[The circumferential decompression by posterior transpedicular osteotomy and segmental instrumentation with interbody fusion for thoracic ossification of posterior iongitudinal ligament].

OBJECTIVE

To observe the efficacy of the circumferential decompression with posterior transpedicular osteotomy and segmental instrumentation with interbody fusion for thoracic ossification of posterior Iongitudinal ligament (T-OPLL).

METHODS

From May 2012 to June 2015, 16 consecutive patients underwent posterior transpedicular osteotomy and segmental instrumentation with interbody fusion.Osteotomy range was depended by length and types of OPLL.Patient's data included level, clinical presentation, blood loss, length of surgery, complications, VAS, JOA, and Frankel grading system before and after the surgery. All data were collected, retrospectively.

RESULTS

The follow-up period was (30±19) months (range from 12 to 50 months). The operation time was (261.6±51.3) min (range from 190 to 310 min). The blood loss was (980.3±370.5) ml (range from 600 to 2 100 ml). All patients were well treated with posterior compression and segmental instrumentation with interbody fusion.The VAS score was (4.2±0.2) in all patients at a week, improving to (2.7±0.1) points at 3 months, (2.4±0.2) at 1 year, and (2.0±0.1) at last fellow-up.The statistical analysis of the results showed a significant improvement of pain at 3 months (P<0.05) when compared to the preoperative status.The preoperative JOA score was (4.2±1.7) in all patients, improving to (7.8±2.5) points at 3 months, (8.5±2.7) at 1 year, and (9.0±1.0) at last fellow-up.The mean recovery rate for the total JOA score was (72%±8%). Differences in the overall JOA Scores showed significant postoperative improvement.Frankel grade improved by either 1 or 2 grades in 16 patients at the last follow-up.None of the patients showed any signs of instrument migration or failure during follow-up.

CONCLUSION

The results suggested that the procedure achieved a total resection of the ossified posterior longitudinal ligament.The treatment method with posterior transpedicular osteotomy and circumferential decompression was found to be safe, effective, reliable, and technically feasible.