Surgical Technique for Decompression of Severe Thoracic Myelopathy due to Tuberous Ossification of Ligamentum Flavum

Wang, Ting; Yin, Chuqiang; Wang, Dechun; Li, Shuzhong; Chen, Xiaoliang

doi:10.1097/bsd.0000000000000213

Cited by 29 publications

(30 citation statements)

References 23 publications

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“…Instability can subsequently result in progressive kyphotic deformity and associated neurological deterioration, local recurrence of OLF, or development of OLF at adjacent proximal levels. 13,14,32 Concurrent posterior instrumentation and fusion has been proposed as a strategy to prevent progression of thoracic kyphosis from surgical decompression, although this remains controversial. 11,32 However, two studies in this meta-analysis specifically proposed that good clinical results can be achieved with decompression alone without fusion.…”

Section: Discussionmentioning

confidence: 99%

“…13,14,32 Concurrent posterior instrumentation and fusion has been proposed as a strategy to prevent progression of thoracic kyphosis from surgical decompression, although this remains controversial. 11,32 However, two studies in this meta-analysis specifically proposed that good clinical results can be achieved with decompression alone without fusion. 1,23 The late-onset complication of thoracic kyphosis was not reported in these two studies at a follow-up period of 17.3 and 53.2 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…Posterior full‐lamina or semi‐lamina decompression is the traditional operative method for the treatment of OLF. Multiple studies have demonstrated that thoracic vertebra wall excision is the safest and most effective operative method to cure thoracic vertebra OLF. Wang et al .…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have demonstrated that thoracic vertebra wall excision is the safest and most effective operative method to cure thoracic vertebra OLF. Wang et al . used the en bloc surgical method centrum posterior column to cure 18 OLF patients.…”

Section: Discussionmentioning

confidence: 99%

Using Visual Trepan to Treat Single Segment Ossification of the Ligamentum Flavum Under Endoscopy

Zhao

Yang

Diao³

et al. 2019

Orthopaedic Surgery

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This article describes the trepan technique for treating single segment ossification of the ligamentum flavum (OLF) using an endoscope. OLF is the most common cause of thoracic spinal stenosis. The most common surgical procedures involve semi‐lamina or full‐lamina resection and decompression. However, considering the anatomical structure of the thoracic spinal canal and the combination of OLF, traditional surgery has higher risks, more complications, and greater technical requirements. In the past ten years, with the development of endoscopic technology, spinal endoscopy has been increasingly applied for the treatment of intervertebral disc herniation and spinal canal stenosis. The present study demonstrated the effectiveness of visual trepan decompression under spinal endoscopy used for patients with single segment OLF. This surgical procedure had many advantages, including a shorter operation time, minimal trauma, less expenditure, and better functional recovery over the conventional open surgery.

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“…In severe cases, the ossification of the dura mater with the OLF makes surgery more difficult. Hence, several surgical decompression procedures including en-bloc laminectomy (8,21), laminoplasty (19), and foraminotomy (15) have been recommended. The outcomes of te surgical treatment are not always satisfactory, and the possibility of neurological deterioration remains a major concern.…”

Section: █ Introductionmentioning

confidence: 99%

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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Surgical Technique for Decompression of Severe Thoracic Myelopathy due to Tuberous Ossification of Ligamentum Flavum

Abstract: Segmental en bloc resection of the posterior wall of the thoracic canal is a safe and effective alternative for OLF-related severe thoracic myelopathy.

Cited by 29 publications

References 23 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

Using Visual Trepan to Treat Single Segment Ossification of the Ligamentum Flavum Under Endoscopy

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

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