J Neurosurg Spine. 2019 May 24;31(3):326-333. doi: 10.3171/2019.3.SPINE181388. Print 2019 Sep 1.
Surgical management of thoracic ossification of the posterior longitudinal ligament (OPLL) remains challenging because of the anatomical complexity of the thoracic spine and the fragility of the thoracic spinal cord. Several surgical approaches have been described, but it remains unclear which of these is the most effective. The present study describes the microsurgical removal of OPLL in the middle thoracic level via the transthoracic anterolateral approach without spinal fusion, including the surgical outcome and operative tips.
Between 2002 and 2017, a total of 8 patients with thoracic myelopathy due to OPLL were surgically treated via the transthoracic anterolateral approach without spinal fusion. The surgical techniques are described in detail. Clinical outcome, surgical complications, and the pre- and postoperative thoracic kyphotic angle were assessed.
The mean patient age at the time of surgery was 55 years (range 47-77 years). There were 5 women and 3 men. The surgically treated levels were within T3-9. The clinical symptoms and Japanese Orthopaedic Association (JOA) score improved postoperatively in 7 cases, but did not change in 1 case. The mean JOA score increased from 6.4 preoperatively to 7.5 postoperatively (recovery rate 26%). Intraoperative CSF leakage occurred in 4 cases, and was successfully treated with fibrin glue sealing and spinal drainage. The mean follow-up period was 82.6 months (range 15.3-169 months). None of the patients had deterioration of the thoracic kyphotic angle.
Anterior decompression is the logical and ideal procedure to treat thoracic myelopathy caused by OPLL on the concave side of the spinal cord; however, this procedure is technically demanding. Microsurgery via the transthoracic anterolateral approach enables direct visualization of the thoracic ventral ossified lesion. The use of microscopic procedures might negate the need for bone grafting or spinal instrumentation.
由于胸椎解剖结构复杂，胸段脊髓脆弱，胸椎后纵韧带骨化症（OPLL）的手术治疗仍然具有挑战性。已经描述了几种手术入路，但哪种方法最有效仍不清楚。本研究描述了一种通过经胸侧前方入路不进行脊柱融合治疗胸段中间水平 OPLL 的显微切除方法，包括手术结果和手术技巧。
2002 年至 2017 年，共 8 例因 OPLL 导致胸段脊髓病的患者接受了不进行脊柱融合的经胸侧前方入路手术治疗。详细描述了手术技术。评估了临床结果、手术并发症以及术前和术后的胸椎后凸角。
手术时患者的平均年龄为 55 岁（范围 47-77 岁）。女性 5 例，男性 3 例。手术治疗的节段位于 T3-9 之间。7 例患者的临床症状和日本矫形协会（JOA）评分在术后得到改善，但 1 例无变化。JOA 评分从术前的 6.4 分提高到术后的 7.5 分（恢复率 26%）。术中发生 4 例脑脊液漏，采用纤维蛋白胶密封和脊髓引流成功治疗。平均随访时间为 82.6 个月（范围 15.3-169 个月）。所有患者的胸椎后凸角均无恶化。
对于脊髓受压侧的胸椎 OPLL 引起的脊髓病，前路减压是合理且理想的治疗方法；然而，该方法技术要求较高。经胸侧前方入路的显微手术可直接观察胸椎前侧骨化病变。采用显微镜手术可能不需要植骨或脊柱内固定。
