Bo An1, Xing-Chen Li2, Cheng-Pei Zhou1, Bi-Sheng Wang2, Hao-Ran Gao1, Hai-Jun Ma2, Yi He2, Hong-Gang Zhou2, He-Jun Yang3, Ji-Xian Qian4. 1. Department of Orthopedics, Tangdu Hospital Affiliated to Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710000, Shanxi Province, China. 2. Department of Spinal Surgery, Third Hospital of Henan Province, No.198, Funiu Road, Zhongyuan District, Zhengzhou, 450000, Henan Province, China. 3. Department of Spinal Surgery, Third Hospital of Henan Province, No.198, Funiu Road, Zhongyuan District, Zhengzhou, 450000, Henan Province, China. syyanghejun@sina.com. 4. Department of Orthopedics, Tangdu Hospital Affiliated to Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, 710000, Shanxi Province, China. pasmiss2012@163.com.
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.
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.
Entities:
Keywords:
Minimally invasive; Ossification of the ligamentum flavum; Percutaneous full endoscopic posterior decompression; Thoracic myelopathy
Authors: Sung Uk Kuh; Young Soo Kim; Yong Eun Cho; Byung Ho Jin; Keun Su Kim; Young Sul Yoon; Dong Kyu Chin Journal: Eur Spine J Date: 2005-05-18 Impact factor: 3.134