Decompression through pedicel-flavum tunnel for continuous thoracic ossification of ligamentum flavum

English Keywords:Thoracic ossification of ligamentum flavum  Continuous  Pedicle-flavum tunnel  Surgery

English Abstract:

  【Abstract】 Objectives: To investigate the effect of decompression through pedicle-flavum tunnel(PFT) for continuous thoracic ossification of ligamentum flavum(TOLF). Methods: From June 2006 to September 2012, 56 patients(35 males, 21 females; 31-73 years old, average 51.9) with continuous TOLF were enrolled in our study. Among the 56 patients, decompression surgery through PFT was performed in 2 continuous levels in 41 cases, 3 continuous levels in 10 cases, 4 continuous levels in 4 cases, 5 continuous levels in 1 case, a total of 133 ossified segments was decompressed. According to the axial CT classifications, among 133 ossified segments, 45 were lateral type, 34 were bilateral type, 54 were connect type. There were 1 upper PFT and 1 lower PFT in lateral type, 2 upper PFTs and 2 lower PFTs in bilateral and connect type, a total of 221 upper PFTs and 221 lower PFTs. All patients underwent upper facet joint en bloc resection through PFT. The neurological status was evaluated by JOA scores preoperatively and at 2 days, 1 month, and 3 months after surgery and the final follow-up. Results: All patients were successfully operated with surgery time of 3.7±0.8h, blood loss of 260±120ml. 51 patients′ initial symptoms were significantly alleviated postoperatively; 5 patients experienced transient cerebrospinal fluid(CSF) leakage postoperatively, and the CSF leakage disappeared after conservative treatment. All the incisions healed. No neurologic deficit, meningitis, wound infection or spinocutaneous fistula was noted during the follow-up. The JOA score at 2 days, 1 month, 3 months after surgery and final follow-up was 6.37±2.89, 8.73±1.58, 9.45±1.03, 9.67±1.07 respectively, which showed significant difference compared with the preoperative JOA score of 5.14±1.59（P<0.05）. At the final follow-up, the recovery rate calculated by JOA scores was （75.24±18.01）%, ranged from 50%-100%. And the surgical out come was excellent in 38 cases, good in 13 cases, fair in 5 cases. Conclusions: Decompression surgery through PFT is reliable and effective for continuous TOLF.