA scores were improved with statistical significance at the level of P < 0.05. The recovery rate was (39.09 ± 33.85) %, (51.35 ± 42.60) %, (55.79 ± 36.10) %, (64.98 ± 29.24) % and (60.98 ± 35.96) % for 3 days, 3 months, 6 months, 12 months and 24 months after surgery, respectively. There were 2 cases of SSI (surgical site infection), 1 case of NI (neurovascular injury) and 1 case of cerebrospinal fluid (CSF) leakage. CONCLUSIONS This study highlights a safe and effective technique, the gantry crane technique, for treating severe thoracic spinal stenosis and myelopathy caused by TOLF.
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Affiliation(s)
- Jian Zhu
- Department of Spine Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Xi Luo
- Department of Spine Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Kaiqiang Sun
- Department of Spine Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Jingchuan Sun
- Department of Spine Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Yuan Wang
- Department of Spine Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Ximing Xu
- Department of Spine Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China,Jian-gang Shi and Xi-ming Xu, Department of
Spine Surgery, Changzheng Hospital, Naval Medical University, No.415 Fengyang
Road, Shanghai 200003, People’s Republic of China.
| | - Jiangang Shi
- Department of Spine Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China,Jian-gang Shi and Xi-ming Xu, Department of
Spine Surgery, Changzheng Hospital, Naval Medical University, No.415 Fengyang
Road, Shanghai 200003, People’s Republic of China.
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Sun K, Sun X, Zhu J, Huang F, Huan L, Xu X, Zhang P, Sun J, Shi J. Comparison of Surgical Results of the Bridge Crane Technique Versus Laminectomy for the Treatment of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum. Global Spine J 2023; 13:384-392. [PMID: 33685278 PMCID: PMC9972286 DOI: 10.1177/2192568221996689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES This study aimed to evaluate the safety and effectiveness of the bridge crane technique versus laminectomy for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum (OLF). METHODS Totally 41 patients who underwent surgical decompression due to thoracic OLF from May 2017 to June 2018 in our institution were enrolled in this study and were divided into group BG (bridge crane technique, n = 19) and group L (laminoectomy, n = 22). Demographic data was collected from medical records and the modified Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological outcomes during the follow-up. Surgery-related complications were analyzed. RESULTS The mean duration of follow-up was comparable between group BG (19.4 ± 1.5 months) and group L (19.6 ± 1.4 months). No statistical differences were observed between two groups in terms of gender, age, duration of symptoms, preoperative occupying rate, involved levels, operation time, intraoperative blood loss, and complications. The JOA score significantly increased at the final follow-up in both groups. However, patients in group BG had higher JOA score and recovery rate (P < 0.05). Four patients in group L experienced complications, including 3 cerebrospinal fluid (CSF) leakage and one postoperative hematoma. Only one patient in group BG had CSF leakage. CONCLUSION The results of this study suggested that bridge crane technique may be relatively safe and effective for patients with symptomatic thoracic OLF with more satisfactory clinical improvement. However, high-quality studies are still required to validate the results of this study.
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Affiliation(s)
- Kaiqiang Sun
- Department of Spine Surgery, Changzheng
Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Xiaofei Sun
- Department of Spine Surgery, Changzheng
Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Jian Zhu
- Department of Spine Surgery, Changzheng
Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Fei Huang
- The First Department of Orthopedics, The
910th Hospital, Quanzhou City, Fujian Province, People’s Republic of China
| | - Le Huan
- Department of Spine Surgery, Changzheng
Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Ximing Xu
- Department of Spine Surgery, Changzheng
Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Peng Zhang
- Department of Spine Surgery, Changzheng
Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Jingchuan Sun
- Department of Spine Surgery, Changzheng
Hospital, Naval Medical University, Shanghai, People’s Republic of China,Jiangang Shi and Jingchuan Sun, Department
of Spine Surgery, Changzheng Hospital, Naval Medical University, No. 415
Fengyang Road, Shanghai 200003, People’s Republic of China. Emails:
;
| | - Jiangang Shi
- Department of Spine Surgery, Changzheng
Hospital, Naval Medical University, Shanghai, People’s Republic of China,Jiangang Shi and Jingchuan Sun, Department
of Spine Surgery, Changzheng Hospital, Naval Medical University, No. 415
Fengyang Road, Shanghai 200003, People’s Republic of China. Emails:
;
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12
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Pan Q, Zhang Z, Zhu Y, Jiang W, Su K, Liu P, Kang Y, Shao Z, Mei W, Wang Q. Zoning laminectomy for the treatment of ossification of the thoracic ligamentum flavum. Asian J Surg 2023; 46:723-729. [PMID: 35803890 DOI: 10.1016/j.asjsur.2022.06.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/06/2022] [Accepted: 06/23/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Spinal cord injury is a common occurrence during spinal surgery. In this study, we proposed a zoning laminectomy, which could reduce the incidence of nerve injury. We also discussed the safety and clinical efficacy of the zoning laminectomy for thoracic ossification of the ligamentum flavum (TOLF). METHODS Forty-five patients with TOLF who underwent zoning laminectomy from October 2016 to February 2020 were included in the retrospective analysis. The Japan Orthopedic Association (JOA) score was used to evaluate clinical outcomes. Meanwhile, the occurrence of complications was recorded. RESULTS All 45 patients underwent the operation successfully, and the mean follow-up period was 25.3 months, the mean operation time was 160.2 min, the average blood loss was 474.2 ml, and the average hospital time was 8.0 days. At the final evaluation, the JOA score was significantly higher than the preoperative JOA score (P < 0.001) and the overall recovery rate of the JOA score averaged 69.6%. Seventeen patients were graded as excellent, twenty-six as good, and two as fair. The complications included dural tears in nine patients (20.0%), cerebrospinal fluid leakage in seven patients (15.6%), deep infection in one patient (2.2%), and epidural hematoma in one patient (2.2%). All patients recovered well after treatment. Besides, there was no neurological deterioration and thoracic kyphosis occurred. CONCLUSIONS Zoning laminectomy adopts a phased resection from "safe zone" to "danger zone" and defines the safe removal range of the lamina, which reduces the risks of spinal cord injury caused by instrument manipulation. Therefore, it is a safe and effective surgical option.
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Affiliation(s)
| | - Zhenhui Zhang
- Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China
| | - Yanyu Zhu
- Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China
| | - Wentao Jiang
- Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China
| | - Kai Su
- Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China
| | - Peilin Liu
- Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China
| | - Yongsheng Kang
- Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China
| | - Zhe Shao
- Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China
| | - Wei Mei
- Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China
| | - Qingde Wang
- Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China.
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Liu T, Yang S, Tian S, Liu Z, Ding W, Wang Z, Yang D. Analysis of the surgical strategy and postoperative clinical effect of thoracic ossification of ligament flavum with dural ossification. Front Surg 2022; 9:1036253. [PMID: 36311949 PMCID: PMC9604592 DOI: 10.3389/fsurg.2022.1036253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Our research was designed to analyse the postoperative clinical results of patients suffering from single-segment thoracic ossification of the ligamentum flavum (TOLF) combined with dural ossification (DO) who underwent posterior laminar decompression and internal fixation. Methods This retrospective research included thirty-two patients who underwent surgery for ossifying the ligamentum flavum in the thoracic spine between January 2016 and January 2020. Patients were fallen into one group included patients with evidence of DO during surgery, and the other group included patients without evidence of DO. We assessed and compared general clinical characteristics and health-related outcomes before surgery and during follow-up. Results The DO group had a longer operation duration, more blood loss, and longer hospital stay (operation time: 94.75 ± 6.78 min vs. 80.00 ± 10.13 min, p < 0.001; blood loss: 331.67 ± 50.06 ml vs. 253.00 ± 48.24 ml, p < 0.001; length of hospital stay: 13.83 ± 2.76 days vs. 10.05 ± 2.33 days, p < 0.001). Complications There were 12 cases of cerebrospinal fluid leakage and 1 case of superficial wound infection in the DO group. However, the neurological recovery and health-associated quality of life (HRQOL) scores showed no statistically significant changes between the DO and non-DO groups (p > 0.05). Conclusions Posterior laminectomy and internal fixation combined with intraoperative resection of the ossified ligamentum flavum and dura is an efficient and relatively safe method for treating TOLF with DO, which can provide satisfactory results. Moreover, DO had no significant effect on postoperative neurological recovery and health-related quality of life scores.
