Minimally invasive surgery for resection of ossification of the ligamentum flavum in the thoracic spine

Wei Zhao; Chaoxiong Shen; Ranze Cai; Jianfeng Wu; Yuandong Zhuang; Zhaowen Cai; Rui Wang; Chunmei Chen

doi:10.5114/wiitm.2017.66473

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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1/2017
vol. 12

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Neurosurgery

abstract:

Original paper

Minimally invasive surgery for resection of ossification of the ligamentum flavum in the thoracic spine

Wei Zhao

,

Chaoxiong Shen

,

Ranze Cai

,

Jianfeng Wu

,

Yuandong Zhuang

,

Zhaowen Cai

,

Rui Wang

,

Chunmei Chen

Videosurgery Miniinv 2017; 12 (1): 96–105

DOI: https://doi.org/10.5114/wiitm.2017.66473

Online publish date: 2017/03/13

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Introduction: Thoracic ossification of the ligamentum flavum (TOLF) is a common cause of progressive thoracic myelopathy.Surgical decompression is commonly used to treat TOLF.

Aim: This study aimed to evaluate the clinical outcomes of microsurgical decompression of thoracic ossification of the ligamentum flavum (TOLF) via a paraspinal approach, using a percutaneous tubular retractor system.

Material and methods: First, three-dimensional (3D) image reconstruction and printed models were made from thin computed tomography scans for each patient. Then, 3D computer-assisted virtual surgery was performed using the 3D reconstruction to calculate the precise location and sizes of the bone window and the angle of insertion of the percutaneous tubular retractor system. In total, 13 patients underwent the surgery through the percutaneous micro channel unilateral vertebral approach under electrophysiological monitoring. Five days after the surgery, increased creatine phosphokinase levels returned to preoperative levels. The Japanese Orthopedic Association (JOA) score was improved and computed tomography reconstruction and magnetic resonance imaging of the thoracic spine showed that decompression was achieved without injuries to the spinal cord or nerve root. The stability of the spine was not affected, nor were any deformities of the spine detected. Finally, nerve functional recovery was achieved with minimal injury to the paraspinal muscle, articulum, spinous process and ligament.

Results: The mean operative time was 98.23 ±19.10 min, and mean blood loss was 19.77 ±5.97 ml. At a mean follow-up of 13.3 months (median: 12 months), the mean JOA score was 7.54 ±1.13 at the final follow-up, yielding a mean RR of 49.10 ±15.71%. Using The recovery rate, 7 (53.85%) patients had good outcomes, 5 (38.46%) patients had a fair outcome, and 1 (7.69%) patient had poor outcomes, indicating significant improvement by the final follow-up examination (p < 0.05).

Conclusions: The 3D printed patient model-based microsurgical resection of TOLF via the paraspinal approach can achieve decompression of the spinal canal with minimal complications, faster recovery and improved stability of the vertebral body.

keywords:

Minimally invasive surgery for resection of ossification of the ligamentum flavum in the thoracic spine

Wei Zhao , Chaoxiong Shen , Ranze Cai , Jianfeng Wu , Yuandong Zhuang , Zhaowen Cai , Rui Wang , Chunmei Chen

thoracic, ossification of ligamentum flavum, minimally invasive surgery, tubular retractors, 3D printing

Wei Zhao

,

Chaoxiong Shen

,

Ranze Cai

,

Jianfeng Wu

,

Yuandong Zhuang

,

Zhaowen Cai

,

Rui Wang

,

Chunmei Chen