Treatment for Thoracic Ossification of Posterior Longitudinal Ligament with Posterior Circumferential Decompression
Treatment for Thoracic Ossification of Posterior Longitudinal Ligament with Posterior Circumferential Decompression
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DOI：
10.1111/os.12331
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发表时间：
2017-05-01
影响因子：
2.1
通讯作者：
Zhuang, Qing-shan
中科院分区：
文献类型：
--
作者：
Xu, Zhao-wan;Hu, Yong-cheng;Zhuang, Qing-shan
目的：目的：报告应用特制L型骨凿后路手术治疗胸椎后纵韧带骨化症（TOPLL）的结果。方法：本研究于2009年5月至2013年9月期间连续纳入16例患者（9例男性，7例女性）。所有患者均接受后路环周减压截骨术和节段内固定联合椎间融合术。手术时的平均年龄为57.3岁（范围：37-68岁）。收集患者资料、临床表现、失血量、手术时间、并发症、视觉模拟评分（VAS）、日本骨科协会（乔亚）和Frankel分级系统，并在手术前后进行回顾性评估。所有患者均采用后路加压和节段内固定联合椎间融合术成功治疗。平均手术时间为261.6 ± 51.3 min（范围：190-310 min）。平均失血量为980.3 ± 370.5 mL（范围：600-2100 mL）。所有患者的运动能力和步态均有主观改善。术前和术后平均乔亚评分分别为4.2 ± 1.7和7.8 ± 2.5分。总体乔亚评分的差异显示术后显著改善。在最后一次随访时，所有患者的Frankel分级均提高了1或2级。术前VAS评分与术后3个月比较差异有统计学意义（P < 0.05）。术后3个月与12个月比较，差异无统计学意义（P > 0.05）。3例患者发生脑脊液（CSF）漏。结论：后路经椎弓根截骨环周减压术治疗腰椎间盘突出症安全、有效、可靠，技术上可行，保留了胸腔完整性，避免了前路手术的诸多缺点，获得了满意的椎管减压效果。
Objective: To report the results of the posterior approach for thoracic ossification of posterior longitudinal ligament (TOPLL) by using a special "L" osteotome.Methods: The present study enrolled 16 consecutive patients (9 men and 7 women) between May 2009 and September 2013. All patients underwent a posterior circumferential decompression osteotomy and segmental instrumentation with interbody fusion. The mean age at surgery was 57.3 years (range, 37-68 years). Patients' data, clinical manifestation, blood loss, length of surgery, complications, visual analog scale (VAS), Japanese Orthopedic Association (JOA), and Frankel grading system before and after surgery were collected and evaluated, retrospectively.Results: The average follow-up period was 30 +/- 19 months (range, 12-50 months). All patients were successfully treated with posterior compression and segmental instrumentation with interbody fusion. The average operation time was 261.6 +/- 51.3 min (range, 190-310 min). The mean blood loss was 980.3 +/- 370.5 mL (range, 600-2100 mL). All patients had subjective improvement of motor power and gait. Average preoperative and postoperative JOA scores were 4.2 +/- 1.7 and 7.8 +/- 2.5 points, respectively. Differences in the overall JOA scores showed significant postoperative improvement. At the last follow-up, all patients improved either by one or two Frankel grades. There was a significant difference between preoperative VAS scores and those 3 months after surgery (P < 0.05). No significant difference was observed between the 3-month and 12-month results (P > 0.05). Cerebrospinal fluid (CSF) leakage occurred in 3 patients. Acute neurological deterioration was encountered postoperatively in 1 patient.Conclusion: Treatment with posterior transpedicular osteotomy and circumferential decompression was found to be safe, effective, reliable, and technically feasible, and keeping the thoracic cavity intact avoids many shortcomings of anterior surgery and results in a satisfactory spinal decompression.