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Hwang SH, Chung CK, Kim CH, Yang SH, Choi Y, Yoon J. Value of Additional Instrumented Fusion in the Treatment of Thoracic Ossification of the Ligamentum Flavum. J Korean Neurosurg Soc 2022; 65:719-729. [PMID: 35988925 PMCID: PMC9452387 DOI: 10.3340/jkns.2021.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objective The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group).
Methods A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model.
Results After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the F-group than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months.
Conclusion Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.
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15
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Ossified Ligamentum Flavum: Epidemiology, Treatment, and Outcomes. J Am Acad Orthop Surg 2022; 30:e842-e851. [PMID: 35298441 DOI: 10.5435/jaaos-d-21-01253] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/13/2022] [Indexed: 02/01/2023] Open
Abstract
Ossification of the ligamentum flavum (OLF) is an uncommon but potentially serious spinal condition which can cause progressive compression of the spinal canal with associated devastating neurologic compromise. Although debate exists regarding the exact etiology of OLF, overexpression of genes and transcription factors centered around the Notch and Wnt signaling pathways because of increased mechanical stress seems to be related. There are many clinical and radiographic presentations of OLF; however, progressive myelopathy is the most commonly encountered. Radiographic analysis may reveal isolated OLF or OLF combined with ossification of other areas of the spine, such as disk, posterior longitudinal ligament, and dura. When surgery is necessary for OLF, several surgical strategies exist including open laminectomy with excision, endoscopic decompression, Bridge Crane resection, en block resection, and combined anterior and posterior approaches. Resection may be complicated by dural adhesion or dural ossification, and postoperative neurologic deficits are not uncommon.
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16
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Li X, Huang H, Zheng Z, Liu Y, Wei G, Chen X, Xu Y. Clinical Efficacy of Endoscopic-Assisted Resection of Single-Segment Ossification of the Posterior Longitudinal Ligament in the Treatment of Thoracic Spinal Stenosis. Front Surg 2022; 9:897182. [PMID: 35599795 PMCID: PMC9121015 DOI: 10.3389/fsurg.2022.897182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/15/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To explore the clinical efficacy, characteristics and safety of endoscopic-assisted resection of single-segment posterior longitudinal ligament ossification in the treatment of thoracic spinal stenosis (TSS). Method Fifteen TSS patients, including 6 males and 9 females aged 43–70 years treated with endoscopic-assisted resection of single-segment posterior longitudinal ligament ossification through the transfacet joint approach by our team from November 2016 to June 2020 were retrospectively analyzed. The operation time, intraoperative blood loss, and postoperative complications were recorded. The VAS score, ODI and JOA score (full score, 11 points) were recorded before the operation, after the operation and at the last follow-up to evaluate the clinical efficacy and calculate the improvement rate. Results The ventral side of the spinal cord was decompressed in all patients, providing improvements in neurological symptoms and significant pain relief. The mean follow-up time was 20.27 ± 3.87 months. Mean operation time, intraoperative blood loss, and hospitalization time were found to be 84.80 ± 13.23 min, 36.33 ± 7.41 mL, 5.13 ± 1.02 days; respectively.The JOA score at the last follow-up was 8.6 ± 1.25, which was significantly better than the preoperative (5.53 ± 1.20) and postoperative (6.87 ± 1.31) scores (p < 0.05). The mean JOA score improvement rate was 56.5 ± 18.00%. The JOA score improvement rate classification at the last follow-up was excellent in 3 cases, good in 8 cases, effective in 3 cases, and no change in 1 case; for an effective rate of 93.33%. The VAS score significantly decreased from 6.67 ± 1.01 preoperatively to 3.47 ± 0.88 postoperatively and 1.73 ± 0.67 at the last follow-up (p < 0.05). The ODI significantly decreased from 72.07 ± 6.08 preoperatively to 45.93 ± 5.01 postoperatively and 12.53 ± 2.33 at the last follow-up (p < 0.05). Dural rupture occurred in 2 patients during the operation; 1 patient experienced neck discomfort during the operation, which was considered to be caused by high fluid pressure and was relieved by massage and by lowering the height of the irrigation fluid. No cases of cerebrospinal fluid leakage, wound infection or other complications occurred. Conclusion Endoscopic-assisted resection of posterior longitudinal ligament ossification through the facet joint approach is a safe and effective method for the treatment of TSS.
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Affiliation(s)
- Xingchen Li
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Correspondence: Xingchen Li
| | - Honghan Huang
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhong Zheng
- Department of Spine Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou China
| | - Yunxuan Liu
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guicai Wei
- Department of Spine Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou China
| | - Xiaoxin Chen
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yusheng Xu
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Du P, Ma L, Ding W. The influence of ossification morphology on surgery outcomes in patients with thoracic ossification of ligamentum flavum (TOLF). J Orthop Surg Res 2022; 17:229. [PMID: 35413915 PMCID: PMC9004029 DOI: 10.1186/s13018-022-03064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background To determine whether there is a correlation between the type of ossification and radiological parameters, modified thoracic JOA scores, and complications in patients with thoracic ossification of ligamentum flavum treated by posterior thoracic surgery. Methods This retrospective cohort study included 48 patients with thoracic myelopathy caused by single-level thoracic ossification of ligamentum flavum who underwent thoracic posterior approach surgery in our Hospital o between December 2013 to December 2018. Patients were divided into unilateral, bilateral, and bridged groups in axial position, and beak and round groups in sagittal position. The differences were analyzed according to the ossification morphology. Results In axial myelopathy, there was no significant difference in preop and postop JOA scores and RR among the three groups in axial position (P = 0.884). In sagittal view, there was no significant difference in preoperative JOA score between the two groups (P = 0.710), while the postop JOA score and the recovery rate in the beak group were significantly lower than that of the round group (P = 0.010, P = 0.034). Two-way ANOVA showed that sagittal morphology had a significant effect on postop JOA score (P = 0.028), but axial morphology don’t (P = 0.431); there was no interaction between them (P = 0.444). For the recovery rate, sagittal morphology also had a significant effect (P = 0.043), but axial ossification don’t (P = 0.998); there was no interaction between them (P = 0.479). Conclusion Sagittal morphology had a significant adverse effect on postop JOA score and surgical outcome, while axial morphology had no effect on surgical outcome, and there was no interaction between sagittal morphology and axial morphology.
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Affiliation(s)
- Peiyu Du
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Lei Ma
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Wenyuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
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Mori K. The Essence of Clinical Practice Guidelines for Ossification of Spinal Ligaments, 2019: 7. Treatment of Thoracic OLF. Spine Surg Relat Res 2021; 5:336-338. [PMID: 34708170 PMCID: PMC8502514 DOI: 10.22603/ssrr.2021-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/08/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Shiga, Japan
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Comparison of Anterior and Posterior Surgical Approaches for Treatment of Thoracic Myelopathy. World Neurosurg 2021; 154:e343-e348. [PMID: 34280541 DOI: 10.1016/j.wneu.2021.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study a large multi-institutional sample of patients undergoing anterior versus posterior approaches for surgical decompression of thoracic myelopathy. METHODS The American College of Surgeons National Surgical Quality Improvement Program was queried for patients who underwent decompression for thoracic myelopathy between 2007 and 2015 via anterior or posterior approaches. Patients were excluded if they were undergoing surgery for tumors to isolate a degenerative cohort. Demographics, patient comorbidities, operative details, and postoperative complications were compared between the 2 cohorts. RESULTS Although there were no differences in age (P = 0.06), sex (P = 0.72), or American Society of Anesthesiologists class (P = 0.59), there were higher rates of steroid use (P = 0.01) and hematologic disorders that predispose to bleeding (P = 0.04) at baseline in the posterior approach cohort. The posterior approach patients had longer operative times (P = 0.03), but there were no differences in length of stay (P = 0.64). Although there were no significant differences in the rates of major organ system complications or return to the operating room (P = 0.52), the posterior approach cohort displayed a trend toward increased severe adverse complications (29.8% vs. 17.6%, P = 0.28) compared with the anterior approach cohort. CONCLUSION Although the anterior approach to surgical decompression of thoracic myelopathy demonstrated a lower complication rate, this result did not reach statistical significance. The anterior approach was associated with significantly shorter mean operative time, but otherwise there were no significant differences in operative or postoperative outcomes. These findings may support the favorability of the anterior approach but warrant further investigation in a larger study.
