Clinical outcomes after decompressive laminectomy for symptomatic ossification of ligamentum flavum at the thoracic spine

Zhong, Zhaoming; Wu, Qian; Meng, Tao; Zhu, Yongjian; Qu, Dongbin; Wang, Jixing; Jiang, Jianming; Lu, Kai-wu; Zheng, Shuai; Zhu, Siyuan; Chen, Jianting

doi:10.1016/j.jocn.2015.09.023

Cited by 44 publications

(53 citation statements)

References 23 publications

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“…The mean Hirabayashi recovery rate was 65.49%. However, surgical complications occurred such as dural tear in five patients and CSF leakage, immediate postoperative neurologic deterioration, epidural hematoma, and wound infection in one patient each, respectively 30) . Ando et al 31) reported that the risk factors related to surgical outcomes were duration of the disease, combined ossification of the dura mater, and the presence of discontinuous type ossification of the anterior longitudinal ligament (OALL).…”

Section: Surgical Resultsmentioning

confidence: 95%

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Ossification of the ligamentum flavum

Hirabayashi

2017

Spine Surg Relat Res

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Abstract:Ossification of the ligamentum flavum (OLF or OYL: ossification of the yellow ligament) usually occurs at the lower thoracic level and causes various types of neurological symptoms in accordance with the compression level of the spinal cord, the nerve roots, the conus medullaris, and the cauda equina. Although the greatest compression level to the nerve tissues is thought to be the most pathognomonic one, it is difficult to diagnose it in some cases. The effectiveness of conservative treatment such as applying a corset is small. Early surgical treatment is strongly recommended for the patients with spastic gait, severe decrease of muscle power in the lower extremities, bladder-bowel disturbance, combined ossification of the posterior longitudinal ligament at the same level, and severe compression to the spinal cord due to thickly hypertrophied ossification. However, numbness of the lower extremities and spastic gait tend to remain even after surgery. . Some information is added here, especially concerning genetic studies, recent etiological studies, and surgical results. This article is being permitted to be published as an updated second version by the editors on both sides. ConceptThe ligamentum flavum locates within the spinal canal posterolaterally connecting two adjacent laminae and is divided into two portions: capsular portion and interlaminar portion 2) . It is composed of 80% elastic fiber and 20% collagen fiber 3) . OLF is a neurological disease in which the ligamentum flavum is chronically ossified and compresses the spinal cord, the nerve roots, the conus medullaris, and cauda equine to various degrees and extents. It can be said that it is a presentation of degenerative changes of the whole spinal column due to aging, and at the same time, it is one of the presentations of systematic ossification trait of the vertebral ligaments. It usually occurs at the lower thoracic level combined with ossification of the posterior longitudinal ligament (OPLL) at the cervical and/or thoracic levels. CauseAlthough the cause of the ossification of the vertebral ligaments is yet unclear, two factors are conjectured: systematic factors and local factors. The former includes heredity, abnormal metabolism of carbohydrate, abnormal metabolism of calcium, abnormal secretion of gender hormone, and degeneration of the ligament, and so on. The latter includes mechanical stress to the enthesis where the ligament attaches to the bone, especially at the capsular portion.The chondrocytes are activated by mechanical stress and produce high volume of type-II collagen, and that type-II collagen is then transformed into type-I collagen in the course of endochondral ossification, resulting in formation of bone within the vertebral ligament 4) . Concerning OPLL, it is reported that collagen 11A2 gene and collagen 6A1 gene are related to its formation 5) . It is also reported that in OPLL, growth factors and transcription factors such as cartilage-derived morphogenetic protein-1, promyelocytic leukemia zinc finger...

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Section: Surgical Resultsmentioning

confidence: 95%

“…The surgical methods include open-door type laminectomy, en bloc laminectomy, fenestration, and hemilaminectomy 22,[27][28][29][30][31][32] . In patients in whom the dura mater is ossified and adhered to the OLF, both the ossified dura mater and OLF are resected en bloc with preserving arachnoid.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Ossification of the ligamentum flavum

Hirabayashi

2017

Spine Surg Relat Res

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“…7,8 Most commonly, a posterior laminectomy, with or without fusion, is performed to decompress the spinal cord. However, other techniques such as fenestration, laminoplasty, and hemilaminectomy have been reported as well.…”

