Xu Zhao-Wan, Hu Yong-Cheng, Sun Chui-Guo, Shang Xiao-Peng, Lun Deng-Xing, Li Feng, Ji Xu-Bin, Liu Da-Yong, Chen Nai-Wang, Zhuang Qing-Shan
Department of Spine Surgery, Weifang People's Hospital, Weifang, China.
Department of Bone Oncology, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2017 May;9(2):206-214. doi: 10.1111/os.12331. Epub 2017 Jun 14.
To report the results of the posterior approach for thoracic ossification of posterior longitudinal ligament (TOPLL) by using a special "L" osteotome.
The present study enrolled 16 consecutive patients (9 men and 7 women) between May 2009 and September 2013. All patients underwent a posterior circumferential decompression osteotomy and segmental instrumentation with interbody fusion. The mean age at surgery was 57.3 years (range, 37-68 years). Patients' data, clinical manifestation, blood loss, length of surgery, complications, visual analog scale (VAS), Japanese Orthopedic Association (JOA), and Frankel grading system before and after surgery were collected and evaluated, retrospectively.
The average follow-up period was 30 ± 19 months (range, 12-50 months). All patients were successfully treated with posterior compression and segmental instrumentation with interbody fusion. The average operation time was 261.6 ± 51.3 min (range, 190-310 min). The mean blood loss was 980.3 ± 370.5 mL (range, 600-2100 mL). All patients had subjective improvement of motor power and gait. Average preoperative and postoperative JOA scores were 4.2 ± 1.7 and 7.8 ± 2.5 points, respectively. Differences in the overall JOA scores showed significant postoperative improvement. At the last follow-up, all patients improved either by one or two Frankel grades. There was a significant difference between preoperative VAS scores and those 3 months after surgery (P < 0.05). No significant difference was observed between the 3-month and 12-month results (P > 0.05). Cerebrospinal fluid (CSF) leakage occurred in 3 patients. Acute neurological deterioration was encountered postoperatively in 1 patient.
Treatment with posterior transpedicular osteotomy and circumferential decompression was found to be safe, effective, reliable, and technically feasible, and keeping the thoracic cavity intact avoids many shortcomings of anterior surgery and results in a satisfactory spinal decompression.
报告使用特制“L”形骨刀经后路治疗胸段后纵韧带骨化症（TOPLL）的结果。
本研究纳入了2009年5月至2013年9月期间连续的16例患者（9例男性，7例女性）。所有患者均接受了后路环形减压截骨术及节段性内固定并椎间融合术。手术时的平均年龄为57.3岁（范围37 - 68岁）。回顾性收集并评估患者术前及术后的数据、临床表现、失血量、手术时长、并发症、视觉模拟评分（VAS）、日本矫形外科学会（JOA）评分及Frankel分级系统。
平均随访时间为30 ± 19个月（范围12 - 50个月）。所有患者均通过后路减压及节段性内固定并椎间融合术获得成功治疗。平均手术时间为261.6 ± 51.3分钟（范围190 - 310分钟）。平均失血量为980.3 ± 370.5毫升（范围600 - 2100毫升）。所有患者的运动能力和步态均有主观改善。术前及术后JOA评分的平均值分别为4.2 ± 1.7分和7.8 ± 2.5分。JOA总分差异显示术后有显著改善。在末次随访时，所有患者Frankel分级提高了一级或两级。术前VAS评分与术后3个月时的评分有显著差异（P < 0.05）。3个月与12个月的结果之间未观察到显著差异（P > 0.05）。3例患者发生脑脊液（CSF）漏。1例患者术后出现急性神经功能恶化。
经后路椎弓根截骨及环形减压治疗安全、有效、可靠且技术可行，保持胸腔完整可避免前路手术的诸多缺点，实现满意的脊髓减压效果。
