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Kumar V, Bansal P, Ksheerasagar VP, Dhatt SS. Comparison of endoscopic decompression to open laminectomy in patients with thoracic ossified ligamentum flavum - a systematic review and meta-analysis. Neurosurg Rev 2024; 47:345. [PMID: 39037535 DOI: 10.1007/s10143-024-02591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/02/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
In recent years, there has been growing interest in an alternative approach for treating TOLF, such as endoscopic decompression, which minimizes the disruption of surrounding tissues. It is important to understand the advantages, disadvantages, and potential differences in outcomes associated with each approach. This comparative study aims to evaluate and contrast the effectiveness, safety, and outcomes of these two surgical techniques, open laminectomy and endoscopic decompression, in the management of thoracic OLF. The literature review was conducted on Embase, PubMed, Scopus and Google Scholar databases. After a thorough screening of all search results, 14 studies were shortlisted, from which data was extracted, and statistical analysis was done. Pooled analysis was done to ascertain the intra-operative and post-operative outcomes after surgery for TOLF. Overall, 351 patients were included in the study for evaluation. 174 patients were operated on by open laminectomy, and 177 patients were seen in the endoscopy group. Decreased operative time was seen in the endoscopic subgroup. The mean length of hospital stay of 6.6 days. Both groups showed improvement in mJOA and VAS score. The recovery rate for the reported study cohort was 66.8%, with the Endoscopic surgical approach showing a positive correlation with the mean recovery rate. The dural tear was the most common complication, with a rate of 6.6%. The mean estimated infection rate was 2.7% and postoperative CSF leak was 3.7%, with a trend of significantly higher rates in the open subgroup. Both of the groups showed improvement in functional scores, VAS scores, and cross-sectional area. However, the Endoscopic decompression group experienced reduced hospital stays, operating times, and intraoperative blood loss. The most frequent side effects were CSF leak and dural tear. A few cases showed revision and infection. None of the problems differed between the groups.
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Affiliation(s)
- Vishal Kumar
- Department Of Orthopaedics, PGIMER, Chandigarh, India
| | - Parth Bansal
- Department Of Orthopaedics, PGIMER, Chandigarh, India
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Li J, Deng Z, Wang L, Wang L, Yang H, Yang X, Song Y. The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ-5D-5L. Orthop Surg 2024; 16:57-71. [PMID: 38010864 PMCID: PMC10782254 DOI: 10.1111/os.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE There is a lack of studies on the quality of life (QoL) after posterior laminectomy in patients with thoracic ossification of the ligamentum flavum (TOLF), and risk factors associated with poor prognosis remain controversial. Therefore, the present study was conducted to illustrate the QoL for TOLF patients after surgery and determine its relationship with their demographic, surgery-related, clinical characteristics and imaging data. METHODS One hundred and eighteen patients diagnosed with thoracic myelopathy because of TOLF were enrolled in this retrospective study. They all underwent posterior decompressive laminectomy from August 2010 to January 2022. The QoL was evaluated based on the EQ-5D-5L. Collecting gender, age, number of operations, compressed segments, Frankel grade, complications, body mass index (BMI), symptoms and duration, modified Japanese Orthopaedic Association (mJOA) score (preoperative), follow-up time and type of ossification, increased signal on Sagittal T2-weighted Images (ISST2I), occupancy rate and analyzing by Mann-Whitney U-test, Kruskal-Wallis test, the χ2 -test, and logistic regression tests. RESULTS Average follow-up 70.8 months (18-149), the mean age was 59.74 ± 9.81 years and the mean score for the QoL based on the EQ-5D-5 L and visual analogue scale (VAS) score were 0.71 ± 0.28 and 78.88 ± 10.21 at the final follow-up. Moderate and severe problems were found in the pain/discomfort in 22.0% of the patients. These mobility and usual activities numbers were slightly higher (24.6% and 30.4%, respectively). The mean scores for QoL and VAS were significantly higher in patients with mild and moderate neurological impairment, normal BMI, <60 years of age, no dural tears, symptom relief at hospital discharge, unilateral and bilateral ossification on axial CT scan, ≤ 50% spinal canal occupancy on CT and MRI, and none or fuzzy on ISST2I. CONCLUSION QoL after posterior laminectomy in TOLF patients is generally satisfactory compared to preoperative levels. Preoperative mJOA score, Age, comorbid diabetes, the major symptom is activity limitation, BMI, ISST2I, Intraoperative dural tears and spinal canal occupancy rate correlate significantly with the corresponding dimensions and are predictive. Age, spinal canal occupancy rate, ISST2I, preoperative mJOA score, BMI are significantly associated with and have predictive value for overall postoperative QoL.
