Thoracic laminectomy with dekyphosis for thoracic myelopathy secondary to multi-segmental ossification of the posterior longitudinal ligament / 中华骨科杂志

ABSTRACT

Objective To investigate the safety and efficiency of thoracic laminectomy with dekyphosis for thoracic myelopathy due to multi-segmental ossification of the posterior ligaments.Methods The clinical data of five cases of thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments who were surgically treated in our hospital between August 2012 and March 2013 were retrospectively analyzed,among which two were male and the other three were female,with an average age of 52 (range,45-56) years old.The pre-operative duration ranged from 2 months to 6 years.All five cases were suffering from progressive bilateral partial paraplegia with an average preoperative JOA score 3.8 (range,3-6),an average segment-number of ossification of the posterior ligaments 7.6 (range,5-10),and also an average segment-number of 5.0 (range,2-10) ossification of the ligamentum flavum.All the five cases showed different kyphosis at the stenotic area of thoracic spine,with an average kyphotic angle (Cobb) of 35.8° (range,22°-56°).Their pre-operative Japanese Orthopaedic Association score (JOA) was 3.8 averagely (range,3-6).Clinical features,operation time,blood loss,perioperative complications and postoperative outcome were recorded.Results The segment number of laminectomy of these five cases was 8.2 averagely.The segment number of dekyphosis was 2 for 2 cases and 1 for the other 3 cases,with a average dekyphotic degree of 7.8° (range,2°-15°).The average operation time was 6.3 hours (range,5.5-7.0 hours) and the average blood loss was 3900 ml.The perioperative complications included cerebrospinal fluid leakage in 4 cases who were treated conservatively,and epidural hematoma in 1 case who underwent reoperation for removing the hematoma.All cases were followed up for 21 to 27 months,and their average final JOA score was 10,with an average recovery rate of 85.6％,and a rate of excellent or good was 100％ by the modified Epstein standard.Conclusion The result of thoracic laminectomy combined with dekyphosis for thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments is quite satisfying,however this procedure is demanding with a long operation time,a huge blood loss and a high complication rate.