Journal of Korean Neurosurgical Society

  • 제58권6호
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  • Pages.571-577
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  • 2015
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Use of an Ultrasonic Osteotome for Direct Removal of Beak-Type Ossification of Posterior Longitudinal Ligament in the Thoracic Spine

  • Kim, Chi Heon (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Renaldo, Nicholas (Department of Orthopedic Surgery, Orthopaedic Associates of Dutchess County/Vassar Brothers Medical Center) ;
  • Chung, Chun Kee (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Lee, Heui Seung (Department of Neurosurgery, Seoul National University Hospital)
  • 투고 : 2015.03.23
  • 심사 : 2015.09.03
  • 발행 : 2015.12.28
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초록

Direct removal of beak-type ossification of posterior longitudinal ligament at thoracic spine (T-OPLL) is a challenging surgical technique due to the potential risk of neural injury. Slipping off the cutting surface of a high-speed drill may result in entrapment in neural structures, leading to serious complications. Removal of T-OPLL with an ultrasonic osteotome, utilizing back and forth micro-motion of a blade rather than rotatory-motion of drill, may reduce such complications. We have applied the ultrasonic osteotome for posterior circumferential decompression of T-OPLL for three consecutive patients with beak-type OPLL and have described the surgical techniques and patient outcomes. The preoperative chief complaint was gait disturbance in all patients. Japanese orthopedic association scores (JOA) was used for functional assessment. Scores measured 2/11, 5/11, 2/11, and 4/11 for each patient. The ventral T-OPLL mass was exposed after posterior midline approach, laminotomy and transeversectomy. The T-OPLL mass was directly removed with an ultrasonic osteotome and instrumented segmental fixation was performed. The surgeries were uneventful. Detailed surgical techniques were presented. Gait disturbance was improved in all patients. Dural tear occurred in one patient without squeal. Postoperative JOA was 6/11, 10/11, 8/11, and 8/11 (recovery rate; 44%, 83%, 67%, and 43%) respectively at 18, 18, 10, and 1 months postoperative. T-OPLL was completely removed in all patients as confirmed with computed tomography scan. We hope that surgical difficulties in direct removal of T-OPLL might be reduced by utilizing ultrasonic osteotome.