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Lin YP, Lin R, Chen S, Rao SY, Zhao S, Wen T, Wang HS, Hu WX, Liu BX, Li XY, Li YJ, Chen BL. Thoracic full-endoscopic unilateral laminotomy with bilateral decompression for treating ossification of the ligamentum flavum with myelopathy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:977. [PMID: 34277777 PMCID: PMC8267270 DOI: 10.21037/atm-21-2181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/15/2021] [Indexed: 11/06/2022]
Abstract
Background The aim of the present study was to evaluate the curative effect and safety of thoracic full-endoscopic unilateral laminotomy with bilateral decompression (TE-ULBD) for treating ossification of the ligamentum flavum (OLF) with myelopathy. Methods Between January 2015 and December 2018, 23 consecutive patients with symptomatic thoracic OLF were treated with TE-ULBD. Of these, 21 (13 women and 8 men, aged 49-75 years) were included in the study and followed up for a minimum of 1 year. The mean blood loss was 15.48 mL (10-30 mL), operative duration was 78.86 min (55-115 min), and hospitalization was 5.05 days (3-15 days). The Japanese Orthopaedic Association (JOA) was used to evaluate spinal cord function, and the curative effect was defined by the JOA improvement rate. The area of OLF (AOLF), the maximum spinal cord compression (MSCC), and the area of spinal cord (ASC) were used to evaluate OLF clearance and spinal cord decompression status. Results At the final follow up,the JOA score was 8.33 points (5-11 points), which was a significant improvement from the preoperative 5.33 points (3-9 points, P<0.01). The excellent and good rate was 76.19% (16/21). The average preoperative AOLF and AOLF ratio were 85.27±23.66 mm2 and 57.86%±11.86%, respectively, and the postoperative AOLF and AOLF ratio were 16.27±11.75 mm2 and 8.13%±5.38%, respectively. The MSCC increased from 27.99%±13.51% preoperatively to 48.02%±6.66% postoperatively. The ASC was 42.90±10.60 mm2 preoperatively and 64.54±21.36 mm2 postoperatively. There were statistically significant differences in all parameters preoperatively and postoperatively (P<0.01). One case had postoperative hematoma, and the symptoms gradually eased after 3 weeks of conservative treatment. There were no other complications. No recurrence of OLF was detected during the follow-up period. Conclusions TE-ULBD is safe and effective for thoracic OLF with the advantages of reduced trauma and bleeding, and faster recovery.
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Affiliation(s)
- Yong-Peng Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Rui Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Song Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Si-Yuan Rao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuai Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Tao Wen
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Hong-Shen Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wei-Xiong Hu
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Bing-Xin Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin-Yi Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Jin Li
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Bo-Lai Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Comparing Thoracic Extensive Laminoplasty (TELP) and Laminectomy in Treating Severe Thoracic Ligamentum Flavum Ossification: A Proposed Novel Technique and Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8410317. [PMID: 33997042 PMCID: PMC8081600 DOI: 10.1155/2021/8410317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 01/14/2021] [Accepted: 04/10/2021] [Indexed: 11/24/2022]
Abstract
Objective (1) To propose a novel technique named thoracic extensive laminoplasty (TELP) in curing severe thoracic ligamentum flavum ossification (STOLF) and (2) to compare outcomes between TELP and laminectomy in curing STOLF. Methods Cases with fused or tuberous STOLF (Sato classification) treated from Jan 2015 to Jan 2017 were reviewed and divided into the TELP group (G1) and laminectomy group (G2) according to their surgical management. Data on demographics, complications, pre- and postoperative symptoms, residual spinal canal area (RSCA-1), residual spinal cord area (RSCA-2), modified Japanese Orthopedic Association score (mJOA), and health-related quality of life (HRQOL, based on the SF-36) were collected. Results Fifty-nine G1 and sixty-two G2 patients were enrolled. No significant differences in demographic data or preoperative data of RSCA-1, RSCA-2, mJOA, or HRQOL were observed between the two groups (p > 0.05). Patients in G1 and G2 showed similar postoperative improvements in RSCA-1 and RSCA-2 at the final follow-up (p > 0.05). However, patients in G1 showed higher postoperative improvements in mJOA (OR = 2.706, 95% CI: 1.279~5.727, p = 0.008) at the final follow-up. Patients in G1 also showed higher postoperative improvements in HRQOL than patients in G2 (p < 0.05) at the final follow-up, and patients with more severe STOLF presented with better improvements in HRQOL in G1 (p < 0.05). Dural laceration and cerebrospinal fluid leakage were observed in seven G2 patients, and no complications were found in G1 patients after surgery. Conclusion TELP is a novel, effective, and safer surgical technique in treating STOLF and could be a substitute for traditional laminectomy.
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Zhu S, Wang Y, Yin P, Su Q. A systematic review of surgical procedures on thoracic myelopathy. J Orthop Surg Res 2020; 15:595. [PMID: 33302988 PMCID: PMC7727254 DOI: 10.1186/s13018-020-02081-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose The surgical treatment of thoracic myelopathy is still controversial and also a challenge for spine surgeons. Therefore, the objective of this study was to review the related literature on the surgical treatment of thoracic myelopathy and try to define treatment guidelines for spine surgeons on thoracic myelopathy. Methods Relevant literatures were searched based on the PubMed, EMBASE, and Cochrane Library between January 2008 and December 2018. Some data on the characteristics of patients were extracted, including number of patients, mean age, surgical procedures, blood loss, complications, and pre-/post-operation modified JOA score. Recovery rate was used to assess the effect of surgery outcome, and the safety was evaluated by blood loss and incidence of complications. Results Thirty-five studies met the inclusion criteria and were retrieved. A total of 2183 patients were included in our systematic review, with the average age of 55.2 years. There were 69.8% patients diagnosed as ossification of ligamentum flavum (OLF), 20.0% as ossification of posterior longitudinal ligament (OPLL), 9.3% as disk herniation (DH), and 0.9% as others including diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS). The volume of blood loss was more in the treatment of circumferential decompression (CD) than posterior decompression (PD), and the incidence of complications was higher in CD (P < 0.05). The volume of blood loss in minimally invasive surgery (MIS) was lowest and the incidence of complications was 19.2%. Post-operation recovery rate was 0.49 in PD, 0.35 in CD, and 0.29 in MIS while the recovery rate was 0.54 in PD, 0.55 in CD, and 0.49 in MIS at the last follow-up. When focusing on the OLF specifically, incidence of complications in PD was much lower than CD, with less blood loss and higher recovery rate. Focusing on the OPLL specifically, incidence of complications in PD was much lower than CD, with less blood loss while there was no statistical difference in recovery rate between these two methods. Conclusions This systematic review showed that posterior decompression for thoracic myelopathy is safer and better than circumferential decompression according to the complication rate and surgical outcome. And we should also consider the location of compression before the operation.
