Resection of Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament from a Posterior Approach under Intraoperative Neurophysiological Monitoring for Paralysis after Posterior Decompression and Fusion Surgery.
Resection of Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament from a Posterior Approach under Intraoperative Neurophysiological Monitoring for Paralysis after Posterior Decompression and Fusion Surgery.
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在术中神经生理学监测和融合手术后瘫痪的神经生理学监测下，从后膜上切除后纵韧带的喙型胸腔骨化。
DOI：
10.1055/s-0036-1579662
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发表时间：
2016-12
影响因子：
2.4
通讯作者：
Ishiguro N
中科院分区：
文献类型：
--
作者：
Imagama S;Ando K;Ito Z;Kobayashi K;Hida T;Ito K;Ishikawa Y;Tsushima M;Matsumoto A;Tanaka S;Morozumi M;Machino M;Ota K;Nakashima H;Wakao N;Nishida Y;Matsuyama Y;Ishiguro N
研究设计前瞻性临床研究。 目的后路减压植骨融合术治疗喙型胸椎后纵韧带骨化症（T-OPLL）疗效满意。 然而，一些患者需要额外的手术治疗术后严重瘫痪，这种情况在文献中没有充分讨论。本研究的目的是描述我们称为“后路脊髓前部切除术”（RASPA）的手术对喙型T-OPLL后路减压和融合手术后严重瘫痪患者的疗效。 方法自1999年以来，对58例喙型T-OPLL患者行后路减压融合术，其中3例（5%）术后瘫痪，在我院行RASPA。 对这些病例的临床记录、日本骨科协会评分、步态状态、术中神经生理监测（IONM）结果和并发症进行了评价。 结果3例患者均在首次手术后手动肌肉测试（MMT）评分下降0 ~ 2分。 RASPA在首次手术后3周进行。所有患者的下肢和行走状态的MMT评分均逐渐改善; RASPA手术后平均4个月，所有患者均可以使用手杖行走。无术后并发症。 结论RASPA手术治疗后路减压融合术后喙型T-OPLL可获得良好的功能恢复，是重度瘫痪患者的一种挽救手术。 RASPA的优点包括工作空间宽，无脊髓牵拉，在额外的去后凸和压迫操作后，在不切除T-OPLL和脊髓缩短的节段进行额外减压。当与IONM一起使用时，该手术可能有助于避免永久性术后瘫痪。
Study Design Prospective clinical study. Objective Posterior decompression and fusion surgery for beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) generally has a favorable outcome. However, some patients require additional surgery for postoperative severe paralysis, a condition that is inadequately discussed in the literature. The objective of this study was to describe the efficacy of a procedure we refer to as “resection at an anterior site of the spinal cord from a posterior approach” (RASPA) for severely paralyzed patients after posterior decompression and fusion surgery for beak-type T-OPLL. Methods Among 58 consecutive patients who underwent posterior decompression and fusion surgery for beak-type T-OPLL since 1999, 3 with postoperative paralysis (5%) underwent RASPA in our institute. Clinical records, the Japanese Orthopaedic Association score, gait status, intraoperative neurophysiological monitoring (IONM) findings, and complications were evaluated in these cases. Results All three patients experienced a postoperative decline in Manual Muscle Test (MMT) scores of 0 to 2 after the first surgery. RASPA was performed 3 weeks after the first surgery. All patients showed gradual improvements in MMT scores for the lower extremity and in ambulatory status; all could walk with a cane at an average of 4 months following RASPA surgery. There were no postoperative complications. Conclusions RASPA surgery for beak-type T-OPLL after posterior decompression and fusion surgery resulted in good functional outcomes as a salvage surgery for patients with severe paralysis. Advantages of RASPA include a wide working space, no spinal cord retraction, and additional decompression at levels without T-OPLL resection and spinal cord shortening after additional dekyphosis and compression maneuvers. When used with IONM, this procedure may help avoid permanent postoperative paralysis.
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影响因子：
3
作者：
Kato, Satoshi;Kawahara, Norio;Fujimaki, Yoshiyasu
通讯作者：
Fujimaki, Yoshiyasu
影响因子：
3
作者：
Muramoto, Akio;Imagama, Shiro;Ishigro, Naoki
通讯作者：
Ishigro, Naoki
影响因子：
2.8
作者：
Yamazaki, Masashi;Okawa, Akihiko;Koda, Masao
通讯作者：
Koda, Masao
影响因子：
3
作者：
HIRABAYASHI, K;MIYAKAWA, J;WAKANO, K
通讯作者：
WAKANO, K
影响因子：
2.8
作者：
Aizawa, Toshimi;Sato, Tetsuro;Kokubun, Shoichi
通讯作者：
Kokubun, Shoichi