The causes and management of the neurological complications following posterior approach surgery for thoracic spinal stenosis

English Keywords:Thoracic spinal stenosis  Posterior approach surgery  Neurological complications  Management

English Abstract:

  【Abstract】 Objectives: To analyze the causes and management of neurological complications following posterior approach surgery for thoracic spinal stenosis. Methods: 101 patients with thoracic spinal stenosis undergoing posterior approach surgery from January 2008 to January 2014 were reviewed retrospectively. 52 males and 49 females with a mean age of 55.6 years( range, 32 to 81 years) were included in this study. Ossification of longitudinal flavum(OLF) was noted in 89 cases, ossification of posterior longitudinal ligament(OPLL) and thoracic disc herniation complicated with ossification of longitudinal flavum was noted in 3 and 9 cases respectively. 89 OLF cases consisted of 29 single-segment OLF, 56 multi-segment OLF and 4 non-continuous OLF cases. The causes of complications and corresponding interventions were documented. Record the recovery of ASIA classification. Results: Neurological complications were noted in 11 cases(7 patients) with an incidence rate of 6.9%. There were 2 cases with spinal cord injury, 5 cases with dural injury, 3 cases with cerebrospinal fluid leakage and 1 case with epidural hematoma. 1 case of spinal cord injury was noted due to careless operation during the surgery and the other was due to the epidural hematoma; both of the 2 cases with spinal cord injury were treated by Methylprednisolone and rehabilitation exercise which partially restored the spinal cord function. 1 case underwent emergency operation due to epidural hematoma. 5 cases with dural injury were treated by pressure dressing and fibrin glue, 4 of whom had the dura repaired during the operation. Among all the cerebrospinal fluid leakage cases, 3 had dura repaired and recovered completely after drainage and corresponding support management. All the 7 patients were followed up from 5 to 62 months with an average of 26 months, 2 patients of ASIA B pre-operatively improved to C and D respectively at the final follow-up; 2 patients of ASIA C improved to D, and all the other patients with neurological complications improved to E. Conculsions： The morbidities of posterior approach surgery for thoracic spinal stenosis is high, the careful and effective management is critical to decrease and/or prevent the incidence of complications.