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Affiliation(s)
- Shiqi Zhu
- Departmen of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Capital Medical University, NO.8 Gongtinanlu, Beijing, 100020, People's Republic of China
| | - Yu Wang
- Departmen of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Capital Medical University, NO.8 Gongtinanlu, Beijing, 100020, People's Republic of China
| | - Peng Yin
- Departmen of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Capital Medical University, NO.8 Gongtinanlu, Beijing, 100020, People's Republic of China.
| | - Qingjun Su
- Departmen of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Capital Medical University, NO.8 Gongtinanlu, Beijing, 100020, People's Republic of China.
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Baba S, Shiboi R, Yokosuka J, Oshima Y, Takano Y, Iwai H, Inanami H, Koga H. Microendoscopic Posterior Decompression for Treating Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum: Case Series. ACTA ACUST UNITED AC 2020; 56:medicina56120684. [PMID: 33321989 PMCID: PMC7763969 DOI: 10.3390/medicina56120684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Ossification of the ligamentum flavum (OLF) is a relatively common cause of thoracic myelopathy. Surgical treatment is recommended for patients with myelopathy. Generally, open posterior decompression, with or without fusion, is selected to treat OLF. We performed minimally invasive posterior decompression using a microendoscope and investigated the efficacy of this approach in treating limited type of thoracic OLF. Materials and Methods: Microendoscopic posterior decompression was performed for 19 patients (15 men and four women) with thoracic OLF with myelopathy aged between 35 to 81 years (mean age, 61.9 years). Neurological examination and preoperative magnetic resonance imaging (MRI) and computed tomography (CT) were used to identify the location and morphology of OLF. The surgery was performed using a midline approach or a unilateral paramedian approach depending on whether the surgeon used a combination of a tubular retractor and endoscope. The numerical rating scale (NRS) and modified Japanese Orthopedic Association (mJOA) scores were compared pre- and postoperatively. Perioperative complications and the presence of other spine surgeries before and after thoracic OLF surgery were also investigated. Results: Four midline and 15 unilateral paramedian approaches were performed. The average operative time per level was 99 min, with minor blood loss. Nine patients had a history of cervical or lumbar spine surgery before or after thoracic spine surgery. The mean pre- and postoperative NRS scores were 6.6 and 5.3, respectively. The mean recovery rate as per the mJOA score was 33.1% (mean follow-up period, 17.8 months), the recovery rates were significantly different between patients who underwent thoracic spine surgery alone (50.5%) and patients who underwent additional spine surgeries (13.7%). Regarding adverse events, one patient experienced dural tear, another experienced postoperative hematoma, and one other underwent reoperation for adjacent thoracic stenosis. Conclusion: Microendoscopic posterior decompression was applicable in limited type of thoracic OLF surgery including beak-shaped type and multi vertebral levels. However, whole spine evaluation is important to avoid missing other combined stenoses that may affect outcomes.
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Affiliation(s)
- Satoshi Baba
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa, Edogawa-ku, Tokyo 133-0056, Japan; (R.S.); (J.Y.); (Y.O.); (Y.T.); (H.I.); (H.I.); (H.K.)
- Department of Orthopaedic Surgery, The University of Tokyo, 57-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Department of Spinal Surgery, Japan Community Health Care Organization, Tokyo Shinjuku Medical Center, 5-1 Tsukudo-chou, Shinjuku-ku, Tokyo 162-8643, Japan
- Correspondence: ; Tel.: +81-3-3269-8111; Fax: +81-3-3260-7840
| | - Ryutaro Shiboi
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa, Edogawa-ku, Tokyo 133-0056, Japan; (R.S.); (J.Y.); (Y.O.); (Y.T.); (H.I.); (H.I.); (H.K.)
- Department of Orthopaedic Surgery, Ohno Chuo Hospital, 3-20-3 Shimokaizuka, Ichikawa-shi, Chiba 272-0821, Japan
| | - Jyunichi Yokosuka
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa, Edogawa-ku, Tokyo 133-0056, Japan; (R.S.); (J.Y.); (Y.O.); (Y.T.); (H.I.); (H.I.); (H.K.)
| | - Yasushi Oshima
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa, Edogawa-ku, Tokyo 133-0056, Japan; (R.S.); (J.Y.); (Y.O.); (Y.T.); (H.I.); (H.I.); (H.K.)
- Department of Orthopaedic Surgery, The University of Tokyo, 57-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yuichi Takano
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa, Edogawa-ku, Tokyo 133-0056, Japan; (R.S.); (J.Y.); (Y.O.); (Y.T.); (H.I.); (H.I.); (H.K.)
| | - Hiroki Iwai
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa, Edogawa-ku, Tokyo 133-0056, Japan; (R.S.); (J.Y.); (Y.O.); (Y.T.); (H.I.); (H.I.); (H.K.)
| | - Hirohiko Inanami
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa, Edogawa-ku, Tokyo 133-0056, Japan; (R.S.); (J.Y.); (Y.O.); (Y.T.); (H.I.); (H.I.); (H.K.)
| | - Hisashi Koga
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa, Edogawa-ku, Tokyo 133-0056, Japan; (R.S.); (J.Y.); (Y.O.); (Y.T.); (H.I.); (H.I.); (H.K.)
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Acute Thoracic Myelopathy. J Orthop Sports Phys Ther 2020; 50:723. [PMID: 33256518 DOI: 10.2519/jospt.2020.9262] [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] [Indexed: 02/07/2023]
Abstract
A 45-year-old man presented to an emergency department reporting back pain, bilateral lower extremity weakness with paresthesia, and 1 episode of bladder incontinence. Radiographs and magnetic resonance imaging of the thoracolumbar spine were negative for cauda equina syndrome and positive for central canal stenosis and cord signal change from T2 to T4. The emergency department referred him to his primary care provider, who referred him to physical therapy. Following examination, due to the progressive neurological compromise correlated with magnetic resonance imaging findings, the physical therapist contacted neurosurgery for immediate referral. Two days later, the patient underwent emergency thoracic laminectomies, without fusion, for decompression of the spinal stenosis had resulted in thoracic myelopathy. J Orthop Sports Phys Ther 2020;50(12):723. doi:10.2519/jospt.2020.9262.
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Bilateral translaminar osseous-channel assisted percutaneous full-endoscopic ligamentectomy decompression for thoracic myelopathy due to ossification of the ligamentum flavum: a technical note. Wideochir Inne Tech Maloinwazyjne 2020; 16:429-441. [PMID: 34136042 PMCID: PMC8193760 DOI: 10.5114/wiitm.2020.100719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction A variety of surgical procedures have been introduced to treat patients with thoracic myelopathy (TM) caused by ossification of the ligamentum flavum (OLF). However, they are accompanied by significant trauma and risk, and their surgical outcomes are not always satisfactory. Aim To describe a bilateral translaminar osseous-channel assisted posterior percutaneous full-endoscopic ligamentectomy decompression (p-PELD) technique as a novel minimally invasive procedure for treating patients with TM due to OLF. Material and methods A 51-year-old female patient with persistent thoracolumbar back pain and progressive numbness in the bilateral lower extremities for 2 years underwent percutaneous vertebroplasty (PVP) for T11 osteoporotic compression fractures (OCF) in a regional hospital one week prior to hospitalization. TM caused by canal stenosis and dorsal spinal cord compression at T10/11 secondary to OLF and an OCF at T11 were diagnosed based on clinical presentations and radiologic examinations. After bilateral p-PELD for TM was performed at T10/11, the result was confirmed based on postoperative radiographic and clinical results. Results The bilateral OLF was completely removed by the p-PELD technique. No complications were encountered, and her symptoms were sufficiently improved after surgery. The VAS score was 6 points preoperatively and decreased to 0 points at the last follow-up (24 months). The modified Japanese Orthopaedic Association (mJOA) score improved from 2 points preoperatively to 10 points at the final follow-up. Conclusions As a minimally invasive technique, the bilateral translaminar osseous-channel assisted p-PELD procedure provided precise and sufficient decompression for the treatment of OLF-related TM.
