Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Gu, Seoul 137-701, Korea.
Eur Spine J. 2012 Dec;21(12):2443-9. doi: 10.1007/s00586-012-2413-x. Epub 2012 Jun 30.
The objective of this study was to investigate thoracic myelopathy caused by ossification of the yellow ligament (OYL) in patients with posterior instrumented lumbar fusion.
Seven patients, who had undergone posterior instrumented lumbar fusion, presented with thoracic myelopathy caused by OYL. No patient had a history of thoracic myelopathy at previous surgery. Instrumented fusions were performed from L1-5 in two patients, L2-5 in three patients and L1-S1 and L2-S1 in one patient each, respectively. MRI and CT scans were performed to confirm cord compression by OYL. Of the seven patients, six patients underwent decompressive laminectomy and OYL removal while one was treated conservatively.
The average time to presentation after first surgery was 63.4 months. OYL was located at T9-10 in two patients, T11-12 in three patients, and T10-11 and T9-11 in one patient each, respectively. All patients had a myelopathic gait and the average Japanese Orthopaedic Association (JOA) score was 3.9, preoperatively. The average JOA score improved from 3.7 to 8 and the average recovery rate was 58.9 % in the six patients who underwent surgical intervention. However, the JOA score fell from 5 to 4 in the one patient who was treated conservatively.
We report seven patients who suffered from thoracic myelopathy after instrumented lumbar fusion. Surgeons must be aware of the possibility of thoracic myelopathy caused by OYL at the thoracolumbar junction, especially in patients with a complaint of gait disturbance after long instrumented lumbar fusion.
本研究旨在探讨后路腰椎融合术后黄韧带骨化(OYL)引起的胸段脊髓病。
7 例后路腰椎融合术后患者出现 OYL 引起的胸段脊髓病。这些患者既往均无胸段脊髓病病史。2 例患者行 L1-5 节段融合,3 例患者行 L2-5 节段融合,1 例患者分别行 L1-S1 和 L2-S1 节段融合。所有患者均行 MRI 和 CT 扫描以明确 OYL 所致脊髓压迫。7 例患者中,6 例行减压椎板切除术和 OYL 切除,1 例患者行保守治疗。
首次手术后出现症状的平均时间为 63.4 个月。2 例患者 OYL 位于 T9-10 节段,3 例患者位于 T11-12 节段,1 例患者分别位于 T10-11 和 T9-11 节段。所有患者均存在脊髓病步态,术前平均日本矫形协会(JOA)评分为 3.9 分。6 例行手术干预的患者术后 JOA 评分从 3.7 分提高至 8 分,平均恢复率为 58.9%。1 例行保守治疗的患者 JOA 评分从 5 分降至 4 分。
我们报告了 7 例后路腰椎融合术后发生胸段脊髓病的患者。对于长节段后路腰椎融合术后出现步态异常的患者,外科医生必须意识到胸段脊髓病可能由胸腰椎交界处的 OYL 引起。