Treatment for Thoracic Ossification of Posterior Longitudinal Ligament with Posterior Circumferential Decompression.

Autor: Xu ZW; Department of Spine Surgery, Weifang People's Hospital, Weifang, China., Hu YC; Department of Bone Oncology, Tianjin Hospital, Tianjin, China., Sun CG; Department of Orthopaedics, Peking University Third Hospital, Beijing, China., Shang XP; Department of Spine Surgery, Weifang People's Hospital, Weifang, China., Lun DX; Department of Spine Surgery, Weifang People's Hospital, Weifang, China., Li F; Department of Spine Surgery, Weifang People's Hospital, Weifang, China., Ji XB; Department of Spine Surgery, Weifang People's Hospital, Weifang, China., Liu DY; Department of Spine Surgery, Weifang People's Hospital, Weifang, China., Chen NW; Department of Spine Surgery, Weifang People's Hospital, Weifang, China., Zhuang QS; Department of Spine Surgery, Weifang People's Hospital, Weifang, China.
Jazyk: angličtina
Zdroj: Orthopaedic surgery [Orthop Surg] 2017 May; Vol. 9 (2), pp. 206-214. Date of Electronic Publication: 2017 Jun 14.
DOI: 10.1111/os.12331
Abstrakt: 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 scores 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.
(© 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)
Databáze: MEDLINE
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