Decompression Procedure using a Microendoscopic Technique for Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Ikuta, Kentaro; Tarukado, Kiyoshi; Senba, Hideyuki; Kitamura, Takahiro; Komiya, Norihiro; Fukutoku, Y.; Shidahara, Satoshi

doi:10.1055/s-0031-1297986

Cited by 24 publications

(21 citation statements)

References 5 publications

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“…Some research showed that, if OLF encroached dura mater, we can select 'floating method' which is a microscopic technique for decompression to avoid CSF leakage. 73,74 Another serious surgical complication in thoracic OLF surgery is spinal cord injury. 62,75,76 Several procedures were followed with the aim of minimizing the risk of spinal cord injury.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Ren

Zhao

et al. 2015

Spinal Cord

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Study design: A retrospective comparative study. Objectives: To describe the clinical features and radiological findings, to assess the safety and effectiveness of posterior decompressive laminectomy and resection of the ossification of the ligamentum flavum (OLF), and to determine which presurgical and surgical variables were most closely related to postsurgical prognosis of thoracic myelopathy (TM) caused by OLF in China. Methods: Eighty-five patients with the diagnosis of TM caused by OLF received surgical treatment from July 1998 to May 2012. Clinical data were collected from medical and operative records. Correlations between the surgical outcome and various factors were also analyzed. Results: All cases were followed up for a mean of 49.2 months (range, 24-190 months) postoperatively. The mean Japanese Orthopaedic Association score was 3.8 points preoperatively and 8.2 points at the final follow-up, yielding a mean recovery rate of 63.0%. Postoperative complications included transient neurological deficits (9 cases), persistent neurological deficits (4 cases), dural tears (17 cases), cerebrospinal fluid leakage (9 cases), wound dehiscence (2 cases) and wound infection (3 cases). The OLF level (middle thoracic), preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were important predictors of surgical outcome. Conclusions: Biomechanical and anatomical factors may have a key role in thoracic OLF progression. Posterior decompressive laminectomy and resection of the OLF can be considered an effective, reliable and safe alternative procedure. The OLF level, preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were confirmed and significantly correlated with the surgical outcome.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Ren

Zhao

et al. 2015

Spinal Cord

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“…However, only a few case reports are available on the use of this approach for treatment of thoracic OLF. Ikuta et al reported successful microendoscopic decompression of OLF at T11/12, but concluded that because of technical difficulties, this procedure is only indicated for particular cases of thoracic OLF, such as those without fusion at the middle of the spinal canal and OLF in the absence of dural ossification [25]. Wang et al also reported successful treatment of OLF at T10/11 using MISS and an expandable tubular retractor system to enable extensive retraction of the surgical area (a 3-cm skin incision is required) [26].…”

Section: Discussionmentioning

confidence: 99%

Microendoscopic posterior decompression for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum: a technical report

Baba

Oshima

Iwahori³

et al. 2015

Eur Spine J

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“…Pro ble mem jest znacz nie ogra ni czo na kwali fi ka cja do te go ty pu za bie gów. Zrost skost nień z oponą twar dą rdze nia krę go we go spra wia, że za bieg ope racyj ny sta je się trud ny i znacz nie wzra sta ry zy ko śródo pe ra cyj ne go uszko dze nia opo ny twar dej z wy cie kiem pły nu mó zgo wo -rdze nio we go oraz za pa le nia opon mózgo wo -rdze nio wych [39]. Le cze nie ope ra cyj ne nie zawsze przy no si po zy tyw ny re zul tat.…”

Section: Treatmentunclassified

“…The seriously limited qualification criteria for this type of surgery constitute a major problem, however. The adhesion of ossifications to the dura mater of the spinal cord complicates surgery and significantly increases the risk of intraoperative damage to the dura mater with seepage of cerebro-spinal fluid and meningitis of the brain and spinal cord [39]. Surgical treatment does not always produce a positive outcome.…”

Section: Podsumowaniementioning

confidence: 99%

Contemporary views on the ossification of the ligamenta flava

Kłosiński

Skrzat²,

Walocha³

et al. 2012

Ortopedia, traumatologia, rehabilitacja

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Wię za dła żół te są struk tu ra mi, któ re wraz z blasz ka mi łu ków krę go wych, bu du ją tyl ną ścia nę ka na łu krę gowe go. Bez po śred nie są siedz two z struk tu ra mi ner wo wy mi rdze nia krę go we go po wo du je, że ka żda pa to lo gia pro wa dzą ca do ich prze ro stu pro wa dzi w kon se kwen cji do za bu rzeń neu ro lo gicz nych. Jed ną z naj częst szych przy czyn ta kie go prze ro stu jest he te ro to po we kost nie nie. Głów ny mi re jo na mi świa ta do tknię ty mi tym scho rzeniem są kra je Azji, zwłasz cza Ja po nia. Zda rza ją się jed nak co raz częst sze przy pad ki wy stę po wa nia skost nień wię za deł żół tych wśród in nych po pu la cji. Za naj wa żniej szą przy czy nę two rze nia się ek to pi czej tkan ki kost nej w ob rę bie tych wię za deł uwa ża się stres me cha nicz ny o cha rak te rze ro ta cyj nym i roz cią go wym, a ta kże uwarun ko wa nia ge ne tycz ne. Le cze nie tej pa to lo gii ogra ni cza się głów nie do pro ce dur ope ra cyj nych. Ni niej szy arty kuł jest prze glą dem współ cze snej wie dzy na te mat przy czyn he te ro to po we go kost nie nia wię za deł żół tych, skut ków wy wo ły wa nych przez to scho rze nie oraz spo so bów ich le cze nia. Sło wa klu czo we: wię za dła żół te, kost nie nie he te ro to po we, ka nał krę go wy, krę go słup SUMMARY The ligamenta flava, together with the vertebral lamina, form the posterior wall of the spinal canal. Since they are located immediately adjacent to the nerve structures of the spinal cord, every pathology that involves hypertrophy produces neurological disturbances as a result. One of the most common reasons for hypertrophy of the ligamenta flava is heterotopic ossification. The main regions of the world where this disorder occurs are the Asian countries, especially Japan, but there are increasing numbers of such cases in other populations. The most important causes of the formation of ectopic osseous tissue in the vicinity of the ligamenta flava are thought to be mechanical stress and genetic predisposition. Treatment is mostly limited to surgical procedures. The present study is a review of the current state of our knowledge concerning the ossification of the ligamenta flava, the sequelae of this pathology, and the treatment methods.

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Decompression Procedure using a Microendoscopic Technique for Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Cited by 24 publications

References 5 publications

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

Microendoscopic posterior decompression for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum: a technical report

Contemporary views on the ossification of the ligamenta flava

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