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Li W, Gao S, Zhang L, Cao C, Wei J. Full-endoscopic decompression for thoracic ossification of ligamentum flavum: surgical techniques and clinical outcomes: A retrospective clinical study. Medicine (Baltimore) 2020; 99:e22997. [PMID: 33126379 PMCID: PMC7598816 DOI: 10.1097/md.0000000000022997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many complications are associated with thoracic open decompression surgery, such as dural tears and neurological deficits. The clinical outcomes are also not satisfactory. Full-endoscopic decompression of the lumbar spinal canal has achieved satisfactory results for the treatment of lumbar spinal stenosis. This surgery may be used for the treatment of thoracic ossification of the ligamentum flavum (OLF) under local anesthesia. The aim of our study is to introduce the surgical techniques used for full-endoscopic decompression for thoracic OLF and to evaluate its safety and efficacy. METHODS Fourteen patients with thoracic OLF (4 combined with dural ossification) underwent full-endoscopic decompression surgery. An interlaminar approach was performed. The anchoring method was used to establish the working passage. Spinal cord exposure began at a space between the ossification and the spinal cord, and dorsal and contralateral decompression were performed with the "Over the Top" technique. The modified Japanese Orthopedic Association score (11 points) was used to evaluate the efficacy during follow-up. At the same time, the visual analogue scale score for assessing back pain before and after the operation was evaluated. RESULTS The average operation time was 159.73 ± 62.09 minutes, and the hospitalization time was 7.43 ± 1.79 days. The follow-up period ranged from 8 to 22 months. Neurological function was improved. There were no serious complications. Dural tears occurred in 5 patients, intraoperative neurological deterioration occurred in 1 patient, and intraoperative headache and neck pain occurred in 1 patient. CONCLUSION Full-endoscopic decompression is an effective, safe surgical technique for thoracic OLF even the cases combined with dural ossification.
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Chen G, Fan T, Yang X, Sun C, Fan D, Chen Z. The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2164-2172. [DOI: 10.1007/s00586-020-06520-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 11/25/2022]
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Cheng XK, Chen B. Percutaneous Endoscopic Thoracic Decompression for Thoracic Spinal Stenosis Under Local Anesthesia. World Neurosurg 2020; 139:488-494. [PMID: 32376381 DOI: 10.1016/j.wneu.2020.04.199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thoracic spinal stenosis (TSS), a common vertebral degenerative disease, is generally treated via surgical decompression. Percutaneous endoscopic thoracic decompression (PETD) under local anesthesia is considered a relatively safe, minimally invasive procedure. Few reports detail the success of endoscopic decompression for treatment of TSS caused by ossification of ligamentum flavum, the most common cause of TSS. This study investigated application of PETD for treatment of TSS caused by ossification of ligamentum flavum, ossification of posterior longitudinal ligament, or thoracic disc herniation. METHODS From January 2017 to January 2019, 12 consecutive patients (6 men and 6 women) underwent PETD. TSS was caused by ossification of ligamentum flavum in 5 patients, thoracic disc herniation in 5 patients, and ossification of posterior longitudinal ligament in 2 patients. All cases were followed up for 1 year postoperatively. Preoperative and postoperative neurologic status was evaluated using the modified Japanese Orthopaedic Association score, and complications were documented. RESULTS Average modified Japanese Orthopaedic Association score improved significantly from 6.25 ± 1.60 preoperatively to 9.75 ± 1.21 at final follow-up. Dural tear was observed in 1 case during the intervention, and 1 case had transient worsening of preoperative paralysis. Recovery at final follow-up was classified as excellent in 5 cases, good in 6 cases, and poor in 1 case. CONCLUSIONS This retrospective analysis showed that PETD under local anesthesia may be a feasible alternative to treat TSS in elderly patients with other underlying complications for whom general anesthesia or major surgical trauma would be harmful.
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Affiliation(s)
- Xiao-Kang Cheng
- Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Bin Chen
- Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde, China.
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Kadone H, Kubota S, Abe T, Noguchi H, Miura K, Koda M, Shimizu Y, Hada Y, Sankai Y, Suzuki K, Yamazaki M. Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report. Front Neurol 2020; 11:102. [PMID: 32296380 PMCID: PMC7136555 DOI: 10.3389/fneur.2020.00102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/29/2020] [Indexed: 01/02/2023] Open
Abstract
Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.
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Affiliation(s)
- Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Duggan EW, Vadlamudi R, Spektor B, Sharifpour M. Abdominal Surgery With Bilateral Rectus Sheath Block: A Case Report. A A Pract 2020; 13:278-280. [PMID: 31361662 DOI: 10.1213/xaa.0000000000001055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 44-year-old man, American Society of Anesthesiologists physical status class IV, presented for fulguration of anal condyloma and diverting colostomy. The patient's medical history includes World Health Organization (WHO) class I pulmonary hypertension (PH), right heart failure, and bilateral lower extremity paralysis due to Pott's disease. The patient was not a candidate for neuraxial anesthesia due to sacral decubitus ulcers, and alternative options to general anesthesia (GA) were considered to avoid the high risk of right ventricular (RV) failure and ensuing complications. The case was successfully performed under sedation with dexmedetomidine infusion and bilateral rectus sheath blocks for surgical anesthesia.
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Affiliation(s)
- Elizabeth W Duggan
- From the Department of Anesthesiology, Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia
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Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum. Sci Rep 2020; 10:1305. [PMID: 31992790 PMCID: PMC6987090 DOI: 10.1038/s41598-020-58198-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022] Open
Abstract
Minimally invasive surgery (MIS) has shown satisfactory surgical results for the treatment of thoracic myelopathy (TM) caused by ossification of the ligamentum flavum (OLF). This study investigated the prognostic factors following MIS and was based on the retrospective analysis of OLF patients who underwent percutaneous full endoscopic posterior decompression (PEPD). Thirty single-segment OLF patients with an average age of 60.4 years were treated with PEPD under local anaesthesia. Clinical data were collected from the medical and operative records. The surgical results were assessed by the recovery rate (RR) calculated from the modified Japanese Orthopaedic Association (mJOA) score. Correlations between the RR and various factors were analysed. Patients’ neurological status improved from a preoperative mJOA score of 6.0 ± 1.3 to a postoperative mJOA score of 8.5 ± 2.0 (P < 0.001) at an average follow-up of 21.3 months. The average RR was 53.8%. Dural tears in two patients (6.7%, 2/30) were the only observed complications. Multiple linear regression analysis showed that a longer duration of preoperative symptoms and the presence of a high intramedullary signal on T2-weighted MRI (T2HIS) were significantly associated with poor surgical results. PEPD is feasible for the treatment of TM patients with a particular type of OLF. Patients without T2HIS could achieve a good recovery if they received PEPD early.
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Wu D, Wang H, Hu P, Xu W, Liu J. The Postoperative Prognosis of Thoracic Ossification of the Ligamentum Flavum can be Described by a Novel Method: The Thoracic Ossification of the Ligamentum Flavum Score. World Neurosurg 2019; 130:e47-e53. [DOI: 10.1016/j.wneu.2019.05.185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/26/2022]
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Wu W, Diao W, Yang S, Guo Y, Yan M, Luo F. The Effect of Using Visual Trepan to Treat Single-Segment Ossification of Ligamentum Flavum Under the Endoscope. World Neurosurg 2019; 131:e550-e556. [PMID: 31398521 DOI: 10.1016/j.wneu.2019.07.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the surgical outcome of using a trepan to treat single-segment ossification of ligamentum flavum under endoscopy and the clinical value of the new surgical treatment. MATERIALS AND METHODS Patients who underwent surgery for single-segment ossification of ligamentum flavum from January 2015 to June 2018 were included in a retrospective analysis. Endoscopic visual trepan decompression was performed in 26 patients and posterior spinal canal resection and decompression was performed in 11 patients. Japanese Orthopaedic Association scores, Japanese Orthopaedic Association improvement rate, and visual analog scale scores of both groups were recorded during follow-up. Computed tomography was used to evaluate patients' residual area ratio of the vertebral canal. Operative time, length of stay, amount of bleeding, and hospital cost in both groups were recorded. RESULTS Average follow-up time was 8.9 ± 2.7 months. Average operative time was 100.6 ± 35.0 minutes in the experimental group and 140.5 ± 28.3 minutes in the control group. At the final follow-up, the average improvement rate of Japanese Orthopaedic Association score was 78.3% in the experimental group and 84.2% in the control group. The average residual area ratio of the vertebral canal, which was <50% before the operation in both groups, recovered to 100% in both groups after the operation. Visual analog scale score of all patients was significantly (P < 0.05) reduced at the final follow-up. CONCLUSIONS The visual trepan technique using a spinal endoscope can be used to treat single-segment ossification of ligamentum flavum. Advantages include less trauma, faster recovery, and lower cost. However, more cases and long-term follow-up are required to further evaluate the clinical effectiveness and safety of this surgical method.
