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Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum

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Abstract

Purpose

Ossification of ligamentum flavum (OLF) is the leading cause of progressive thoracic myelopathy (TM) in East Asian countries. Surgical decompression is the general treatment for TM. This study investigated the application of percutaneous full endoscopic posterior decompression (PEPD) for the treatment of thoracic OLF.

Methods

Eighteen patients with TM were treated by PEPD under local anaesthesia. Patients had an average age of 59.1 years and single-level lesions mostly at the lower thoracic vertebrae. Computed tomography and magnetic resonance imaging were used to classify the OLF. The pre- and postoperative neurological statuses were evaluated using the American Spinal Injury Association (ASIA) sensory and motor score, modified Japanese Orthopaedic Association (mJOA) score and Frankel grade.

Results

OLF for all patients was classed as lateral, extended, and enlarged types without comma and tram track signs. Decompression was completed, and a dome-shaped laminotomy was performed through limited laminectomy and flavectomy. Dural tears in 2 patients were the only observed complication. The average score of ASIA sensory and motor, mJOA, as well as the Frankel grade improved significantly after surgery at an average follow-up time of 17.4 months. The average recovery rate (RR) was 47.5% as calculated from the mJOA scores. According to RR, 10 cases were classified as good, 4 cases fair, and 4 cases unchanged.

Conclusions

For patients with thoracic OLF at a single level and lateral, extended, and enlarged types without comma and tram track signs, it is safe and reliable to perform PEPD, which has satisfactory clinical results.

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Author notes

  1. Bo An and Xing-Chen Li contribute equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Tangdu Hospital Affiliated to Air Force Medical University, No.1 Xinsi Road, Baqiao District, Xi’an, 710000, Shanxi Province, China

    Bo An, Cheng-Pei Zhou, Hao-Ran Gao & Ji-Xian Qian

  2. Department of Spinal Surgery, Third Hospital of Henan Province, No.198, Funiu Road, Zhongyuan District, Zhengzhou, 450000, Henan Province, China

    Xing-Chen Li, Bi-Sheng Wang, Hai-Jun Ma, Yi He, Hong-Gang Zhou & He-Jun Yang

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  1. Bo An
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  2. Xing-Chen Li
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Correspondence to He-Jun Yang or Ji-Xian Qian.

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An, B., Li, XC., Zhou, CP. et al. Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum. Eur Spine J 28, 492–501 (2019). https://doi.org/10.1007/s00586-018-05866-2

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  • DOI: https://doi.org/10.1007/s00586-018-05866-2

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