Removal of intraosseous cartilaginous node originated from thoracic vertebrae via anterolateral extrapleural approach

English Keywords:Thoracic spinal stenosis  Intraosseous cartilaginous node  Extrapleural approach  Outcome

English Abstract:

  【Abstract】 Objectives： To investigate the surgical method and its outcome of the removal of intraosseous cartilaginous node originated from thoracic vertebrae via anterolateral extrapleural approach. Methods: From April 2002 to September 2012, 18 cases diagnosed as single segmental thoracic vertebral intraosseous cartilaginous node were reviewed retrospectively, those cases with thoracic ossification of ligamentum flavum(OLF) and ossification of posterior longitudinal ligaments(OPLL) were excluded from this series. There were 12 males and 6 females, with an average age of 46 years(33-61 years). 2 cases had lesions located in T7/8, 4 cases in T8/9, 5 cases in T9/10, and 7 cases in T10/11. According to Frankel classification, there were 6 cases at grade C and 12 at grade D preoperatively. The outcome and complication rate were observed. Results: Surgery was performed successfully on all 18 cases. The mean operation time was 3.5 hours, and the mean blood loss was 420ml(350-620ml), pneumothorax or pleural effusion was not noted after operation. Complications were noted in 6 cases, 1 case was complicated with pneumonia one week after operation and 5 cases were founded with rib fractures the next day after operation when taking chest X-ray. All recovered after conservative treatment. All patients were followed up for an average time of 6(2-6 years) years. Based on the Epstein criteria, excellent was noted in 15 cases, good in 2 cases and poor in 1 case, with an excellent and good rate of 94%(17/18). One case had neurofunction remain unchang, while 1 case improved from C to D, and all reached E. At final follow-up, postoperative JOA score increased from 6.6±1.3 to postoperative 9.4±1.6, no instrument failure was noted, and bony union was evidenced on CT scan 1 year later. Conclusions: For patients with thoracic spinal stenosis induced by intraosseous cartilaginous node, decompression via anterolateral extrapleural approach is a safe and effective option.