"Diamond" osteotomy for removing anterior compressions of spinal cord in sclerosing thoracic and thoracolumbar disc herniation

English Keywords:Thoracic disc herniation  Thoracolumbar disc herniation  Diamond surgical approach  Surgical treatment  Discectomy

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical outcome of "diamond" osteotomy in sclerosing thoracic and thoracolumbar disc herniation． Methods: Twenty-six cases of patients from August 2009 to July 2014 were included in this study, 19 patients were males and 7 patients were females. The age ranged from 18 to 70 years, with an average of 43．8±23.3 years. 19 patients had thoracic disc herniation, including 14 cases of thoracic disc protrusion with ossification and 5 cases of thoracic vertebra posterior osteophytes. 7 patients had thoracolumbar disc herniation with ossification. The preoperative Frankel grade evaluation showed that there were 3 cases of grade B, 14 cases of grade C and 9 cases of grade D. All the cases were treated by the "diamond" osteotomy to remove anterior compressions of spinal cord. The modified Macnab criteria and Frankel grade were used to evaluate the clinical outcomes. Results: The "diamond" osteotomy was successfully completed in all the patients. Only 1 case(T10/11) was observed exacerbation in preexisting deficits after operation. The patient recovered to preoperative level after treated with methylprednisolone, dehydrate and neural nutrition. X-ray showed no malposition of internal fixation, and the computerized tomography(CT) scan showed complete removal of compressor. All the 26 patients were subjected to an average of 19.8 months(range 5 to 36 months) follow-up. Neurological function improved in all the patients. According to the modified Macnab criteria, there were 15 cases of excellent grade, 8 cases of good grade, 2 cases of improvement, and only 1 case of poor grade. The rate of excellent and good grades was 88.46% and the total effective rate was 96.15%. All patients acquired bony fusion without instrument failure． Conclusions: The "diamond" osteotomy was effective to improve the clinical outcome obviously in patients with thoracic and thoracolumbar disc herniation．