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Affiliation(s)
- Wenjie Wu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wenbo Diao
- Zhoukou Xiehe Orthopaedics Hospital, Henan Province, China
| | - Sen Yang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yang Guo
- Department of Orthopaedics, Affiliated First Hospital, Jilin University, Jilin Province, China
| | - Ming Yan
- Department of Orthopaedics, Affiliated First Hospital, Jilin University, Jilin Province, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China.
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Kasukawa Y, Miyakoshi N, Hongo M, Ishikawa Y, Kudo D, Kimura R, Ono Y, Iida J, Sato C, Shimada Y. Surgical Results of Patients with Myelopathy due to Ossification of the Ligamentum Flavum with Ossification of the Posterior Longitudinal Ligament or a Vertebral Fracture at the Same Level of the Thoracic Spine: A Retrospective Comparative Study. Asian Spine J 2019; 13:832-841. [PMID: 31154703 PMCID: PMC6773995 DOI: 10.31616/asj.2018.0278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/10/2019] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective and comparative study. Purpose We assessed surgical treatment outcomes in patients with thoracic myelopathy due to ossification of the ligamentum flavum (OLF), and OLF combined with ossification of the posterior longitudinal ligament (OPLL) or vertebral fracture (VF) at the same level. Overview of Literature OLF and OPLL cause severe thoracic myelopathy. Osteoporotic VF commonly occurs at the thoracolumbar junction. There have been no investigations of thoracic myelopathy due to OLF and VF. Methods Forty patients were divided among three groups: the OLF group (n=23): myelopathy due to OLF, the OLF+OPLL group (n=12): myelopathy due to OLF and OPLL, and the OLF+VF group (n=5): myelopathy due to OLF and VF. We recorded OLF, OPLL, and VF sites and operative procedures. Each patient’s neurological status, according to the Japanese Orthopaedic Association (JOA) score, and walking ability were evaluated pre- and postoperatively. Results Patients in the OLF+OPLL group were significantly younger than those in the other two groups. The preoperative JOA score was significantly lower in the OLF+VF than OLF group. The final JOA score was significantly lower in the OLF+VF than OLF and OLF+OPLL groups. The JOA score recovery rate was significantly lower in the OLF+VF than OLF group. Final walking ability was significantly worse in the OLF+OPLL and OLF+VF groups than in the OLF group and significantly worse in the OLF+VF than OLF+OPLL group. Conclusions Thoracic myelopathy due to OLF+VF occurs primarily in older females, who also exhibit worse preoperative and postoperative neurological status, and worse walking ability, than patients with thoracic myelopathy due to OLF or OLF+OPLL.
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Affiliation(s)
- Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuichi Ono
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Jumpei Iida
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Chiaki Sato
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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An B, Li XC, Zhou CP, Wang BS, Gao HR, Ma HJ, He Y, Zhou HG, Yang HJ, Qian JX. Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:492-501. [PMID: 30656471 DOI: 10.1007/s00586-018-05866-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Ossification of ligamentum flavum (OLF) is the leading cause of progressive thoracic myelopathy (TM) in East Asian countries. Surgical decompression is the general treatment for TM. This study investigated the application of percutaneous full endoscopic posterior decompression (PEPD) for the treatment of thoracic OLF. METHODS Eighteen patients with TM were treated by PEPD under local anaesthesia. Patients had an average age of 59.1 years and single-level lesions mostly at the lower thoracic vertebrae. Computed tomography and magnetic resonance imaging were used to classify the OLF. The pre- and postoperative neurological statuses were evaluated using the American Spinal Injury Association (ASIA) sensory and motor score, modified Japanese Orthopaedic Association (mJOA) score and Frankel grade. RESULTS OLF for all patients was classed as lateral, extended, and enlarged types without comma and tram track signs. Decompression was completed, and a dome-shaped laminotomy was performed through limited laminectomy and flavectomy. Dural tears in 2 patients were the only observed complication. The average score of ASIA sensory and motor, mJOA, as well as the Frankel grade improved significantly after surgery at an average follow-up time of 17.4 months. The average recovery rate (RR) was 47.5% as calculated from the mJOA scores. According to RR, 10 cases were classified as good, 4 cases fair, and 4 cases unchanged. CONCLUSIONS For patients with thoracic OLF at a single level and lateral, extended, and enlarged types without comma and tram track signs, it is safe and reliable to perform PEPD, which has satisfactory clinical results. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Bo An
- Department of Orthopedics, Tangdu Hospital Affiliated to Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710000, Shanxi Province, China
| | - Xing-Chen Li
- Department of Spinal Surgery, Third Hospital of Henan Province, No.198, Funiu Road, Zhongyuan District, Zhengzhou, 450000, Henan Province, China
| | - Cheng-Pei Zhou
- Department of Orthopedics, Tangdu Hospital Affiliated to Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710000, Shanxi Province, China
| | - Bi-Sheng Wang
- Department of Spinal Surgery, Third Hospital of Henan Province, No.198, Funiu Road, Zhongyuan District, Zhengzhou, 450000, Henan Province, China
| | - Hao-Ran Gao
- Department of Orthopedics, Tangdu Hospital Affiliated to Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710000, Shanxi Province, China
| | - Hai-Jun Ma
- Department of Spinal Surgery, Third Hospital of Henan Province, No.198, Funiu Road, Zhongyuan District, Zhengzhou, 450000, Henan Province, China
| | - Yi He
- Department of Spinal Surgery, Third Hospital of Henan Province, No.198, Funiu Road, Zhongyuan District, Zhengzhou, 450000, Henan Province, China
| | - Hong-Gang Zhou
- Department of Spinal Surgery, Third Hospital of Henan Province, No.198, Funiu Road, Zhongyuan District, Zhengzhou, 450000, Henan Province, China
| | - He-Jun Yang
- Department of Spinal Surgery, Third Hospital of Henan Province, No.198, Funiu Road, Zhongyuan District, Zhengzhou, 450000, Henan Province, China.
| | - Ji-Xian Qian
- Department of Orthopedics, Tangdu Hospital Affiliated to Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710000, Shanxi Province, China.
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Xiaobing Z, Xingchen L, Honggang Z, Xiaoqiang C, Qidong Y, Haijun M, Hejun Y, Bisheng W. "U" route transforaminal percutaneous endoscopic thoracic discectomy as a new treatment for thoracic spinal stenosis. INTERNATIONAL ORTHOPAEDICS 2018; 43:825-832. [PMID: 30218183 DOI: 10.1007/s00264-018-4145-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/05/2018] [Indexed: 11/24/2022]
Abstract
PURPOSES To describe the rationale, surgical technique, and short-term follow-up results of a new minimally invasive treatment for thoracic spinal stenosis (TSS) caused by herniation, ossification of the ligamentum flavum (OLF), and/or ossification of the posterior longitudinal ligament (OPLL) with a "U" route transforaminal percutaneous endoscopic thoracic discectomy (PETD). METHODS Fourteen patients, including seven males and seven females, underwent "U" route PETD. Myelopathy was caused by OLF in 14 patients, OPLL in one, combined OLF-OPLL in ten, and intervertebral disc herniation (IDH) in five. Decompression was performed in one segment in 12 patients, and in two segments in two patients. The Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, and complications were documented. RESULTS The JOA scores improved from 4.64 ± 2.31 pre-operatively to 7.07 ± 1.59 one day post-operatively and 11.79 ± 1.85 at final follow-up. The difference between pre-operation and post-operation was statistically significant (P < 0.05). Moreover, the VAS score was 6.07 ± 2.06 points pre-operatively, decreasing to 3.00 ± 1.24 points at one day post-operatively, and 1.14 ± 0.86 points at last follow-up (P < 0.05). Dural tear was observed in two cases during the intervention. No patient had transient worsening of pre-operative paralysis. CONCLUSIONS This retrospective analysis shows that "U" route PETD for decompression may be a feasible alternative to treat thoracic spinal stenosis.