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Affiliation(s)
- Junhu Li
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Zhipeng Deng
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Linnan Wang
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Lei Wang
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Hailing Yang
- Program in Cellular and Molecular Physiology, Graduate School of Biomedical Sciences, Tufts UniversityBostonMassachusettsUSA
| | - Xi Yang
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Yuemin Song
- Department of Orthopaedic SurgeryOrthopaedic Research Institute, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
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Wu PH, Chin BZJ, Kim HS, Sim SI, Jang IT. Uniportal Thoracic Endoscopic Unilateral Laminotomy with Bilateral Decompression of Thoracic Ossification of Ligamentum Flavum: A Systematic Review of Current Literature. World Neurosurg 2023; 178:340-350.e2. [PMID: 37480986 DOI: 10.1016/j.wneu.2023.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Thoracic ossification of ligamentum flavum (TOLF) is a rare disease that often results in worsening neurologic sequelae if left untreated. Although the gold standard treatment for TOLF is open posterior laminectomy, it is often accompanied by high rates of complications and perioperative morbidity. There have been studies looking into feasibility of endoscopic posterior decompression for TOLF, citing potential for lower perioperative morbidity and achieving similar functional outcomes to its open laminectomy counterparts. We provide an up-to-date systematic review of clinical outcomes after endoscopic posterior decompression for TOLF from the latest assemblage of evidence. METHODS A systematic review of the technique was conducted from May 2000 to May 2023. Articles were selected based on PRISMA guidelines. Eligibility of studies was independently by 2 reviewers, with disagreements resolved by a third author. RESULTS Nineteen primary references comprising 337 patients with TOLF who underwent endoscopic posterior decompression were included in the systematic review. Mean follow-up time across all studies ranged from 8.9 to 65.3 months. Mean age ranged from 51.2 to 63 years, with mean intraoperative blood loss ranging from 15 to 62 mL. There is significant improvement in visual analog scale (VAS) score, VAS back, VAS leg, modified Japanese Orthopaedic Association score, and Oswestry Disability Index compared with preoperative recorded values across all studies, with low rates of complications reported. CONCLUSIONS Endoscopic posterior spinal decompression is a safe and effective technique for treatment of TOLF, with a low rate of complications and improvement in pain and function.
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Affiliation(s)
- Pang Hung Wu
- Achieve Spine And Orthopaedic Centre, Mount Elizabeth Hospital, Singapore; National University Health System, Jurong Health Campus, Orthopaedic Surgery, Singapore
| | - Brian Zhao Jie Chin
- National University Health System, Jurong Health Campus, Orthopaedic Surgery, Singapore; National University Health System, Kent Ridge Campus, Orthopaedic Surgery, Singapore
| | - Hyeun Sung Kim
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea.
