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

Baba, Shigeaki; Oshima, Yasushi; Iwahori, Tomoyuki; Takano, Yuichi; Inanami, Hirohiko; Koga, Hisashi

doi:10.1007/s00586-015-4158-9

Cited by 47 publications

(42 citation statements)

References 35 publications

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“…A 8-mm skin and fascia incision was made at the target spinal level under fluoroscopic guidance. The muscle attached to the underneath ligamentum flavum and inner surface of the facet joint was carefully detached using an obturator in a similar manner to the operating technique for MED (14). Next, a 30-degree angled-working sheath was inserted onto the ligamentum flavum, and the ligamentum was removed using several types of forceps.…”

Section: Surgical Techniquementioning

confidence: 99%

Consideration of proper operative route for interlaminar approach for percutaneous endoscopic lumbar discectomy

Tonosu¹,

Oshima

Shiboi³

et al. 2016

J. Spine Surg.

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Section: Surgical Techniquementioning

confidence: 99%

Consideration of proper operative route for interlaminar approach for percutaneous endoscopic lumbar discectomy

Tonosu¹,

Oshima

Shiboi³

et al. 2016

J. Spine Surg.

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“…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]. The use of a slender high-speed diamond grinding head is thus recommended in the surgical procedure, which decreases the risk of spinal cord and blood supply injury from a Kerrison rongeur.…”

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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“…For the fused type, the ossification of bilateral ligamentum flavum fused at the midline, and no epidural fat was observed on MRI at the most severe narrowing compressed level (Figures 1, 2). For the nonfused type, the ossification of bilateral ligamentum flavum did not fuse at the midline as apparent on CT, and epidural fat was recorded by MRI at the most severe narrowing level (Figures 3,4). In definition, the level where the spinal cord was deformed morphologically by the OLF, as visible on sagittal MRI, is the most severe narrowing level.…”

Section: Classification Of Olfmentioning

confidence: 95%

Surgical strategies for thoracic myelopathy due to ossification of ligamentum flavum: a technical note based on radiological type

Wang

Du²,

Zheng³

et al. 2017

Turkish Neurosurgery

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

Abstract: Microendoscopic posterior decompression combined with MEP monitoring can be used to treat patients with thoracic OLF. The optimal surgical indication is OLF at a single vertebral level and of a unilateral or bilateral nature, without comma and tram track signs, and a round morphology.

Cited by 47 publications

References 35 publications

Consideration of proper operative route for interlaminar approach for percutaneous endoscopic lumbar discectomy

Consideration of proper operative route for interlaminar approach for percutaneous endoscopic lumbar discectomy

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

Surgical strategies for thoracic myelopathy due to ossification of ligamentum flavum: a technical note based on radiological type

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