Treatment for Thoracic Ossification of Posterior Longitudinal Ligament with Posterior Circumferential Decompression.

OBJECTIVE: To report the results of the posterior approach for thoracic ossification of posterior longitudinal ligament (TOPLL) by using a special "L" osteotome. METHODS: The present study enrolled 16 consecutive patients (9 men and 7 women) between May 2009 and September 2013. All patients underwent a posterior circumferential decompression osteotomy and segmental instrumentation with interbody fusion. The mean age at surgery was 57.3 years (range, 37-68 years). Patients' data, clinical manifestation, blood loss, length of surgery, complications, visual analog scale (VAS), Japanese Orthopedic Association (JOA), and Frankel grading system before and after surgery were collected and evaluated, retrospectively. RESULTS: The average follow-up period was 30 ± 19 months (range, 12-50 months). All patients were successfully treated with posterior compression and segmental instrumentation with interbody fusion. The average operation time was 261.6 ± 51.3 min (range, 190-310 min). The mean blood loss was 980.3 ± 370.5 mL (range, 600-2100 mL). All patients had subjective improvement of motor power and gait. Average preoperative and postoperative JOA scores were 4.2 ± 1.7 and 7.8 ± 2.5 points, respectively. Differences in the overall JOA scores showed significant postoperative improvement. At the last follow-up, all patients improved either by one or two Frankel grades. There was a significant difference between preoperative VAS scores and those 3 months after surgery (P < 0.05). No significant difference was observed between the 3-month and 12-month results (P > 0.05). Cerebrospinal fluid (CSF) leakage occurred in 3 patients. Acute neurological deterioration was encountered postoperatively in 1 patient. CONCLUSION: Treatment with posterior transpedicular osteotomy and circumferential decompression was found to be safe, effective, reliable, and technically feasible, and keeping the thoracic cavity intact avoids many shortcomings of anterior surgery and results in a satisfactory spinal decompression.

[The biomechanical study and clinical application of monosegmental pedicle instrumentation by endplate method in the fracture vertebrae for thoracolumbar fracture].

OBJECTIVE: To evaluate the biomechanical and clinical effect of the treatment of thoracolumbar fracture with monosegmental pedicle instrumentation in the fracture vertebrae by endplate method. METHODS: Twenty-four porcine thoracolumbal spinal model, divided into four groups randomly, compared the stability of these four groups through pull-out testing. Retrospective study of 49 patients with thoracolumbar fracture who were treated with this technique, to observe the fusion of bone graft, the height of the anterior and posterior range, the angle of kyphosis and the volume of spinal canal, the loss of rectification, low back pain, and the limitation of activity of lumbar. RESULTS: The endplate method group is more stability than the parallel method group, and the pedicle screw in the fracture vertebrae can get enough stability. After operation all 49 cases achieved satisfactory reduction, strong bone fusion, no reduction loss, no refractoriness low back pain, limitation of motion of lumbar et al. CONCLUSION: Monosegmental pedicle instrumentation by endplate method in the fracture vertebrae for thoracolumbar fracture can get enough extraction stability, and get satisfied clinical effect.