Full-endoscopic decompression for thoracic ossification of ligamentum flavum: surgical techniques and clinical outcomes

Li, Wenyi; Gao, Shangju; Zhang, Long; Cao, Can; Wei, Jingchao

doi:10.1097/md.0000000000022997

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…In total, 23 relevant studies were included in this analysis, 10–32 enrolling 323 patients (177 males, 146 females) with a mean age of 58.40±10.06 years (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification

Ye,

Guo,

et al. 2023

Spine

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Study Design. Systematic review and meta-analysis. Objective. This study systematically reviewed and evaluated the safety and efficacy of spinal endoscopic techniques as a treatment for thoracic ligamentum flavum ossification (TOLF). Summary of Background Data. The use of spinal endoscopic techniques for the treatment of TOLF has increased in recent years. The present study is the first comprehensive systematic review and meta-analysis focused on the use of spinal endoscopic techniques for TOLF. Methods. The Cochrane Central, PubMed, Web of Science, and Embase databases were systematically searched for studies focused on patients undergoing spinal endoscopic techniques to treat symptomatic TOLF. Results. This meta-analysis included 23 studies. We included 323 patients (177 males, 146 females) with a mean age of 58.40±10.06 years, with 304 total recorded lesion locations of which 245 were located in the lower thoracic spine. Complications affected 35/323 patients, and the mean operative duration for 305 patients was 108.15±47.34 minutes. For 187 patients, the mean operative bleeding was 25.13±12.54 mL, while for 87 patients the mean duration of hospitalization was 4.59±1.93 days. At last follow-up，functional assessment was performed for 260 patients, of whom 200 were in excellent condition, visual analog scale (VAS) scores were assessed for 160 patients, with a mean improvement of 4.40 (3.95,4.86) Japanese Orthopedic Association (JOA) scores were recorded for 115 patients, with a mean improvement of 2.99 (2.77,3.22) , and modified Japanese Orthopedic Association (mJOA) scores were recorded for 208 patients, with a mean improvement of 3.41 (3.17,3.64) . Conclusions. These results support several advantages of spinal endoscopic techniques for the treatment of symptomatic TOLF. These include low complication rates, rapid postoperative recovery, and good functional recovery when used for single-segment, non-nodular ossification and no combined dural ossification.

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“…In total, 23 relevant studies were included in this analysis, 10–32 enrolling 323 patients (177 males, 146 females) with a mean age of 58.40±10.06 years (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification

Ye,

Guo,

et al. 2023

Spine

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“…With the evolution of endoscopic surgical tools, endoscopic techniques in spine surgery have gradually found utility in the treatment of TOLF. When compared with open surgeries, FESS procedures offer benefits in terms of minimal invasiveness and expedited recovery 9 – 11 . Nevertheless, FESS approaches have shown some new issues including limitations due to the coaxial approach in a single hole endoscope, a steep learning curve, and necessitating surgeons to possess extensive experience in endoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Recent advancements in minimally invasive spine techniques have shown the prospective application of full endoscopic spine surgeries (FESS) in treating TOLF 9 – 11 . However, these procedures are limited because of the steep learning curves in FESS, and controversies remain regarding approach selection, surgical instruments, and decompression strategies.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of one-hole split endoscope technique for surgical treatment of thoracic ossification of the ligamentum flavum

Sha,

Huang,

Liu

et al. 2024

Sci Rep

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Surgical intervention is typically recommended for thoracic ossification of the ligamentum flavum (TOLF). This study aimed to evaluate the efficacy and safety of a novel non-coaxial one-hole split endoscope (OSE) technique for treating TOLF. We performed OSE procedure on 13 patients with TOLF from June 2022 to July 2023. The mean operative time was 117.5 ± 15.4 min. VAS scores for lower limbs decreased from 6.5 ± 0.8 preoperative to 1.6 ± 0.4 at the last follow-up (P < 0.001). ODI scores improved from 62.4 ± 5.7 preoperative to 18.6 ± 2.2 at the last follow-up (P < 0.001), and mJOA scores increased from 5.1 ± 1.6 preoperative to 8.4 ± 1.5 at the latest follow-up (P < 0.001). All patients achieved ASIA scale grade D or E at the final follow-up, except for two patients remained residual limb numbness. None of the thirteen patients suffered from severe perioperative complications. The OSE technique proves to be a safe and effective procedure for treating TOLF or even with dura mater ossification, characterized by minimal surgical trauma, relatively smooth learning curve and flexible operation.

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“…Rutten et al reported a 20% (5/25) rate of complications including 1 dural tear, 1 epidural hematoma, 2 transient intercostal neuralgias, and 1 deterioration of myelopathy [ 28 ]. In our previous research on the endoscopic surgery for thoracic OLF, we found complications such as neck pain and dural tear [ 29 ]. However, no complication was observed in this study or in Choi and Guo's.…”

Section: Discussionmentioning

confidence: 99%

Full-Endoscopic Transforaminal Ventral Decompression for Symptomatic Thoracic Disc Herniation with or without Calcification: Technical Notes and Case Series

Gao

Wei

et al. 2021

Pain Research and Management

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Background. Symptomatic thoracic disc herniation is a challenge in spinal surgery, especially for cases with calcification. Traditional open operation has a high complication rate. The authors introduced a modified full-endoscopic transforaminal ventral decompression technique in this study and evaluated its imaging and clinical outcomes. Materials and Methods. Eleven patients with symptomatic thoracic disc herniation who underwent full-endoscopic transforaminal ventral decompression in a single medical center were enrolled. The surgical technique was performed as described in detail. Dilator sliding punching, endoscope-monitored foraminoplasty, and base cutting through the “safe triangle zone” are the key points of the technique. Clinical outcomes were assessed by the modified Japanese Orthopedic Association (mJOA) score for neurological improvement and the visual analogy score (VAS) for thoracic and leg pain. The operation time, hospital stay, and complications were also analyzed. Results. Postoperative magnetic resonance imaging (MRI) revealed good decompression of the spinal cord. The mJOA improved from 7.4 (range: 5–10) to 10.2 (range: 9–11). Axial thoracic pain improved in 8 of 9 patients. Leg pain and thoracic radicular pain improved in all patients. No complications were observed. The average operation time was 136 minutes (range: 70–180 minutes). The average length of hospital stay was 5.3 days (range: 2–8 days). Conclusion. Minimally invasive full-endoscopic transforaminal ventral decompression for the treatment of symptomatic thoracic disc herniation with or without calcification is feasible and may be another option for this challenging spine disease.

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Full-endoscopic decompression for thoracic ossification of ligamentum flavum: surgical techniques and clinical outcomes

Abstract: Supplemental Digital Content is available in the text

Cited by 10 publications

References 19 publications

Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification

Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification

Safety and efficacy of one-hole split endoscope technique for surgical treatment of thoracic ossification of the ligamentum flavum

Full-Endoscopic Transforaminal Ventral Decompression for Symptomatic Thoracic Disc Herniation with or without Calcification: Technical Notes and Case Series

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