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confidence: 99%

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum

Osman

Cheung

Hussain

et al. 2018

Spine

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Study Design. Systematic review and meta-analysis. Objective. Examine the functional outcomes and complications following laminectomy for thoracic myelopathy due to ossification of the ligamentum flavum (OLF). Summary of Background Data. OLF is a rare condition that can cause thoracic myelopathy. Laminectomy is a procedure that can be performed to decompress the spinal cord in patients with thoracic myelopathy due to OLF. Few studies have examined postoperative outcomes and complications following laminectomy for thoracic myelopathy secondary to OLF. Methods. A systematic review and meta-analysis was performed. Literature search yielded six studies that met our selection criteria. Study characteristics and baseline patient demographics were extracted from each study. Primary outcomes included pre- and postoperative Japanese Orthopedic Association (JOA) scores and perioperative complications including dural tears, cerebrospinal fluid (CSF) leaks, neurological deficits, surgical site infections, and other complications. We calculated pooled proportion estimates for JOA scores and complications using a random effects model. Results. A total of 137 patients were included. The pooled pre-and postoperative JOA scores were 5.08 (95% confidence interval [CI], 2.70–7.47; I2 = 98%) and 8.29 (95% CI, 7.73–8.85; I2 = 18%), respectively, with a mean improvement of +3.03 points (95% CI, 1.08–4.98; I2 = 88%). Pooled proportion estimates for dural tears, CSF leaks, infections, and early neurological deficits were 18.4% (95% CI, 12.6–26.1; I2 = 0%), 12.1% (95% CI, 6.6–21.2; I2 = 0%), 5.8% (95% CI, 2.1–15.4; I2 = 0%), and 5.7% (95% CI, 2.2–14.3; I2 = 0%), respectively. Conclusion. Thoracic myelopathy secondary to OLF can be treated with laminectomy. However, despite some improvement in JOA score, functional status remains poor postoperatively. Perioperative complications are common, with dural tears and CSF leaks occurring most frequently. OLF is an uncommon condition and more research is needed to better understand how we can improve the outcomes of laminectomy alone for the treatment of thoracic myelopathy due to OLF.

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“…Previously, the use of intraoperative sequential nerve electrophysiological monitoring has been reported to aid in the avoidance of serious spinal injury [29–31]. Anatomically, the spinal canal in the thoracic region is smaller than in the lumbar areas, which allows less room for operating [32]. Consequently, surgery is harder to perform in the thoracic spinal canal than in the lumbar region [33].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for resection of ossification of the ligamentum flavum in the thoracic spine.

Zhao¹,

Shen²,

Cai³

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionThoracic ossification of the ligamentum flavum (TOLF) is a common cause of progressive thoracic myelopathy. Surgical decompression is commonly used to treat TOLF.AimTo evaluate the clinical outcomes of microsurgical decompression of TOLF via a paraspinal approach, using a percutaneous tubular retractor system.Material and methodsFirst, three-dimensional (3D) image reconstruction and printed models were made from thin computed tomography scans for each patient. Then, 3D computer-assisted virtual surgery was performed using the 3D reconstruction to calculate the precise location and sizes of the bone window and the angle of insertion of the percutaneous tubular retractor system. In total, 13 patients underwent the surgery through the percutaneous micro channel unilateral vertebral approach under electrophysiological monitoring. Five days after the surgery, increased creatine phosphokinase levels returned to preoperative levels. The Japanese Orthopedic Association (JOA) score was improved and computed tomography reconstruction and magnetic resonance imaging of the thoracic spine showed that decompression was achieved without injuries to the spinal cord or nerve root. The stability of the spine was not affected, nor were any deformities of the spine detected. Finally, nerve functional recovery was achieved with minimal injury to the paraspinal muscle, articulum, spinous process and ligament.ResultsThe mean operative time was 98.23 ±19.10 min, and mean blood loss was 19.77 ±5.97 ml. At a mean follow-up of 13.3 months (median: 12 months), the mean JOA score was 7.54 ±1.13 at the final follow-up, yielding a mean RR of 49.10 ±15.71%. Using The recovery rate, 7 (53.85%) patients had good outcomes, 5 (38.46%) patients had a fair outcome, and 1 (7.69%) patient had poor outcomes, indicating significant improvement by the final follow-up examination (p < 0.05).ConclusionsThe 3D printed patient model-based microsurgical resection of TOLF via the paraspinal approach can achieve decompression of the spinal canal with minimal complications, faster recovery and improved stability of the vertebral body.

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Clinical outcomes after decompressive laminectomy for symptomatic ossification of ligamentum flavum at the thoracic spine

Cited by 44 publications

References 23 publications

Ossification of the ligamentum flavum

Ossification of the ligamentum flavum

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum

Minimally invasive surgery for resection of ossification of the ligamentum flavum in the thoracic spine.

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