Longjie Wang1, Hui Wang1, Zhongqiang Chen1, Chuiguo Sun1, Weishi Li2,3. 1. Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China. 2. Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China. puh3liweishi@163.com. 3. Beijing Key Laboratory of Spinal Disease Research, Beijing, China. puh3liweishi@163.com.
Abstract
PURPOSE: Non-continuous thoracic spinal stenosis (NTSS) is a rare disease, but it is a challenging clinical entity for spine surgeons. However, few studies have focused on its treatment. Therefore, the purpose of this study was to provide surgical treatment guidelines for it by comparing the clinical outcomes of different surgical approaches. METHODS: Patients who underwent thoracic decompression surgery for two diseased segments with two incisions (normal segments ≥ 3) between January 2010 and December 2018 were included. Among these patients, nine were treated with posterior decompression (PD) and circumferential decompression (CD) procedures in one-stage surgery (group A), 14 with PD and CD procedures in two-stage surgery (group B), 36 patients with PD procedures in one-stage surgery and 15 with PD procedures in two-stage surgery (group D). Medical records, operative time, blood loss and complications were reviewed. Neurologic status was assessed by the modified Japanese Orthopaedic Association scale for thoracic myelopathy. RESULTS: Groups A, B, C and D were followed for 54.11 ± 20.51 months, 49.36 ± 29.30 months, 49.94 ± 31.94 months and 39.93 ± 26.18 months, respectively. When comparing groups A and B, operative time, blood loss and length of stay in hospital were significantly less in group A. However, the average recovery rate in group B was significantly higher than that in group A. In regard to groups C and D, group C showed a significantly shorter length of stay in hospital and lower rate of post-operative neurological deterioration. At final follow-up, groups C and D showed similar average recovery rates. CONCLUSION: Different surgical procedures are suitable for different types of NTSS. For patients with NTSS mainly caused by posterior compression, PD via laminectomy in one-stage with two incisions can achieve satisfying clinical outcomes. Staged surgery, including CD and PD procedures, is recommended for patients with NTSS mainly caused by anterior compression.
PURPOSE: Non-continuous thoracic spinal stenosis (NTSS) is a rare disease, but it is a challenging clinical entity for spine surgeons. However, few studies have focused on its treatment. Therefore, the purpose of this study was to provide surgical treatment guidelines for it by comparing the clinical outcomes of different surgical approaches. METHODS: Patients who underwent thoracic decompression surgery for two diseased segments with two incisions (normal segments ≥ 3) between January 2010 and December 2018 were included. Among these patients, nine were treated with posterior decompression (PD) and circumferential decompression (CD) procedures in one-stage surgery (group A), 14 with PD and CD procedures in two-stage surgery (group B), 36 patients with PD procedures in one-stage surgery and 15 with PD procedures in two-stage surgery (group D). Medical records, operative time, blood loss and complications were reviewed. Neurologic status was assessed by the modified Japanese Orthopaedic Association scale for thoracic myelopathy. RESULTS: Groups A, B, C and D were followed for 54.11 ± 20.51 months, 49.36 ± 29.30 months, 49.94 ± 31.94 months and 39.93 ± 26.18 months, respectively. When comparing groups A and B, operative time, blood loss and length of stay in hospital were significantly less in group A. However, the average recovery rate in group B was significantly higher than that in group A. In regard to groups C and D, group C showed a significantly shorter length of stay in hospital and lower rate of post-operative neurological deterioration. At final follow-up, groups C and D showed similar average recovery rates. CONCLUSION: Different surgical procedures are suitable for different types of NTSS. For patients with NTSS mainly caused by posterior compression, PD via laminectomy in one-stage with two incisions can achieve satisfying clinical outcomes. Staged surgery, including CD and PD procedures, is recommended for patients with NTSS mainly caused by anterior compression.
Authors: Jeffery Head; George Rymarczuk; Geoffrey Stricsek; Lohit Velagapudi; Christopher Maulucci; Christian Hoelscher; James Harrop Journal: Neurospine Date: 2019-09-30