Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of the posterior longitudinal ligament - A case report
Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of the posterior longitudinal ligament - A case report
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DOI：
10.1097/01.brs.0000166504.31627.06
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发表时间：
2005-06-15
期刊：
影响因子：
3
通讯作者：
Moriya, H
中科院分区：
文献类型：
--
作者：
Yamazaki, M;Okawa, A;Moriya, H
研究设计。report.Objectives。我们报告一例由于脊柱后纵韧带骨化而导致的胸椎脊髓病，其中椎板切除术后神经系统恶化，并在额外的后路内固定融合后显着逆转。背景资料摘要。许多不同的外科手术可用于治疗胸椎上睑下垂。然而，术后截瘫的可能性仍然是一个主要的风险，并且尚未建立一致的胸椎上睑下垂手术矫正方案和程序。患者是一名53岁的男性，在T3-T8处出现连续的OPLL，前压迫脊髓。开始采用后路前路减压手术，但在摘除OPLL期间脊髓活动电生理监测显示异常。结果，手术转为宽椎板切除术。在接下来的4周内，胸椎后凸增加，脊髓病恶化，导致严重的截瘫。术后4周，行后路固定融合术（T1-L1），不矫治后凸。融合后，神经功能缺损逐渐恢复，10个月后患者完全康复。在融合术后15年的随访中，尽管存在脊髓前撞击残余，但未见神经功能恶化。本病例提示，后凸和不稳定是影响OPLL所致胸椎脊髓病严重程度的主要因素，脊柱内固定后路融合术是胸椎OPLL手术治疗安全有效的辅助手术。
Study Design. Case report.Objectives. We report a case with thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL) of the spine, in which neurologic deterioration progressed after laminectomy and was markedly reversed after additional posterior instrumented fusion.Summary of Background Data. Many different surgical procedures may be used in the treatment of thoracic OPLL. However, the possibility of postoperative paraplegia remains a major risk, and consistent protocols and procedures for surgical correction of thoracic OPLL have not been established.Methods. The patient was a 53-year-old man with continuous OPLL at T3-T8 that compressed the spinal cord anteriorly. Anterior decompression surgery employing a posterior approach was initiated, but during OPLL extirpation electrophysiologic monitoring of spinal cord activity showed abnormalities. As a result, the procedure was converted to a wide laminectomy. Over the next 4 weeks, kyphosis of the thoracic spine increased and myelopathy worsened, producing severe paraparesis.Results. Four weeks after surgery, posterior instrumented fusion (T1-L1) was performed without correction of the kyphosis. After the fusion, neurologic deficits gradually recovered and the patient was fully recovered after 10 months. At follow-up 15 years after the fusion, no neurologic deterioration was seen despite the presence of residual anterior impingement of spinal cord by OPLL.Conclusions. The present case suggests that kyphosis and instability are major factors that affect the severity of thoracic myelopathy due to OPLL, and posterior fusion with spinal instrumentation is a safe and effective adjunct procedure for surgical treatment of thoracic OPLL.