Wang Hui, Ding Wenyuan
Department of Spine Surgery, The Third Hospital of HeBei Medical University, Shijiazhuang, China.
Department of Spine Surgery, The Third Hospital of HeBei Medical University, Shijiazhuang, China.
World Neurosurg. 2018 Nov;119:321-324. doi: 10.1016/j.wneu.2018.08.077. Epub 2018 Aug 23.
Thoracic ossification of the ligamentum flavum (OLF) is a common cause of thoracic myeloradiculopathy. Thoracolumbar kyphosis derived from abnormal embryonic development of the spine vertebrae often progresses continuously and causes neurologic deterioration. These conditions are presented separately in most cases. A diagnosis of both OLF and thoracolumbar kyphosis in the same patient is rare, and no definite principle of surgical strategy for this case could be found in the literature.
Here we report a 36-year-old woman who suffered from weakness and numbness of bilateral lower extremities for 2 years and urinary dysfunction for 1 month. On physical examination, the strength of muscles of lower limbs was grade 2 and the sensory system was bilaterally lost below the inguinal groove with numbness in the saddle area. Hyperreflexia was found in both lower limbs, and the Babinski sign was positive bilaterally. Thoracic OLF and thoracolumbar kyphosis were diagnosed on the basis of clinical presentation, radiograph, computed tomography, and magnetic resonance imaging. We performed 1-stage laminectomy and kyphosis correction by posterior vertebral column resection. The patient experienced postoperative paraplegia, and the strength of muscles of lower limbs recovered to the preoperative level at 1-year follow-up and stopped improving until the 5-year follow-up. However, the urinary dysfunction became normal at 3 months postoperative. Kyphotic deformity was corrected from preoperative 83.5 degrees to 35.0 degrees at the final follow-up, and bone fusion was achieved around the mesh cage without implantation failure.
For patients with thoracic OLF and thoracolumbar kyphosis derived from wedged vertebrae, 1-stage laminectomy and kyphosis correction has a risk that may lead to a negative outcome. Staging operation should be taken into consideration when planning a surgical strategy for the treatment of kyphosis associated with concurrent compressive myelopathy.
胸椎黄韧带骨化（OLF）是胸段脊髓神经根病的常见病因。源于脊椎胚胎发育异常的胸腰椎后凸通常会持续进展并导致神经功能恶化。在大多数情况下，这些病症是分别出现的。同一患者同时诊断出OLF和胸腰椎后凸的情况很少见，并且在文献中找不到针对这种情况的明确手术策略原则。
在此，我们报告一名36岁女性，她双下肢无力、麻木2年，排尿功能障碍1个月。体格检查时，下肢肌力为2级，双侧腹股沟沟以下感觉系统丧失，鞍区麻木。双下肢均出现反射亢进，双侧巴氏征阳性。根据临床表现、X线片、计算机断层扫描和磁共振成像诊断为胸椎OLF和胸腰椎后凸。我们通过后路脊柱切除术进行了一期椎板切除术和后凸畸形矫正。患者术后出现截瘫，随访1年时下肢肌力恢复到术前水平，直到随访5年时才停止改善。然而，术后3个月排尿功能障碍恢复正常。末次随访时后凸畸形从术前的83.5度矫正至35.0度，网笼周围实现了骨融合，未出现植入失败。
对于患有胸椎OLF和楔形椎骨导致的胸腰椎后凸的患者，一期椎板切除术和后凸畸形矫正存在可能导致不良后果的风险。在为并发压迫性脊髓病的后凸畸形制定手术治疗策略时，应考虑分期手术。