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참고문헌

  1. Bolesta MJ, Caron T, Chinthakunta SR, Vazifeh PN, Khalil S : Pedicle screw instrumentation of thoracolumbar burst fractures : biomechanical evaluation of screw configuration with pedicle screws at the level of the fracture. Int J Spine Surg 6 : 200-205, 2012 https://doi.org/10.1016/j.ijsp.2012.09.002
  2. Chaichana KL, Jallo GI, Dorafshar AH, Ahn ES : Novel use of an ultrasonic bone-cutting device for endoscopic-assisted craniosynostosis surgery. Childs Nerv Syst, 2013 [Epub ahead of print]
  3. Epstein NE : Medicolegal corner : when minimally invasive thoracic surgery leads to paraplegia. Surg Neurol Int 5 (Suppl 3) : S55-S58, 2014
  4. Fujimura Y, Nishi Y, Nakamura M, Toyama Y, Suzuki N : Long-term follow-up study of anterior decompression and fusion for thoracic myelopathy resulting from ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 22 : 305-311, 1997 https://doi.org/10.1097/00007632-199702010-00015
  5. Hanai K, Ogikubo O, Miyashita T : Anterior decompression for myelopathy resulting from thoracic ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 27 : 1070-1076, 2002 https://doi.org/10.1097/00007632-200205150-00012
  6. Hosono N, Sakaura H, Mukai Y, Ishii T, Yoshikawa H : En bloc laminoplasty without dissection of paraspinal muscles. J Neurosurg Spine 3 : 29-33, 2005 https://doi.org/10.3171/spi.2005.3.1.0029
  7. Hu X, Ohnmeiss DD, Lieberman IH : Use of an ultrasonic osteotome device in spine surgery : experience from the first 128 patients. Eur Spine J 22 : 2845-2849, 2013 https://doi.org/10.1007/s00586-013-2780-y
  8. Kawahara N, Tomita K, Murakami H, Hato T, Demura S, Sekino Y, et al. : Circumspinal decompression with dekyphosis stabilization for thoracic myelopathy due to ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 33 : 39-46, 2008 https://doi.org/10.1097/BRS.0b013e31815e3911
  9. Kimura H, Fujibayashi S, Takemoto M, Otsuki B, Matsuda S : Spontaneous reduction in ossification of the posterior longitudinal ligament of the thoracic spine after posterior spinal fusion without decompression : a case report. Spine (Phila Pa 1976) 39 : E417-E419, 2014 https://doi.org/10.1097/BRS.0000000000000187
  10. Lee SE, Jahng TA, Chung CK, Kim HJ : Circumferential spinal cord decompression through a posterior midline approach with lateral auxiliary ports for lower thoracic compressive myelopathy. Neurosurgery 70 (2 Suppl Operative) : 221-229, 2012
  11. Liu X, Zhu B, Liu X, Liu Z, Dang G : Circumferential decompression via the posterior approach for the surgical treatment of multilevel thoracic ossification of the posterior longitudinal ligaments : a single institution comparative study. Chin Med J (Engl) 127 : 3371-3377, 2014
  12. Ma X, An HS, Zhang Y, Brown NM, Chen Z, Zhang G, et al. : A radical procedure of circumferential spinal cord decompression through a modified posterior approach for thoracic myelopathy caused by severely impinging anterior ossification. Spine J 14 : 651-658, 2014 https://doi.org/10.1016/j.spinee.2013.06.091
  13. Matsumoto M, Chiba K, Toyama Y, Takeshita K, Seichi A, Nakamura K, et al. : Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine : a multi-institutional retrospective study. Spine (Phila Pa 1976) 33 : 1034-1041, 2008 https://doi.org/10.1097/BRS.0b013e31816c913b
  14. Matsumoto M, Toyama Y, Chikuda H, Takeshita K, Kato T, Shindo S, et al. : Outcomes of fusion surgery for ossification of the posterior longitudinal ligament of the thoracic spine : a multicenter retrospective survey : clinical article. J Neurosurg Spine 15 : 380-385, 2011 https://doi.org/10.3171/2011.6.SPINE10816
  15. Matsuyama Y, Sakai Y, Katayama Y, Imagama S, Ito Z, Wakao N, et al. : Indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine : is it possible to predict the surgical results? Eur Spine J 18 : 943-948, 2009 https://doi.org/10.1007/s00586-009-0956-2
  16. Matsuyama Y, Yoshihara H, Tsuji T, Sakai Y, Yukawa Y, Nakamura H, et al. : Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine : implication of the type of ossification and surgical options. J Spinal Disord Tech 18 : 492-497; discussion 498, 2005 https://doi.org/10.1097/01.bsd.0000155033.63557.9c
  17. McClendon J Jr, Sugrue PA, Ganju A, Koski TR, Liu JC : Management of ossification of the posterior longitudinal ligament of the thoracic spine. Neurosurg Focus 30 : E16, 2011
  18. Min JH, Jang JS, Lee SH : Clinical results of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine treated by anterior decompression. J Spinal Disord Tech 21 : 116-119, 2008 https://doi.org/10.1097/BSD.0b013e318060091a
  19. Miyashita T, Ataka H, Tanno T : Spontaneous reduction of a floated ossification of the ligamentum flavum after posterior thoracic decompression (floating method); report of a case (abridged translation of a primary publication). Spine J 13 : e7-e9, 2013
  20. Nickele C, Hanna A, Baskaya MK : Osteotomy for laminoplasty without soft tissue penetration, performed using a harmonic bone scalpel : instrumentation and technique. J Neurol Surg A Cent Eur Neurosurg 74 : 183-186, 2013 https://doi.org/10.1055/s-0032-1328958
  21. Onishi E, Sano H, Matsushita M : Surgical treatment for thoracic myelopathy due to simultaneous ossification of the posterior longitudinal ligament and ligamentum flavum at the same level. J Spinal Disord Tech, 2013 [Epub ahead of print]
  22. Park SB, Jahng TA, Kim CH, Chung CK : Thoracic and lumbar laminoplasty using a translaminar screw : morphometric study and technique. J Neurosurg Spine 10 : 603-609, 2009 https://doi.org/10.3171/2009.2.SPINE08257
  23. Sanborn MR, Balzer J, Gerszten PC, Karausky P, Cheng BC, Welch WC : Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci 18 : 1528-1533, 2011 https://doi.org/10.1016/j.jocn.2011.04.016
  24. Schaeren S, Jaquiery C, Heberer M, Tolnay M, Vercellotti T, Martin I : Assessment of nerve damage using a novel ultrasonic device for bone cutting. J Oral Maxillofac Surg 66 : 593-596, 2008 https://doi.org/10.1016/j.joms.2007.03.025
  25. Sugita S, Chikuda H, Takeshita K, Seichi A, Tanaka S : Progression of ossification of the posterior longitudinal ligament of the thoracic spine following posterior decompression and stabilization. J Neurosurg Spine 21 : 773-777, 2014 https://doi.org/10.3171/2014.7.SPINE131191
  26. Takahata M, Ito M, Abumi K, Kotani Y, Sudo H, Minami A : Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine (Phila Pa 1976) 33 : 1199-1208, 2008 https://doi.org/10.1097/BRS.0b013e3181714515
  27. Tomita K, Kawahara N, Baba H, Kikuchi Y, Nishimura H : Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and ligamentum flavum. Spine (Phila Pa 1976) 15 : 1114-1120, 1990 https://doi.org/10.1097/00007632-199011010-00006
  28. Yamazaki M, Mochizuki M, Ikeda Y, Sodeyama T, Okawa A, Koda M, et al. : Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament : operative indication of posterior decompression with instrumented fusion. Spine (Phila Pa 1976) 31 : 1452-1460, 2006 https://doi.org/10.1097/01.brs.0000220834.22131.fb
  29. Yang SH, Kim CH, Chung CK, Park SB, Sohn S, Lee S : Bone fusion rate in the thoracic and lumbar spine after laminoplasty with laminar screws. Spine (Phila Pa 1976) 39 : E1325-E1330, 2014 https://doi.org/10.1097/BRS.0000000000000566
  30. Zhang HQ, Chen LQ, Liu SH, Zhao D, Guo CF : Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level. J Neurosurg Spine 13 : 116-122, 2010 https://doi.org/10.3171/2010.3.SPINE09237

피인용 문헌

  1. Surgical Outcomes According to Dekyphosis in Patients with Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine vol.63, pp.1, 2015, https://doi.org/10.3340/jkns.2018.0177
  2. Ossification of the ligamentum flavum in the upper cervical spine: A report of two cases and literature review vol.20, pp.2, 2015, https://doi.org/10.3892/etm.2020.8834
  3. Ultrasonic bone scalpel for thoracic spinal decompression: case series and technical note vol.15, pp.None, 2020, https://doi.org/10.1186/s13018-020-01838-9