Treatment of Thoracic Ossification of Posterior Longitudinal Ligament with One-Stage 360 Degree Circumferential Decompression Assisted by Piezosurgery

Yang, Peng; Ge, Rile; Chen, Zhongqiang; Wen, Bingtao

doi:10.1080/08941939.2020.1839149

Cited by 6 publications

(10 citation statements)

References 21 publications

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Section: Discussionmentioning

confidence: 99%

“…With the application of the ultrasonic bone curette (UBC) for circumferential decompression, the improvement rate of spinal cord function in patients was much better, and the probability of spinal cord function deterioration was significantly reduced 13,19 . However, as a result of ventral adhesion separation of the dural sac and the surgical instrument prying anterior ossification, electrophysiological early warning events occurred sometimes 16,17 . Sun et al augmented the surgical procedure by maintaining the last thin layer of ossification rather than penetrating it, reducing the incidence of UBC-related nerve root injuries significantly 22 vision under the microscope to minimize disturbance to the spinal cord 17 .…”

Section: Current Status Of Traditional Circumferential Decompressionmentioning

confidence: 99%

“…One explanation is that the dura mater in the ventral spine and the dorsal subarachnoid space is a relatively fragile component, and a slightly greater backward traction of the spinal cord may cause catastrophic consequences 15 . Another reason is that the processes of both ventral adhesion separation of the dural sac and traditional surgical instruments prying thoracic anterior ossifications usually cause electrophysiological early warning events that significantly increase the risk of spinal cord injury 16 , 17 . Furthermore, the total resection of the posterior elements is needed to achieve sufficient space to perform the ventral spinal operation under direct vision in practice in almost all circumferential decompression surgeries that have been reported previously, increasing the incidence of complications, such as long operation times, massive blood loss, and even instrument‐related adverse events 18 , 19 .…”

Section: Introductionmentioning

confidence: 99%

“…Advantages of this device, such as precision safety, self‐irrigation cooling system, soft tissue protection, and better hemostasia, make it a useful instrument for treating various spinal disorders without causing excessive mechanical and thermal injury 20 , 21 . Especially for patients with thoracic myelopathy caused by severely anterior ossification, the application of UBC could effectively reduce the probability of spinal cord injury after circumferential decompression and improve the recovery rate of spinal cord function in comparison with conventional instruments 16 , 22 .…”

Section: Introductionmentioning

confidence: 99%

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Angled Ultrasonic Bone Curette‐Assisted Circumferential Decompression for Thoracic Myelopathy Caused by Severely Anterior Ossification

et al. 2022

Orthopaedic Surgery

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Objective Thoracic myelopathy caused by severe anterior ossification is often progressive and fails to respond to conservative treatment. Removal of the compressing ossification is the most effective method but is hard to operate. In this study, we describe a novel one‐stage posterior circumferential decompressive procedure assisted by an angled ultrasonic bone curette (UBC) for thoracic myelopathy caused by severe anterior ossification and evaluate its safety and efficacy. Methods The current study enrolled 15 consecutive patients (five men and 10 women) with thoracic myelopathy caused by severely anterior ossification between January 2017 and December 2019. All patients underwent posterior circumferential decompression assisted by angled UBC and segmental instrumentation with interbody fusion. At the time of surgery, the average age was 58.6 ± 6.3 years (47–70 years). Before and after surgery, the patient data, clinical manifestation, operative levels, blood loss, operative time, perioperative complications, Japanese Orthopaedic Association (JOA) score were recorded and analyzed retrospectively. Results All patients had successful one‐stage posterior circumferential decompression to remove anterior ossifications directly. There were 12 cases of OPLL, two cases of a calcified giant herniated disc, and one case of osteophyte. The average operation time was 153.4 ± 53.4 min (77–242 min), with a mean blood loss of 463.5 ± 155.8 mL (240–780 mL). The average length of stay in the hospital was 14.3 ± 4.7 days (9–25 days) and the mean follow‐up duration was 20.8 ± 8.8 months (12–39 months). Almost all patients had subjective improvement in motor power and gait. The average preoperative JOA score was 4.5 ± 1.6, which improved to 9.0 ± 1.8 at the final follow‐up. Postoperative differences in the overall JOA scores showed significant improvement (F = 105.446, p < 0.01). The overall recovery rate at the final examination scored 70.9% ± 25.0%. According to Hirabayashi's classification, eight cases were rated as excellent, four as good, two as fair, and one as unchanged. No patient was graded as deteriorated. Two patients (13.3%) experienced intraoperative cerebrospinal fluid leakage, while two cases (13.3%) experienced unilateral intercostal neuralgia, and only one (6.7%) encountered acute neurological deterioration. All these patients were treated conservatively and their neurological function improved significantly. At the follow‐up, there was no evidence of neurological deterioration. Conclusion Circumferential decompression assisted by angled UBC can preserve more posterior elements of the involved levels, maintaining an intact pleura and reducing the operation time and blood loss for thoracic myelopathy caused by severe anterior ossification. It is a safe, effective, and technically feasible method to provide surgeons with a new option for thoracic spinal circumferential decompression.

