Outcomes of Surgical Treatment for Thoracic Myelopathy

Onishi, Eijiro; Yasuda, Tadashi; Yamamoto, Hiroshi; Iwaki, Kentaro; Ota, Satoshi

doi:10.1097/brs.0000000000001622

Cited by 50 publications

(33 citation statements)

References 22 publications

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“…While there are no prospective studies in the literature examining outcomes or complications following surgical treatment of thoracic myelopathy secondary to OLF for comparison, Li et al 11 performed one of the larger retrospective studies of laminectomy with and without fusion in 85 patients with thoracic myelopathy due to OLF and found a complication rate of 51%. Another retrospective study performed by Onishi et al 10 examining laminectomy with and without fusion for thoracic myelopathy of various etiologies ( e.g ., OLF, disc herniation, spinal stenosis, ossified posterior longitudinal ligament) demonstrated an overall complication rate of 21% in 73 patients. Although these two studies cannot provide a perfectly equivalent comparison to our study, it appears that the complication rate found in our meta-analysis is consistent with prior literature.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…The trans-thoracic extra pleural, costotransversectomy and dorsal approaches all are associated with significant drawbacks from an exposure and technical perspective [9,10]. None of these approaches can be universally employed, and each is associated with approach-specific obstacles (Figure 9).…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Printing for Percutaneous Endoscopic Thoracic Discectomy in Thoracic Disc Herniations: Case Report and Anatomy Review

Zhou¹,

Yeung²,

Hui³

et al. 2017

J Spine

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Introduction: Thoracic disc herniations causing unrelenting neuralgia are relatively rare, especially cephalad to T-10 because the rib cage provides enough stability to offer relief with non-surgical methods over time. A transforaminal percutaneous endoscopic thoracic approach (PETD) however, is a feasible minimally invasive option for decompressing and removing the herniation without resorting to a more invasive and surgically more morbid open approach requiring thoracotomy and removal of the rib head through the thoracic cavity.

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“…Muscle strength was measured using the Motor Index Scoring System (MISS) ( Table 1) [9]. Self-reporting questionnaires were used to assess the recovery of subjective symptoms: the Short-Form 36 Health Survey Questionnaire (SF-36) was administered to all patients [10]; the Japanese Orthopedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and Neck Disability Index (NDI) were administered to patients with cervical myelopathy [11]; the JOA score was obtained for patients with thoracic myelopathy [12]; and the JOA Back Pain Evaluation Questionnaire [13]; and Oswestry Disability Index were administered to patients with lumbar disorders [14].…”

Section: Neurological and Clinical Outcome Assessmentmentioning

confidence: 99%

Clinical Significance of Improved Intraoperative Neurophysiological Monitoring Signal during Spine Surgery: A Retrospective Study of a Single-Institution Prospective Cohort

Lee

Kang

et al. 2020

Asian Spine J

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Study Design: Retrospective case series. Purpose: We reviewed the cases that showed significant improvement of intraoperative neurophysiological monitoring (IONM) signals during spine surgery to assess whether there is a correlation with signal improvement and postoperative clinical status and its clinical significance. Overview of Literature: To reduce the risk of neural injury, many spine surgeons are using multimodality IONM. Although many studies attempted to identify valid alarm criteria for predicting postoperative neurologic deterioration, studies concerning the improvement of IONM signals are rare. Methods: We reviewed all spine surgery cases with IONM data treated at our department between January 2013 and May 2017. We found cases showing significant IONM signal improvements. We prospectively analyzed the neurological and clinical outcomes of these patients and compared outcomes pre-and postoperatively. Results: Among 317 cases with the IONM data, we found 29 cases that showed IONM signal improvement compared with baseline. There were 27 cases of compressive myelopathy: 22 had a degenerative cause at the cervical spine, and five, at the thoracic spine. There were two cases of huge neurogenic tumor each at the craniovertebral junction and at the lumbar spine. Both motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) signals were improved in six cases, only the MEPs signal improved in 10, and only SSEP signal improved in 13 cases. All cases showed the IONM signal improvement consistently after the decompression procedure during surgery. All patients had a significant improvement in neurological function and subjective symptoms, and none had neurologic deterioration postoperatively. Conclusions: Improvement of IONM signals during surgery may indicate that no unrecognized neural injury occurred during surgery and a favorable postoperative neurological outcome can be expected.

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Outcomes of Surgical Treatment for Thoracic Myelopathy

Abstract: 4.

Cited by 50 publications

References 22 publications

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

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

Three-Dimensional Printing for Percutaneous Endoscopic Thoracic Discectomy in Thoracic Disc Herniations: Case Report and Anatomy Review

Clinical Significance of Improved Intraoperative Neurophysiological Monitoring Signal during Spine Surgery: A Retrospective Study of a Single-Institution Prospective Cohort

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