Open AccessTreatment for Thoracic Ossification of Posterior Longitudinal Ligament with Posterior Circumferential Decompression
Author(s) -
Xu Zhaowan,
Hu Yongcheng,
Sun Chuiguo,
Shang Xiaopeng,
Lun Dengxing,
Li Feng,
Ji Xubin,
Liu Dayong,
Chen Naiwang,
Zhuang Qingshan
Publication year - 2017
Publication title -
orthopaedic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.666
H-Index - 23
eISSN - 1757-7861
pISSN - 1757-7853
DOI - 10.1111/os.12331
Subject(s) - ossification of the posterior longitudinal ligament , medicine , posterior longitudinal ligament , decompression , anatomy , thoracic spine , surgery , ossification , myelopathy , spinal cord , psychiatry
Objective To report the results of the posterior approach for thoracic ossification of posterior longitudinal ligament ( TOPLL ) by using a special “L” osteotome. Methods The present study enrolled 16 consecutive patients (9 men and 7 women) between May 2009 and September 2013. All patients underwent a posterior circumferential decompression osteotomy and segmental instrumentation with interbody fusion. The mean age at surgery was 57.3 years (range, 37–68 years). Patients’ data, clinical manifestation, blood loss, length of surgery, complications, visual analog scale ( VAS ), Japanese Orthopedic Association ( JOA ), and Frankel grading system before and after surgery were collected and evaluated, retrospectively. Results The average follow‐up period was 30 ± 19 months (range, 12–50 months). All patients were successfully treated with posterior compression and segmental instrumentation with interbody fusion. The average operation time was 261.6 ± 51.3 min (range, 190–310 min). The mean blood loss was 980.3 ± 370.5 mL (range, 600–2100 mL). All patients had subjective improvement of motor power and gait. Average preoperative and postoperative JOA scores were 4.2 ± 1.7 and 7.8 ± 2.5 points, respectively. Differences in the overall JOA s cores showed significant postoperative improvement. At the last follow‐up, all patients improved either by one or two Frankel grades. There was a significant difference between preoperative VAS scores and those 3 months after surgery ( P < 0.05). No significant difference was observed between the 3‐month and 12‐month results ( P > 0.05). Cerebrospinal fluid ( CSF ) leakage occurred in 3 patients. Acute neurological deterioration was encountered postoperatively in 1 patient. Conclusion Treatment with posterior transpedicular osteotomy and circumferential decompression was found to be safe, effective, reliable, and technically feasible, and keeping the thoracic cavity intact avoids many shortcomings of anterior surgery and results in a satisfactory spinal decompression.