| | - Seth Ian Sim
- National University Health System, Kent Ridge Campus, Orthopaedic Surgery, Singapore
| | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea
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Hu Y, Dong Y, Qi J, Chen Z, Li W, Tian Y, Sun C. Learning Curve and Clinical Outcomes of Ultrasonic Osteotome-based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum. Orthop Surg 2023; 15:2318-2327. [PMID: 37403615 PMCID: PMC10475665 DOI: 10.1111/os.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/13/2023] [Accepted: 05/21/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Despite rapid advances in minimally invasive surgery, en bloc laminectomy remains the most common surgical approach for treating thoracic ossification of the ligamentum flavum (TOLF). However, the learning curve of this risky operation is rarely reported. Therefore, we aimed to describe and analyze the learning curve of ultrasonic osteotome-based en bloc laminectomy for TOLF. METHODS Among 151 consecutive patients with TOLF who underwent en bloc laminectomy performed by one surgeon between January 2012 and December 2017, we retrospectively analyzed their demographic data, surgical parameters, and neurological function. Neurological outcome was evaluated with the modified Japanese Orthopaedic Association (mJOA) scale, and the Hirabayashi method was used to calculate the neurological recovery rate. The learning curve was assessed with logarithmic curve-fitting regression analysis. Univariate analysis methods were used for statistical analysis, including t-test, rank sum test, and chi-square test. RESULTS A total of 50% of learning milestones could be reached in approximately 14 cases, and the asymptote in 76 cases. Therefore, 76 of the 151 enrolled patients were defined as the "early group," and the remaining 75 were delimitated as the "late group" for comparison. There was a significant intergroup difference in the corrected operative time (94.80 ± 27.77 vs 65.93 ± 15.67 min, P < 0.001) and the estimated blood loss (median 240 vs 400 mL, P < 0.001). The overall follow-up was 83.1 ± 18.5 months. The mJOA significantly increased from a median of 5 (IQR: 4-5) before the surgery to 10 (IQR: 9-10) at the last follow-up (P < 0.001). The overall complication rate was 37.1%, and no significant intergroup difference was found, except for the incidence of dural tears (31.6% vs 17.3%, p = 0.042). CONCLUSION Initially, mastering the en bloc laminectomy technique using ultrasonic osteotome for TOLF treatment can be challenging, but the surgeon's experience improves as the operative time and blood loss decrease. Improved surgical experience reduced the risk of dural tears but was not associated with the overall complication rate or long-term neurological function. Despite the relatively long learning curve, en bloc laminectomy is a secure and valid technique for TOLF treatment.
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Affiliation(s)
- Yuanyu Hu
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yanlei Dong
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Junbo Qi
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Zhongqiang Chen
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yun Tian
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Chuiguo Sun
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
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Kato K, Yabuki S, Otani K, Nikaido T, Otoshi K, Watanabe K, Kobayashi H, Konno SI. A muscle-preserving, spinous process-splitting approach for ossification of the ligamentum flavum in the thoracic spine in professional athletes: a report of three cases. Fukushima J Med Sci 2023; 69:143-150. [PMID: 37045778 PMCID: PMC10480514 DOI: 10.5387/fms.2022-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
A muscle-preserving, spinous process-splitting approach may be a less invasive approach to conventional laminectomy in patients with thoracic ossification of the ligamentum flavum. Few reports have discussed the usefulness of this procedure for thoracic lesions in professional athletes who need highly active thoracic spinal function after surgery. The treatment of thoracic ossification of the ligamentum flavum using a spinous process-splitting approach in 3 professional athletes is presented. In all three cases the patients could return to play within 3 months after surgery without complications, and in two of the cases, there was no spinal deformity or local recurrence of ossification of the ligamentum flavum at the final follow-up at least 8 years after surgery. The spinous process-splitting approach could be a safe procedure for multi-level and all other forms of ossification of the ligamentum flavum and is less invasive to the paraspinal muscles, relieves back symptoms, and restores function for athletes.
