Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Minimally Invasive Anterior Decompression Technique without Instrumented Fusion for Huge Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine : Technical Note And Literature Review

  • Yu, Jae Won (Department of Neurosurgery, Spine Health Wooridul Hospital) ;
  • Yun, Sang-O (Department of Neurosurgery, Spine Health Wooridul Hospital) ;
  • Hsieh, Chang-Sheng (Department of Orthopedics, Tai Shin Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Spine Health Wooridul Hospital Gangnam)
  • Received : 2017.04.27
  • Accepted : 2017.06.16
  • Published : 2017.09.01
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Abstract

Objective : Several surgical methods have been reported for treatment of ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Despite rapid innovation of instruments and techniques for spinal surgery, the postoperative outcomes are not always favorable. This article reports a minimally invasive anterior decompression technique without instrumented fusion, which was modified from the conventional procedure. The authors present 2 cases of huge beak-type OPLL. Patients underwent minimally invasive anterior decompression without fusion. This method created a space on the ventral side of the OPLL without violating global thoracic spinal stability. Via this space, the OPLL and anterior lateral side of the dural sac can be seen and manipulated directly. Then, total removal of the OPLL was accomplished. No orthosis was needed. In this article, we share our key technique and concepts for treatment of huge thoracic OPLL. Methods : Case 1. 51-year-old female was referred to our hospital with right lower limb radiating pain and paresis. Thoracic OPLL at T6-7 had been identified at our hospital, and conservative treatment had been tried without success. Case 2. This 54-year-old female with a 6-month history of progressive gait disturbance and bilateral lower extremity radiating pain (right>left) was admitted to our institute. She also had hypoesthesia in both lower legs. Her symptoms had been gradually progressing. Computed tomography scans showed massive OPLL at the T9-10 level. Magnetic resonance imaging of the thoracolumbar spine demonstrated ventral bony masses with severe anterior compression of the spinal cord at the same level. Results : We used this surgical method in 2 patients with a huge beaked-type OPLL in the thoracic level. Complete removal of the OPLL via anterior decompression without instrumented fusion was accomplished. The 1st case had no intraoperative or postoperative complications, and the 2nd case had 1 intraoperative complication (dural tear) and no postoperative complications. There were no residual symptoms of the lower extremities. Conclusion : This surgical technique allows the surgeon to safely and effectively perform minimally invasive anterior decompression without instrumented fusion via a transthoracic approach for thoracic OPLL. It can be applied at the mid and lower level of the thoracic spine and could become a standard procedure for treatment of huge beak-type thoracic OPLL.

Keywords

References

  1. Abumi K, Suda K : Surgical strategy for thoracic OPLL. Orthop Surg Traumatol 45 : 615-621, 2002
  2. Aizawa T, Sato T, Sasaki H, Matsumoto F, Morozumi N, Kusakabe T, et al. : Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. J Neurosurg Spine 7 : 13-20, 2007 https://doi.org/10.3171/SPI-07/07/013
  3. 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
  4. Fujimura Y, Nishi Y, Nakamura M, Watanabe M, Matsumoto M : Myelopathy secondary to ossification of the posterior longitudinal ligament of the thoracic spine treated by anterior decompression and bony fusion. Spinal Cord 35 : 777-784, 1997 https://doi.org/10.1038/sj.sc.3100487
  5. Ido K, Shimizu K, Nakayama Y, Yamamuro T, Shikata J, Matsushita M, et al. : Anterior decompression and fusion for ossification of posterior longitudinal ligament in the thoracic spine. J Spinal Disord 8 : 317-323, 1995 https://doi.org/10.1097/00002517-199508040-00010
  6. Kato S, Kawahara N, Tomita K, Murakami H, Demura S, Fujimaki Y : Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of Adamkiewicz: an experimental study using a dog model. Spine (Phila Pa 1976) 33 : 1533-1541, 2008 https://doi.org/10.1097/BRS.0b013e318178e5af
  7. 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
  8. Kawakami N, Mimatsu K, Kato F, Sato K, Matsuyama Y : Intraoperative ultrasonographic evaluation of the spinal cord in cervical myelopathy. Spine (Phila Pa 1976) 19 : 34-41, 1994 https://doi.org/10.1097/00007632-199401000-00007
  9. Kojima T, Waga S, Kubo Y, Matsubara T : Surgical treatment of ossification of the posterior longitudinal ligament in the thoracic spine. Neurosurgery 34 : 854-858; discussion 858, 1994
  10. Kurosa Y, Yamaura I, Nakai O, Shinomiya K : Selecting a surgical method for thoracic myelopathy caused by ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 21 : 1458-1466, 1996 https://doi.org/10.1097/00007632-199606150-00012
  11. Lazorthes G, Gouaze A, Zadeh JO, Santini JJ, Lazorthes Y, Burdin P : Arterial vascularization of the spinal cord. Recent studies of the anastomotic substitution pathways. J Neurosurg 35 : 253-262, 1971 https://doi.org/10.3171/jns.1971.35.3.0253
  12. 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
  13. 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
  14. 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 : 492-498; discussion 498, 2005 https://doi.org/10.1097/01.bsd.0000155033.63557.9c
  15. 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
  16. Murakami H, Kawahara N, Tomita K, Demura S, Kato S, Yoshioka K : Does interruption of the artery of Adamkiewicz during total en bloc spondylectomy affect neurologic function? Spine (Phila Pa 1976) 35 : E1187-E1192, 2010 https://doi.org/10.1097/BRS.0b013e3181e215e5
  17. Ohtsuka K, Terayama K, Tsuchiya T, Wada K, Furukawa K, Ohkubo M : A surgical procedure of the anterior decompression of the thoracic spinal cord through the posterior approach. Orthop Surg Traumatol 26 : 1083-1090, 1983
  18. 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
  19. 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
  20. Tokuhashi Y, Matsuzaki H, Oda H, Uei H : Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine: usefulness of the ossification-kyphosis angle on MRI. Spine (Phila Pa 1976) 31 : E26-E30, 2006 https://doi.org/10.1097/01.brs.0000193940.75354.e5
  21. Tsuyama N : Ossification of the posterior longitudinal ligament of the spine. Clin Orthop Relat Res 184 : 71-84, 1984
  22. Tsuzuki N, Hirabayashi S, Abe R, Saiki K : Staged spinal cord decompression through posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine (Phila Pa 1976) 26 : 1623-1630, 2001 https://doi.org/10.1097/00007632-200107150-00025
  23. 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
  24. Yonenobu K, Korkusuz F, Hosono N, Ebara S, Ono K : Lateral rhachotomy for thoracic spinal lesions. Spine (Phila Pa 1976) 15 : 1121-1125, 1990 https://doi.org/10.1097/00007632-199011010-00007

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