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Section: Discussionmentioning

confidence: 99%

Section: Current Status Of Traditional Circumferential Decompressionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Angled Ultrasonic Bone Curette‐Assisted Circumferential Decompression for Thoracic Myelopathy Caused by Severely Anterior Ossification

et al. 2022

Orthopaedic Surgery

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“…With the familiar use of piezosurgery, the operative time and blood loss will be further reduced in the future. Piezosurgery is a new technology in orthopaedic surgery that exploits high‐frequency ultrasonic drilling to destroy bone tissues and cuts through osseous structures 17 . The advantage of this technique is having a hemostatic effect in time on the surface where the bone has been cut and reducing the intraoperative bleed 18 .…”

Section: Discussionmentioning

confidence: 99%

Application of Piezosurgery in Revision Surgery through Posterior Approach for Infection after Percutaneous Vertebral Augmentation: Technique Note with Case Series

Zhang,

Wang,

Wang

et al. 2024

Orthopaedic Surgery

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ObjectivesPyogenic spondylitis after vertebral augmentation (PSVA) is a severe complication and even threatens the life of patients. How to deal with infectious bone cement is a big problem for surgeons. The application of piezosurgery has advantages in removal the infectious bone cement in limb bone and spinal laminectomy, but it is rarely used in PSVA. So, the present study aimed to introduce the application of piezosurgery in revision surgery for PSVA and report the preliminary radiological and clinical results.MethodsThe data of nine patients with PSVA who had undergone revision surgery were retrospectively reviewed between May 2017 and January 2023 in our hospital. The technique of removal of infectious bone cement and lesion by piezosurgery and the reconstruction of the spinal stability were described, and the operation time and intraoperative blood loss were recorded. Postoperatively, radiographs and computed tomography scans were reviewed to evaluate the condition of bone cement removal, control of infection, and bone fusion. Oswestry disability index (ODI) and visual analog scale (VAS) were assessed pre‐ and postoperatively, and clinical outcomes were assessed using Odom's criteria.ResultsAll patients achieved satisfactory tainted bone cement cleaning and restoration of spinal alignment. The surgical time was 258.8 ± 63.2 (160–360) min, and the intraoperative blood loss was 613.3 ± 223.8 (300–900) mL. The VAS score decreased from 7.0 (6–8) points preoperatively to 2.4 (1–4) points postoperatively. The ODI index decreased from 71% (65%–80%) preoperatively to 20% (10%–30%) postoperatively. The patient's VAS and NDI scores after operation were significantly improved compared with those before surgery (p ≤ 0.05). Odom's outcomes were good for all patients in the last follow‐up, and all patients reported satisfactory results.ConclusionsPiezosurgery can effectively remove large blocks of infectious bone cement through a posterior approach while avoiding nerve and spinal cord damage. We cautiously suggest that a one‐stage posterior approach using piezosurgery is an alternative option for surgical treatment of PSVA.

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Microendoscopic Tailored Spine Decompression as a Less-Invasive, Stability-Preserving Surgical Option to Instrumented Correction in Complex Spine Deformities: A Preliminary Multicenter Experience

Iacoangeli,

Alsagheir,

Aiudi

et al. 2024

World Neurosurgery

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Treatment of Thoracic Ossification of Posterior Longitudinal Ligament with One-Stage 360 Degree Circumferential Decompression Assisted by Piezosurgery

Cited by 6 publications

References 21 publications

Angled Ultrasonic Bone Curette‐Assisted Circumferential Decompression for Thoracic Myelopathy Caused by Severely Anterior Ossification

Angled Ultrasonic Bone Curette‐Assisted Circumferential Decompression for Thoracic Myelopathy Caused by Severely Anterior Ossification

Application of Piezosurgery in Revision Surgery through Posterior Approach for Infection after Percutaneous Vertebral Augmentation: Technique Note with Case Series

Microendoscopic Tailored Spine Decompression as a Less-Invasive, Stability-Preserving Surgical Option to Instrumented Correction in Complex Spine Deformities: A Preliminary Multicenter Experience

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