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Affiliation(s)
- Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shoji Yabuki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Kenichi Otoshi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shin-ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
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Liu Y, Li X, Hou Y, Leng X, Yan M, Chen X, Huang H, Xu Y. Surgical outcomes of percutaneous endoscopic thoracic decompression in the treatment of multi-segment thoracic ossification of the ligamentum flavum. Acta Neurochir (Wien) 2023; 165:2131-2137. [PMID: 37166509 DOI: 10.1007/s00701-023-05603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Previous studies have demonstrated satisfactory outcomes of percutaneous endoscopic thoracic decompression (PETD) for single-segment thoracic ossification of the ligamentum flavum (TOLF). However, the clinical outcomes of PETD in patients with multi-segment TOLF (mTOLF) remain unclear. The aim of the present study was to evaluate the efficacy and safety of PETD for patients with multi-segment mTOLF. METHODS Eighteen consecutive patients (41 segments) with mTOLF were treated with PETD between January 2020 and December 2021. The clinical outcomes were evaluated using the modified Japanese Orthopaedic Association (mJOA) score and Visual Analog Scale (VAS), whereas radiographic parameters were measured by cross-section area of the spinal canal and anteroposterior diameter of the spinal cord. RESULTS The follow-up period ranged from 14 to 34 months. The mean operation time and blood loss were 154.06 ± 32.14 min and 61.72 ± 12.72 ml, respectively. Hospital stay after first-stage operation was 10.89 ± 2.42 days. The mJOA score and VAS score significantly improved at the final follow-up, with a mean mJOA recovery rate of 63.3 ± 21.90%. The incidence of complications was 12.2% per level. The radiographic outcomes showed adequate decompression of the spinal cord. CONCLUSIONS The present study demonstrates that PETD is effective and safe as a minimally invasive procedure to treat patients with mTOLF. All patients showed relief of their symptoms and improvement in neurological function.
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Affiliation(s)
- Yunxuan Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xingchen Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
- Changchun University of Chinese Medicine, Changchun, 130117, China.
| | - Yingying Hou
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiangyang Leng
- Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Ming Yan
- The Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine, Changchun, 130118, China
| | - Xiaoxin Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Honghan Huang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yusheng Xu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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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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8
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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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9
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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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10
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Xue YD, Zhang ZC, Ma C, Dai WX. Preliminary report of modified expansive laminoplasty in the treatment of thoracic ossification of the ligamentum flavum. J Int Med Res 2021; 49:300060520985383. [PMID: 33435762 PMCID: PMC7809308 DOI: 10.1177/0300060520985383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study was performed to evaluate the role of posterior suspension of the laminae–ossification of the ligamentum flavum complex combined with miniplate fixation (modified expansive thoracic laminoplasty) in treating thoracic ossification of the ligamentum flavum (TOLF). Methods Eight patients with TOLF treated by modified expansive thoracic laminoplasty were retrospectively analyzed. Their general information, operative time, intraoperative blood loss, and postoperative complications were recorded. Neurological functional recovery was evaluated by the modified Japanese Orthopaedic Association (mJOA) score and Hirabayashi recovery rate preoperatively, postoperatively, and at the final follow-up. Preoperative and postoperative imaging was performed, and the decompression range and internal fixation positioning were evaluated. Results The mJOA score significantly improved from 4.63 points preoperatively to 9.0 points at the final follow-up (Hirabayashi recovery rate of 77.75%). Postoperative computed tomography and magnetic resonance imaging revealed sufficient decompression of the surgical segment. At the final follow-up, the internal implants were well-placed, the lamina–ligamentum flavum complex showed no significant displacement, and neurological functional recovery was satisfactory. Conclusion Surgical treatment of TOLF is complicated and high-risk. Characterized by simplicity and sufficient decompression, modified expansive thoracic laminoplasty can reduce the risk of cerebrospinal fluid leakage and nerve injury with satisfactory neurological functional recovery.