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Affiliation(s)
- Zhao Xiaobing
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Li Xingchen
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China.
| | - Zhou Honggang
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Cao Xiaoqiang
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Yuan Qidong
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Ma Haijun
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Yang Hejun
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Wang Bisheng
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
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Kim JK, Ryu HS, Moon BJ, Lee JK. Clinical Outcomes and Prognostic Factors in Patients With Myelopathy Caused by Thoracic Ossification of the Ligamentum Flavum. Neurospine 2018; 15:269-276. [PMID: 30185766 PMCID: PMC6226126 DOI: 10.14245/ns.1836128.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/15/2018] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to investigate the surgical outcomes and prognostic factors for thoracic ossification of the ligamentum flavum (OLF) after decompressive laminectomy, focusing on the quantitative signal intensity ratio (SIR) of preoperative magnetic resonance imaging (MRI) and its prognostic significance.
Methods We retrospectively reviewed 24 patients who previously underwent total laminectomy to remove OLF from 2010 to 2015. MRI and computed tomography were performed to detect OLF. The SIR between the regions of interest of high signal intensity lesions and the normal cord at the T1–2 disc levels was calculated. We divided patients into 2 groups based on the extent of the modified Japanese Orthopaedic Association (JOA) recovery rate (RR): good (RR ≥ 50%) and poor (RR < 50%).
Results The mean preoperative and postoperative modified JOA scores for thoracic myelopathy were 6.67 ± 1.73 and 8.63 ± 1.81, respectively (p < 0.001). The preoperative JOA score (7.5 vs. 5.83, p = 0.028), postoperative JOA score (9.83 vs. 7.42, p = 0.000), and SIR (1.16 vs. 1.41, p = 0.009) were significantly different between the good and poor RR groups. A higher preoperative JOA score and lower SIR were associated with a good RR according to the JOA criteria.
Conclusion The clinical outcomes for thoracic OLF after decompressive laminectomy were favorable. A higher RR was correlated with a lower SIR and higher preoperative modified JOA score. Therefore, a relatively low SIR on MRI and a relatively high preoperative JOA score could be positive prognostic indicators for the JOA RR in patients with thoracic OLF.
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Affiliation(s)
- Jae-Kwang Kim
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Seung Ryu
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Bong Ju Moon
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Affiliation(s)
- Joseph P Garry
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
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Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2018; 43:E842-E848. [PMID: 29940604 PMCID: PMC6252088 DOI: 10.1097/brs.0000000000002563] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Examine the functional outcomes and complications following laminectomy for thoracic myelopathy due to ossification of the ligamentum flavum (OLF). SUMMARY OF BACKGROUND DATA OLF is a rare condition that can cause thoracic myelopathy. Laminectomy is a procedure that can be performed to decompress the spinal cord in patients with thoracic myelopathy due to OLF. Few studies have examined postoperative outcomes and complications following laminectomy for thoracic myelopathy secondary to OLF. METHODS A systematic review and meta-analysis was performed. Literature search yielded six studies that met our selection criteria. Study characteristics and baseline patient demographics were extracted from each study. Primary outcomes included pre- and postoperative Japanese Orthopedic Association (JOA) scores and perioperative complications including dural tears, cerebrospinal fluid (CSF) leaks, neurological deficits, surgical site infections, and other complications. We calculated pooled proportion estimates for JOA scores and complications using a random effects model. RESULTS A total of 137 patients were included. The pooled pre- and postoperative JOA scores were 5.08 (95% confidence interval [CI], 2.70-7.47; I = 98%) and 8.29 (95% CI, 7.73-8.85; I = 18%), respectively, with a mean improvement of +3.03 points (95% CI, 1.08-4.98; I = 88%). Pooled proportion estimates for dural tears, CSF leaks, infections, and early neurological deficits were 18.4% (95% CI, 12.6-26.1; I = 0%), 12.1% (95% CI, 6.6-21.2; I = 0%), 5.8% (95% CI, 2.1-15.4; I = 0%), and 5.7% (95% CI, 2.2-14.3; I = 0%), respectively. CONCLUSION Thoracic myelopathy secondary to OLF can be treated with laminectomy. However, despite some improvement in JOA score, functional status remains poor postoperatively. Perioperative complications are common, with dural tears and CSF leaks occurring most frequently. OLF is an uncommon condition and more research is needed to better understand how we can improve the outcomes of laminectomy alone for the treatment of thoracic myelopathy due to OLF. LEVEL OF EVIDENCE 3.
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The bridge crane technique for the treatment of the severe thoracic ossification of the ligamentum flavum with myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1846-1855. [DOI: 10.1007/s00586-018-5683-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/24/2018] [Indexed: 11/26/2022]
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Ju JH, Kim SJ, Kim KH, Ryu DS, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU. Clinical relation among dural adhesion, dural ossification, and dural laceration in the removal of ossification of the ligamentum flavum. Spine J 2018; 18:747-754. [PMID: 28939168 DOI: 10.1016/j.spinee.2017.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Dural laceration frequently occurs during surgery in patients with ossification of the ligamentum flavum (OLF), mainly because of dural adhesion (DA) and dural ossification (DO) between the ligamentum flavum and the dura mater. However, the radiological predictive factors of DA in OLF have rarely been reported. PURPOSE The objective of this study was to determine the preoperative radiological signs for predicting intraoperative DA in OLF by using preoperative magnetic resonance imaging (MRI) and computed tomography (CT). STUDY DESIGN This is a retrospective study. PATIENT SAMPLE This study included 182 patients who underwent decompressive laminectomy and OLF removal from 2005 to 2014. OUTCOME MEASURE Demographic data, preoperative neurologic status, surgical procedure and results, and intraoperative and postoperative complications were analyzed. Clinical outcome was assessed with the Japanese Orthopaedic Association score. MATERIALS AND METHODS Depending on the morphologic appearance of OLF in preoperative radiographs, we aimed to investigate the prevalence of intraoperative DA and DO. We used the following factors of representative classifications: (1) surface appearance, (2) "double-layer" or "tram-track" sign, (3) cross-sectional area of the stenosed level, (4) Sato classification as axial classification, (5) Kuh classification as sagittal classification, and (6) high-signal-intensity change on T2-weighted MRI. RESULTS Intraoperative evidence of DA was observed in 52 patients (29%), and DO was observed in 23 patients (13%). Twenty-seven patients (15%) had dural laceration during surgery. Statistically, DA was closely associated with the non-uniform type of surface appearance (odds ratio 5.396, p=.001) and with the presence of either a double-layer sign or a tram-track sign (odds ratio 11.525, p<.001). In the preoperative CT and MRI, 21 out of 23 patients with DO showed a "double-layer sign" or a "tram-track sign." CONCLUSIONS This study identified two predictive factors of DA in OLF, which were the non-uniform surface appearance and the presence of a double-layer sign or a tram-track sign. The presence of DO in OLF was closely associated with a double-layer sign or a tram-track sign in the preoperative radiological images.
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Affiliation(s)
- Jeong-Hyuk Ju
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Sung-Jun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Kyung-Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Dal-Sung Ryu
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Keun-Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Sung-Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea.
