Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum

• Published in: European spine journal Vol. 28; no. 3; pp. 492 - 501
• Main Authors: An, Bo, Li, Xing-Chen, Zhou, Cheng-Pei, Wang, Bi-Sheng, Gao, Hao-Ran, Ma, Hai-Jun, He, Yi, Zhou, Hong-Gang, Yang, He-Jun, Qian, Ji-Xian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2019; Springer Nature B.V
• Subjects: Anesthesia; Central nervous system diseases; Computed tomography; Decompression; Endoscopy; Injuries; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Ossification; Patients; Spinal cord; Surgery; Surgical Orthopedics; Thorax; Vertebrae; Percutaneous full endoscopic posterior decompression; Thoracic myelopathy; Ossification of the ligamentum flavum; Minimally invasive
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-018-05866-2

Purpose Ossification of ligamentum flavum (OLF) is the leading cause of progressive thoracic myelopathy (TM) in East Asian countries. Surgical decompression is the general treatment for TM. This study investigated the application of percutaneous full endoscopic posterior decompression (PEPD) for the treatment of thoracic OLF. Methods Eighteen patients with TM were treated by PEPD under local anaesthesia. Patients had an average age of 59.1 years and single-level lesions mostly at the lower thoracic vertebrae. Computed tomography and magnetic resonance imaging were used to classify the OLF. The pre- and postoperative neurological statuses were evaluated using the American Spinal Injury Association (ASIA) sensory and motor score, modified Japanese Orthopaedic Association (mJOA) score and Frankel grade. Results OLF for all patients was classed as lateral, extended, and enlarged types without comma and tram track signs. Decompression was completed, and a dome-shaped laminotomy was performed through limited laminectomy and flavectomy. Dural tears in 2 patients were the only observed complication. The average score of ASIA sensory and motor, mJOA, as well as the Frankel grade improved significantly after surgery at an average follow-up time of 17.4 months. The average recovery rate (RR) was 47.5% as calculated from the mJOA scores. According to RR, 10 cases were classified as good, 4 cases fair, and 4 cases unchanged. Conclusions For patients with thoracic OLF at a single level and lateral, extended, and enlarged types without comma and tram track signs, it is safe and reliable to perform PEPD, which has satisfactory clinical results. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.