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Affiliation(s)
- You-Di Xue
- Department of Orthopaedic Surgery, XuZhou Central Hospital, XuZhou, JiangSu Province, China
| | - Zhao-Chuan Zhang
- Department of Orthopaedic Surgery, XuZhou Central Hospital, XuZhou, JiangSu Province, China
| | - Chao Ma
- Department of Orthopaedic Surgery, XuZhou Central Hospital, XuZhou, JiangSu Province, China
| | - Wei-Xiang Dai
- Department of Orthopaedic Surgery, XuZhou Central Hospital, XuZhou, JiangSu Province, China
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11
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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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12
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Wang H, Wang L, Sun Z, Jiang S, Li W. Unplanned hospital readmission after surgical treatment for thoracic spinal stenosis: incidence and causative factors. BMC Musculoskelet Disord 2021; 22:93. [PMID: 33472615 PMCID: PMC7818723 DOI: 10.1186/s12891-021-03975-6] [Citation(s) in RCA: 3] [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] [Received: 07/23/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the incidence and causative factors of unplanned hospital readmission within 90 days after surgical treatment of thoracic spinal stenosis (TSS). METHODS Hospital administrative database was queried to identify patients who underwent surgical treatment of TSS from July 2010 through December 2017. All unplanned readmissions within 90 days of discharge were reviewed for causes and the rate of unplanned readmissions was calculated. Patients of unplanned readmission were matched 1:3 to a control cohort without readmission. RESULTS Twenty-one patients (incidence of 1.7 % in 1239 patients) presented unplanned hospital readmission within a 90-day period and enrolled as the study group, 63 non-readmission patients (a proportion of 1: 3) were randomly selected as the control group. Causes of readmission include pseudomeningocele (8 patients; 38 %), CSF leakage combined with poor incision healing (6 patients; 29 %), wound dehiscence (2 patient; 9 %), surgical site infection (2 patients; 9 %), spinal epidural hematoma (1 patient; 5 %), inadequate original surgical decompression (2 patients; 9 %). Mean duration from re-admission to the first surgery was 39.6 ± 28.2 days, most of the patients readmitted at the first 40 days (66.7 %, 14/21 patients). When compared to the non-readmitted patients, diagnosis of OPLL + OFL, circumferential decompression, dural injury, long hospital stay were more to be seen in readmitted patients. CONCLUSIONS The incidence of 90-day unplanned readmission after surgical treatment for TSS is 1.7 %, CSF leakage and pseudomeningocele were the most common causes of readmission, the peak period of readmission occurred from 10 to 40 days after surgery, patients should be closely followed up within this period.
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Affiliation(s)
- Hui Wang
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research , Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China
| | - Longjie Wang
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research , Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research , Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China
| | - Shuai Jiang
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research , Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China
| | - Weishi Li
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China. .,Beijing Key Laboratory of Spinal Disease Research , Beijing, China. .,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China.
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13
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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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14
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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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15
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Cheng XK, Bian FC, Liu ZY, Yang FK, Chen B. A comparison study of percutaneous endoscopic decompression and posterior decompressive laminectomy in the treatment of thoracic spinal stenosis. BMC Musculoskelet Disord 2020; 21:717. [PMID: 33143667 PMCID: PMC7641830 DOI: 10.1186/s12891-020-03739-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background Percutaneous endoscopic decompression (PED) is considered a minimally invasive and safe procedure in lumbar degenerative disease. Few authors report the success of PED for thoracic spinal stenosis (TSS) with thoracic myelopathy. The objective of this study was to compare the outcome of PED versus posterior decompressive laminectomy (PDL) for TSS. Methods We retrospectively reviewed 30 consecutive patients who underwent surgery for single-level TSS from January 1, 2015 to May 1, 2019.These patients were divided into PED (n = 16) and PDL(n = 14) group. Preoperative demographic characteristics and perioperative outcomes were reviewed. Pre- and postoperative neurological status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score and the recovery rate (RR). Results The patients’ mean age was 57.3 years (27–76) in PED group and 58.8 years (34–77) in PDL group. No statistical difference was found between two groups with regards to neurological status at pre-operative and final follow-up. The RR in PED group achieved the same improvement as PDL group (87.5% vs 85.7%, P > 0.05), while the PED brought advantages in operative time(m) (86.4 vs 132.1, p < 0.05), blood loss (mL) (18.21 vs 228.57, p < 0.05),drainage volume(mL) (15.5 vs 601.4, p < 0.05), and hospital stay (d) (3.6 vs 5.6, p < 0.05). Conclusions Both PED and PDL showed favorable outcome in the treatment of TSS. Besides, PED had advantages in reducing traumatization. In terms of perioperative quality of life, PED could be an efficient supplement to traditional posterior decompressive laminectomy in patients with TSS.
