Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China.
Chin Med J (Engl). 2011 Dec;124(23):3879-85.
The surgical outcomes of decompression for thoracic spinal stenosis (TSS) are unfavorable. The purpose of this study was to determine the efficacy of intraoperative ultrasonography during "cave-in" 360° circumferential decompression surgery in patients with TSS.
Thirteen patients with TSS underwent "cave-in" 360° circumferential decompression surgery between May 2010 and November 2010. Intraoperative ultrasonography was used after removal of the posterior wall of thoracic spinal canal to assess the morphologic restoration of the spinal cord and the anterior surface of the spinal canal. In seven patients, ultrasonography was used again after circumferential decompression to compare the cross-sectional area of the spinal cord before and after circumferential decompression.
The average period of follow-up was (12 ± 2) months (range 9 - 15 months). The Japanese Orthopedic Association score was significantly higher at the final follow-up (8.5 ± 2.1, range 3 - 10) than preoperatively (5.2 ± 1.1, range 3 - 7; P < 0.01). The cross-sectional area of the spinal cord was (30.8 ± 6.6) mm2 before and (53.6 ± 19.1) mm2 after circumferential decompression (P < 0.01). For five patients with TSS caused by thoracic disc herniation, the levels of circumferential decompression performed corresponded to those expected preoperatively. In contrast, for eight patients with TSS caused by ossification of the posterior longitudinal ligament, on average 1.6 ± 0.9 fewer levels of circumferential decompression were performed than expected preoperatively.
"Cave-in" 360° circumferential decompression is an effective therapeutic option for TSS. Intraoperative ultrasonographic evaluation may reduce the levels of circumferential decompression and ensure sufficient decompression, and increase the efficacy of this surgical technique.
减压治疗胸椎管狭窄症（TSS）的手术效果并不理想。本研究旨在确定术中超声在 TSS 患者“塌陷”360°环形减压术中的疗效。
2010 年 5 月至 2010 年 11 月，13 例 TSS 患者接受“塌陷”360°环形减压术。在去除胸椎管后壁后，使用术中超声评估脊髓形态恢复和椎管前表面。在 7 例患者中，在环形减压后再次使用超声检查，比较环形减压前后脊髓的横截面积。
平均随访时间为（12±2）个月（范围 9-15 个月）。末次随访时日本矫形协会评分（8.5±2.1，范围 3-10）明显高于术前（5.2±1.1，范围 3-7；P<0.01）。脊髓横截面积术前为（30.8±6.6）mm2，术后为（53.6±19.1）mm2（P<0.01）。对于 5 例由胸椎间盘突出引起的 TSS 患者，环形减压的水平与术前预期相符。相比之下，对于 8 例由后纵韧带骨化引起的 TSS 患者，平均少做了 1.6±0.9 个环形减压水平，低于术前预期。
“塌陷”360°环形减压术是 TSS 的一种有效治疗选择。术中超声评估可减少环形减压水平，确保充分减压，提高该手术技术的疗效。
