En bloc resection of the superior facet process and ossified ligamentum flavum of thoracic spine via pedicel- ligament flavum octagonal tunnel

English Keywords:Thoracic vertebra  Ligamentum flavum  Ossification  Pedicle flavum tunnel  Treatment

English Abstract:

  【Abstract】 Objective：To investigate the efficacy of en bloc resection of the superior facet process and ossified ligamentum flavum of thoracic spine via pedicel-flavum tunnel（PFT）.Method：90 patients from January 2002 to January 2007 diagnosed as thoracic ossification of ligamentum flavum were reviewed retrospectively，there were 58 males and 32 females with an average age of 54.2 years（range，32-79 years）.83 cases presented with sensory deficit of lower limbs，69 cases with constriction on trunk or lower limbs，53 cases with sphincter dysfunction.The CT virtual endoscopy（CTVE） and multiplanar co-localization were used to detect the configuration of OLF and its adjacent morphology.All patients underwent the surgical protocol of removing thoracic superior facet process and OLF through pedicle flavum tunnel（PFT）.The IMSOP Standard Neurological Classification of Spinal Cord Injury was used to determine the level of thoracic spondylopathy.The JOA for lower limb motor function and sphincter function were used to evaluate their neurological status respectively.Result：PFT was evidenced in all the patients on 3-dimensional CT reconstruction.All cases were successfully operated，85 cases had symptom relieved immediately after operation，5 cases were complicated with cerebrospinal fluid leakage.The operative time was 2.7±0.8hr and the amount of blood loss was 260±120ml.The mean follow up was 23.2 months（range，13-38 months）.Among 83 with sensory deficit，66 recovered completely and the other 17 got partial recovery，67 cases with trunk or lower limbs constriction recovered completely.Postoperative JOA score for sphincter function was 2.55±0.34，comparing with preoperative score of 2.27±0.54，which showed significant difference（P<0.01）.Postoperative JOA score for motor function was 3.68±0.43，comparing with preoperative score of 1.53±0.86，which also showed significant difference（P<0.01）.The motor function recovery rate was 86.48%，with the excellent and good rate of 95.56%.Conclusion：En bloc resection of the superior facet process and ossified ligamentum flavum of thoracic spine via pedicle-flavum octagonal tunnel is safe and reliable.