Jingchuan Sun1, Kaiqiang Sun1, Jiangang Shi2, Ximing Xu1, Yuan Wang1, Qingjie Kong1. 1. Second Department of Spine Surgery, Changzheng Hospital, 601 Room, 415# Fengyang Road, Huangpu District, Shanghai, China. 2. Second Department of Spine Surgery, Changzheng Hospital, 601 Room, 415# Fengyang Road, Huangpu District, Shanghai, China. shijiangang616@163.com.
Abstract
PURPOSE: This study aims to investigate the clinical effect and complications of a novel technique named bridge crane for the treatment of the severe thoracic ossification of the ligamentum flavum (TOLF) with myelopathy. METHOD: A patient diagnosed as TOLF (T9-T11) was treated with the bridge crane technique and the outcomes were reported. The main surgical procedures include installation of pedicle screws, rods and transverse connectors; preparation of stay prolene sutures passing through the laminae-OLF complex (LOC); en bloc isolation of the LOC; tightening of the sutures to achieve posterior suspension of the LOC; and fixation of the LOC to the transverse connectors. The modified Japanese Orthopaedic Association (mJOA) scale was studied. The pre- and postoperative radiological parameters and surgical complications were also investigated. RESULTS: Postoperative CT and MRI showed a sufficient decompression of spinal cord by the technique of bridge crane. The ratio of spinal canal encroachment improved significantly. At the final follow-up assessment, no specific complications were identified. Imaging information suggested that the bone graft was fused and the "bridge" was in good position. The mJOA score was 9 with a recovery rate of 75% at the final follow-up. CONCLUSIONS: The technique of bridge crane is feasible and may be relatively safe and effective for the treatment of severe TOLF with myelopathy. However, further studies with large-scale cases and control groups are required to reveal the generalizability and safety of the bridge crane technique in the future. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: This study aims to investigate the clinical effect and complications of a novel technique named bridge crane for the treatment of the severe thoracic ossification of the ligamentum flavum (TOLF) with myelopathy. METHOD: A patient diagnosed as TOLF (T9-T11) was treated with the bridge crane technique and the outcomes were reported. The main surgical procedures include installation of pedicle screws, rods and transverse connectors; preparation of stay prolene sutures passing through the laminae-OLF complex (LOC); en bloc isolation of the LOC; tightening of the sutures to achieve posterior suspension of the LOC; and fixation of the LOC to the transverse connectors. The modified Japanese Orthopaedic Association (mJOA) scale was studied. The pre- and postoperative radiological parameters and surgical complications were also investigated. RESULTS: Postoperative CT and MRI showed a sufficient decompression of spinal cord by the technique of bridge crane. The ratio of spinal canal encroachment improved significantly. At the final follow-up assessment, no specific complications were identified. Imaging information suggested that the bone graft was fused and the "bridge" was in good position. The mJOA score was 9 with a recovery rate of 75% at the final follow-up. CONCLUSIONS: The technique of bridge crane is feasible and may be relatively safe and effective for the treatment of severe TOLF with myelopathy. However, further studies with large-scale cases and control groups are required to reveal the generalizability and safety of the bridge crane technique in the future. These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Bridge crane; Compression of spinal cord; Ossification of ligamentum flavum; Ossification of the yellow ligament; Surgical technique; Thoracic myelopathy
Authors: Jiong Jiong Guo; Keith D K Luk; Jaro Karppinen; Huilin Yang; Kenneth M C Cheung Journal: Spine (Phila Pa 1976) Date: 2010-01-01 Impact factor: 3.468