Surgical technique modification of circumferential decompression for thoracic spinal stenosis and clinical outcome
- Resource Type
- Authors
- Ruofu Tang; Jiawei Shu; Fangcai Li; Hao Li
- Source
- British journal of neurosurgery.
- Subject
- medicine.medical_specialty
Cord
business.industry
Decompression
Ossification
Kyphosis
Anterior decompression
General Medicine
medicine.disease
Posterior approach
Surgery
03 medical and health sciences
0302 clinical medicine
Thoracic myelopathy
030220 oncology & carcinogenesis
Posterior longitudinal ligament
Medicine
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
- Language
- ISSN
- 1360-046X
Progressive thoracic myelopathy caused by ossification of posterior longitudinal ligament (OPLL) responds poorly to conservative therapy. The most direct decompression is extirpation of ossified posterior longitudinal ligament (PLL). Surgical outcomes of posterior approaches to remove ossified PLL are not always satisfactory because of the risk of neurological deterioration. In this study, we modified the conventional anterior decompression technique via a posterior approach for thoracic OPLL. From an anterior approach, the posterior cortex of vertebral body was exposed and the ossified PLL was removed. Then kyphosis correction was done via posterior instrumentation to reduce cord compression between dura under tension and the anterior canal wall. From the back, the distal end of the ossified PLL was displaced anteriorly to create a gap between ossified PLL and dura, remaining adhesions were divided and the ossified PLL was manipulated through this gap under direct vision. The surgical technique was applied in 20 patients with thoracic myelopathy caused by OPLL. One case of postoperative neurological deterioration was encountered but this recovered fully. Our outcomes were relatively favorable.