Surgical treatment for thoracic spinal stenosis

Abstract

Objectives: To describe the underlying causes, surgical results and prognostic factors in thoracic stenosis causing myelopathy. Methods: The underlying causes and surgical results were analyzed retrospectively in 28 cases of thoracic spinal stenosis which caused myelopathy. Degenerative spondylosis was the most common cause, and three cases were associated with systemic diseases. Decompressive laminectomy was performed in 24 cases, anterior decompression in ®ve cases, and combined decompression in one case. Ossi®cation of ligamentum¯avum was found in 18 cases, facet hypertrophy in 13, ossi®cation of posterior longitudinal ligament in six, and ventral spur in four. Postoperatively 16 patients improved and four patients worsened. Follow-up ranged from 2 months to 5 years and 8 months). Statistical analysis was performed using a w 2 test to investigate the relationship between subjects. Multivariant analysis (general linear model) was used to determine the factors which in¯uence surgical outcome. Results: There were neurological improvements in 16 patients, in whom Nurick grade changed from 3.3 preoperatively to 1.8 postoperatively. Eight patients showed no signi®cant change in functional grade and four patients deteriorated after decompressive laminectomy. The group of which initial symptom duration was less than 2 years showed better results (P=0.006). The group with sucient decompression and no additional proximal stenosis had better treatment outcome (P=0.005, P=0.002). Conclusion: Chronic severe myelopathy caused by thoracic spinal stenosis can be reversible with appropriate decompression. Surgical outcome was dependent on initial symptom duration, sucient decompression and presence of additional proximal stenosis.

Contributing factors affecting the prognosis surgical outcome for thoracic OLF

“…Early diagnosis and treatment are important for the postoperative functional prognosis. It is reported that the persistence of residual spasticity at follow-up may be due to irreversible changes within the cord that is caused by the significant cord compression and the delay between the onset of initial symptoms and surgical decompression [2,9,12,14]. In our series, the symptom duration was not related to the surgical outcome statistically, but, especially the short symptom duration, less than 6 months, was a relatively favorable factor to the surgical outcome.…”

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

“…In addition to the anatomical difference relating to mechanical stress involving constraints on the articular processes during segmental motion, this difference may also be attributed to increased instability in lower thoracic spine. 41,55,57 Compared with the middle thoracic spine, it seems to be more particularly easy to make degenerative processes on the lower thoracic spine owing to the high tensile force present on the posterior column. 22,55 Maigne et al 55 reported that OLF occurred most frequently at the lower thoracic spine especially at the thoracolumbar junction, and its appearance correlated with a unique orientation of the facet joints that generated increased rotatory instability and micromotion.…”

“…26,28,57 Surgery is the only treatment that can adequately address the significant compression of neurologic structures caused by OLF. 1,29,62-64 The goal of surgical intervention is to excise the ossified segments and provide sufficient decompression.…”

Outcome of late surgical treatment in patients with incomplete paraplegia due to spinal degenerative diseases

“…Some studies 13,14 have reported that in patients with a spinal degenerative disease, the shorter the duration of the disease is, the more likely the postoperative results are to be excellent. However, the duration of disease is estimated based on information obtained from the patients, and therefore it is often uncertain.…”