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Kim DH, Lee SH, Lee JS, Song GS, Son DW. High thoracic ossification of ligamentum flavum causing partial Horner syndrome. Br J Neurosurg 2018; 35:231-232. [PMID: 29490510 DOI: 10.1080/02688697.2018.1441976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We report a case of high thoracic ossification of the ligamentum flavum (OLF) causing a partial Horner's syndrome. A 57-year-old man developed a walking disorder, as well as right-sided miosis and anhidrosis. Magnetic resonance imaging demonstrated a spinal cord compressing T2-T3 OLF. The patient improved after surgery.
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Affiliation(s)
- Dong Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Hou X, Chen Z, Sun C, Zhang G, Wu S, Liu Z. A systematic review of complications in thoracic spine surgery for ossification of ligamentum flavum. Spinal Cord 2017; 56:301-307. [PMID: 29284792 DOI: 10.1038/s41393-017-0040-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 01/13/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The aim of this systematic review is to summarize the incidence of complications, to relate complication incidence to procedures performed, to assess the impact of the year of study publication and follow-up duration on complication incidence. METHODS The authors conducted the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE searches for relevant literatures. The incidence of complications was summarized. Correlation of the incidence with year of study publications, follow-up duration, and the surgical outcome was statistically evaluated. RESULTS A total of 16 studies met our inclusion criteria, including 475 patients. All of these studies were retrospective case series. The mean age of patients ranged from 55 to 64 years. Average follow-up duration ranged from 26 to 65 months. Partial patients in four studies underwent surgeries and reserved posterior structure of the spinal canal. The others underwent operations removing posterior structure of spinal canal. The mean recovery rate from each individual study varied between 31 and 68% and the pooled neurologic function recovery rate was 53% (95% CI: 43-62%). The mean complication rate was 24%. Cerebrospinal fluid leakage was the most reported postoperative complication (19%), then neurologic deterioration (5%). Other complications included local infections, wound dehiscence, increased kyphotic deformity, an hematoma. CONCLUSIONS Operations removing posterior structure of spinal canal are the main technique to decompress spinal cord. Cerebrospinal fluid leakage and postoperative neurologic deterioration were the most reported complications.
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Affiliation(s)
- Xiaofei Hou
- Department of Orthopaedics, Peking University Shougang Hospital, Beijing, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Guangwu Zhang
- Department of Orthopaedics, Peking University Shougang Hospital, Beijing, China
| | - Sijun Wu
- Department of Orthopaedics, Peking University Shougang Hospital, Beijing, China
| | - Zheng Liu
- Department of Orthopaedics, Peking University Shougang Hospital, Beijing, China
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Minimally invasive surgery for resection of ossification of the ligamentum flavum in the thoracic spine. Wideochir Inne Tech Maloinwazyjne 2017; 12:96-105. [PMID: 28446938 PMCID: PMC5397543 DOI: 10.5114/wiitm.2017.66473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/08/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Thoracic ossification of the ligamentum flavum (TOLF) is a common cause of progressive thoracic myelopathy. Surgical decompression is commonly used to treat TOLF. Aim To evaluate the clinical outcomes of microsurgical decompression of TOLF via a paraspinal approach, using a percutaneous tubular retractor system. Material and methods First, three-dimensional (3D) image reconstruction and printed models were made from thin computed tomography scans for each patient. Then, 3D computer-assisted virtual surgery was performed using the 3D reconstruction to calculate the precise location and sizes of the bone window and the angle of insertion of the percutaneous tubular retractor system. In total, 13 patients underwent the surgery through the percutaneous micro channel unilateral vertebral approach under electrophysiological monitoring. Five days after the surgery, increased creatine phosphokinase levels returned to preoperative levels. The Japanese Orthopedic Association (JOA) score was improved and computed tomography reconstruction and magnetic resonance imaging of the thoracic spine showed that decompression was achieved without injuries to the spinal cord or nerve root. The stability of the spine was not affected, nor were any deformities of the spine detected. Finally, nerve functional recovery was achieved with minimal injury to the paraspinal muscle, articulum, spinous process and ligament. Results The mean operative time was 98.23 ±19.10 min, and mean blood loss was 19.77 ±5.97 ml. At a mean follow-up of 13.3 months (median: 12 months), the mean JOA score was 7.54 ±1.13 at the final follow-up, yielding a mean RR of 49.10 ±15.71%. Using The recovery rate, 7 (53.85%) patients had good outcomes, 5 (38.46%) patients had a fair outcome, and 1 (7.69%) patient had poor outcomes, indicating significant improvement by the final follow-up examination (p < 0.05). Conclusions The 3D printed patient model-based microsurgical resection of TOLF via the paraspinal approach can achieve decompression of the spinal canal with minimal complications, faster recovery and improved stability of the vertebral body.
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Wang H, Ma L, Xue R, Yang D, Wang T, Wang Y, Yang S, Ding W. The incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy. Medicine (Baltimore) 2016; 95:e5519. [PMID: 27930542 PMCID: PMC5266014 DOI: 10.1097/md.0000000000005519] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to explore the incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy, and hope to provide references in decision-making and surgical planning for both spinal surgeon and thoracic stenosis patients.By retrieving the medical records from January 2001 to November 2015, 168 patients were retrospectively reviewed. According to the occurrence of postoperative neurological deterioration, patients were divided into 2 groups: neurological deterioration (ND) group and non-ND group. To investigate risk values for the occurrence of ND, 3 categorized factors were analyzed statistically: patient characteristics-preoperative data of age, sex, body mass index, bone mineral density, the duration of disease (from first symptoms to operation), the preoperative neurological function (Frankel grade), and diagnosis; surgical variables-surgery time, the amount of bleeding, mean arterial pressure, intervertebral fusion or not, and instrumentation or not; radiographic parameters-the spinal canal occupancy ratio, location of the lesion, thoracic kyphosis, and kyphosis correction.Postoperative neurological deterioration was developed in 23 of 168 patients (13.7%), and were enrolled as ND group. There was no statistically significant difference between the 2 groups in age at operation, sex composition, body mass index, and bone mineral density. The preoperative diagnosis presented significant difference between the 2 groups, because ossification of posterior longitudinal ligament combined with ossification of the ligamentum flavum was more common in ND group, whereas ossification of the ligamentum flavum alone was more common in non-ND group. There was no difference between the 2 groups in mean surgery time, the incidence of intraoperative direct trauma, and the number of patients that received instrumentation. The mean bleeding was much more in ND group than that in non-ND group, and the mean arterial pressure was lower in ND group than that in non-ND group. Also, the mean spinal canal occupancy ratio was more severe in ND group than that in non-ND group. There were no statistically significant difference between the 2 groups in stenosis location and preoperative thoracic kyphosis. The mean kyphosis correction was more significant in ND group. When included in a multivariate logistic regression model, thoracic disc herniation + ossification of posterior longitudinal ligament, spinal canal occupancy ratio more than 70%, bleeding more than 800 mL, and mean arterial pressure less than 81 mm Hg were independently associated with the postoperative neurological deterioration.In conclusion, ossification of posterior longitudinal ligament combined with ossification of the ligamentum flavum, spinal canal occupancy ratio more than 70%, intraoperative bleeding more than 800 mL, and mean arterial pressure less than 81 mm Hg are risk factors for the occurrence of postoperative neurologic deterioration. Improving surgical technique, shortening operation time, and paying more attention to hemostasis could provide opportunities to reduce the incidence of neurologic deterioration and to improve therapeutic outcomes.
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Affiliation(s)
- Hui Wang
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, Shijiazhuang
| | - Lei Ma
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, Shijiazhuang
| | - Rui Xue
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, Shijiazhuang
| | - Dalong Yang
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, Shijiazhuang
| | - Tao Wang
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, Shijiazhuang
| | | | - Sidong Yang
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, Shijiazhuang
| | - Wenyuan Ding
- Department of Spine Surgery, The Third Hospital of HeBei Medical University, Shijiazhuang
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