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Affiliation(s)
- Xiao-Kang Cheng
- Department of Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei Province, China.,Chengde Medical University, Chengde, 067000, Hebei, China
| | - Fu-Cheng Bian
- Department of Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei Province, China.,Chengde Medical University, Chengde, 067000, Hebei, China
| | - Zhao-Yu Liu
- Department of Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei Province, China.,Chengde Medical University, Chengde, 067000, Hebei, China
| | - Feng-Kai Yang
- Department of Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei Province, China.,Chengde Medical University, Chengde, 067000, Hebei, China
| | - Bin Chen
- Department of Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei Province, China.
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16
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Zhao W, Yang S, Diao WB, Yan M, Wu WJ, Luo F. Using Visual Trepan to Treat Single Segment Ossification of the Ligamentum Flavum Under Endoscopy. Orthop Surg 2020; 11:906-913. [PMID: 31663291 PMCID: PMC6819184 DOI: 10.1111/os.12538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/04/2019] [Accepted: 08/20/2019] [Indexed: 11/28/2022] Open
Abstract
This article describes the trepan technique for treating single segment ossification of the ligamentum flavum (OLF) using an endoscope. OLF is the most common cause of thoracic spinal stenosis. The most common surgical procedures involve semi‐lamina or full‐lamina resection and decompression. However, considering the anatomical structure of the thoracic spinal canal and the combination of OLF, traditional surgery has higher risks, more complications, and greater technical requirements. In the past ten years, with the development of endoscopic technology, spinal endoscopy has been increasingly applied for the treatment of intervertebral disc herniation and spinal canal stenosis. The present study demonstrated the effectiveness of visual trepan decompression under spinal endoscopy used for patients with single segment OLF. This surgical procedure had many advantages, including a shorter operation time, minimal trauma, less expenditure, and better functional recovery over the conventional open surgery.
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Affiliation(s)
- Wei Zhao
- Department of Orthopaedics, Liu Dong Branch of Liuzhou Maternal and Child Health-Care Hospital, Liuzhou, China
| | - Sen Yang
- Department of Orthopaedics Hospital, Third Military Medical University, Chongqing, China
| | - Wen-Bo Diao
- Zhoukou Xiehe Orthopaedics Hospital, Henan, China
| | - Ming Yan
- Department of Orthopaedics, Affiliated First Hospital, Jilin University, Jilin, China
| | - Wen-Jie Wu
- Department of Orthopaedics Hospital, Third Military Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopaedics Hospital, Third Military Medical University, Chongqing, China
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17
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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: 23] [Impact Index Per Article: 5.8] [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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18
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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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19
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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: 30] [Impact Index Per Article: 6.0] [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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20
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Turel MK, Kerolus MG, O'Toole JE. Ossified ligamentum flavum of the thoracic spine presenting as spontaneous intracranial hypotension: case report. J Neurosurg Spine 2018; 28:401-405. [PMID: 29372863 DOI: 10.3171/2017.8.spine17513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ossification of the ligament flavum in the thoracic spine is an uncommon radiological finding in the Western population but can present with back pain, varying degrees of myelopathy, and even paraplegia on occasion. The authors here present the case of a 50-year-old woman with a history of progressive back pain and symptoms of spontaneous intracranial hypotension who was found to have an ossified ligamentum flavum of the thoracic spine resulting in a dural erosion cerebrospinal fluid leak. Surgery involved removal of the ossified ligament flavum at T10-11, facetectomy, ligation of the nerve root, and primary closure of the dura, which resulted in complete resolution of the patient's symptoms. Radiological, clinical, and intraoperative findings are discussed to assist surgeons with an accurate diagnosis and treatment in the setting of this unusual presentation.
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21
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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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22
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Zhou SY, Yuan B, Chen XS, Li XB, Zhu W, Jia LS. Imaging grading system for the diagnosis of dural ossification based on 102 segments of TOLF CT bone-window data. Sci Rep 2017; 7:2983. [PMID: 28592849 PMCID: PMC5462817 DOI: 10.1038/s41598-017-03178-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/26/2017] [Indexed: 11/12/2022] Open
Abstract
Thoracic ossification of the ligamentum flavum (TOLF) complicated with dural ossification (DO) is a severe clinical disease. The diagnosis of DO preoperatively remains challenging. The current study retrospectively analyzed imaging features of 102 segments with TOLF from 39 patients and proposed a grading system for evaluating DO risk. Logistic regression results showed that unilateral spinal canal occupational rate (UCOR), tram track signs, and C-signs were all risk factors for DO (odds ratios of 5.393, 19.734 and 72.594, respectively). In validation analyses for the TOLF-DO grading system, sensitivity was 76.0% (19/25), specificity was 91.0% (70/77), and Youden’s index was 0.66. Thus, implementation of the TOLF-DO grading system has the potential to improve the diagnosis of DO.
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Affiliation(s)
- Sheng-Yuan Zhou
- Department of Orthopaedics, Shanghai Changzheng Hospital, Fengyang Road No. 415, Shanghai, 200003, China
| | - Bo Yuan
- Department of Orthopaedics, Shanghai Changzheng Hospital, Fengyang Road No. 415, Shanghai, 200003, China
| | - Xiong-Sheng Chen
- Department of Orthopaedics, Shanghai Changzheng Hospital, Fengyang Road No. 415, Shanghai, 200003, China.
| | - Xue-Bin Li
- Department of Orthopaedics, Shanghai Changzheng Hospital, Fengyang Road No. 415, Shanghai, 200003, China
| | - Wei Zhu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Fengyang Road No. 415, Shanghai, 200003, China
| | - Lian-Shun Jia
- Department of Orthopaedics, Shanghai Changzheng Hospital, Fengyang Road No. 415, Shanghai, 200003, China
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Tang CYK, Cheung JPY, Samartzis D, Leung KH, Wong YW, Luk KDK, Cheung KMC. Predictive factors for neurological deterioration after surgical decompression for thoracic ossified yellow ligament. 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 2017; 26:2598-2605. [PMID: 28374331 DOI: 10.1007/s00586-017-5078-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/07/2017] [Accepted: 03/27/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the rate and predictive factors of post-operative neurological deterioration in ossified yellow ligament (OYL) surgery. METHODS A retrospective review was conducted for all patients with thoracic OYL causing myelopathy requiring surgical decompression from January 1998 to December 2012. Clinical parameters under study included clinical presentation, distribution of OYL, pre-operative walking score, pre- and post-operative neurological status, status of intra-operative neurophysiological monitoring, and modified Japanese Orthopaedic Association (mJOA) score. Any complications were also recorded. All outcomes were measured at post-operative 1 week and at 2 years. RESULTS A total of 26 patients were included in this study. Most patients (92.3%) had Frankel grade D pre-operatively. The rate of neurological deterioration was 15.4% and was correlated with the presence of dural tear, extra-dural hematoma and spinal cord injury. Pre-operative walking score was prognostic of patients' walking ability in the post-operative period. Intra-operative monitoring of Somatosensory Evoked Potentials (SSEP) was found to be useful for monitoring spinal cord injury in OYL surgery, with a positive predictive value of 100% and a negative predictive value of 92.3%. The false negative rate of a SSEP signal drop was only 7.7% CONCLUSIONS: This is the first study exploring risk factors for post-operative neurological deterioration after surgery for thoracic OYL. The rate of neurological deficit is not small and prognostic factors for poor outcome include poor pre-operative walking score, presence of intra-operative dural tear, extra-dural hematoma and spinal cord injury, and intra-operative drop of SSEP signal.
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Affiliation(s)
- Chris Yuk Kwan Tang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, Hong Kong, SAR, China.
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, Hong Kong, SAR, China
| | - Ka Hei Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, Hong Kong, SAR, China
| | - Yat Wa Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, Hong Kong, SAR, China
| | - Keith Dip Kei Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, Hong Kong, SAR, China
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Professorial Block, 5th Floor, 102 Pokfulam Road, Hong Kong, SAR, China.
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