The First Affiliated Hospital of Chinese PLA's General Hospital, Beijing, China.
Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
Pain Physician. 2021 Mar;24(2):E239-E248.
Conventional open laminectomy is considered to be the standard procedure for the treatment of thoracic ossified ligamentum flavum, but multi-segment thoracic laminectomy extensively removes the facet joints and ligamentous tissue, destroying the thoracic spine biomechanics and stability, may lead to delayed thoracic spine kyphosis deformities, which in turn can lead to potential neurological deterioration and local intractable pain.
To introduce the technical notes and clinical outcome of ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum.
A prospective cohort study.
Hospital and outpatient surgery center.
From January 2017 to March 2018, 15 patients with 1 - 2 segment thoracic ossified ligamentum flavum were treated with ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum under local anesthesia. The magnetic resonance imaging and computed tomography of the thoracic spine was reexamined after the operation to evaluate the completeness of ossified ligamentum flavum resection and spinal cord decompression. The patients were followed up on the visual analog scale of back pain and radicular pain, Nurick score and mJOA score of neurological function, and Oswestry Disability Index at 1 week, 3 months, 6 months, one year, and 2 years after operation.
All operations of 17 segments thoracic ossified ligamentum flavum in 15 patients were successfully completed without intraoperative conversion to open surgery. There were no intraoperative spinal cord injuries, dura tears, postoperative cerebrospinal fluid leakage, postoperative infections, and postoperative spinal cord injury aggravated symptoms. Postoperative thoracic spine magnetic resonance imaging and computed tomography examinations of all patients showed that the spinal cord was fully decompressed without any residual pressure. Back pain and radicular pain were relieved significantly, and spinal cord function (Nurick, mJOA, and Oswestry Disability Index scores) was obviously restored. The mJOA recovery rate at the 2-year follow-up was 78.3% in average.
This is an observational cohort study with relative small sample and short-term follow-up.
Ultrasonic assisted full-endoscopic en block resection of ossified ligamentum flavum is a safe and effective minimally invasive spine surgery for thoracic myelography caused by thoracic ossified ligamentum flavum.
传统的开放式椎板切除术被认为是治疗胸椎骨化黄韧带的标准手术方法，但多节段胸椎椎板切除术广泛切除关节突关节和韧带组织，破坏胸椎脊柱生物力学和稳定性，可能导致迟发性胸椎后凸畸形，进而导致潜在的神经恶化和局部难治性疼痛。
介绍超声骨刀辅助全内镜整块切除胸椎骨化黄韧带的技术要点和临床效果。
前瞻性队列研究。
医院和门诊手术中心。
2017 年 1 月至 2018 年 3 月，在局部麻醉下，对 15 例 1-2 个节段胸椎骨化黄韧带患者采用超声骨刀辅助全内镜整块切除胸椎骨化黄韧带。术后复查胸椎 MRI 和 CT，评估骨化黄韧带切除和脊髓减压的完整性。术后 1 周、3 个月、6 个月、1 年和 2 年，采用视觉模拟评分（VAS）评估背痛和神经根痛、Nurick 评分和 mJOA 评分神经功能、Oswestry 残疾指数（ODI）。
15 例患者的 17 个节段胸椎骨化黄韧带手术均成功完成，无术中转为开放手术。术中无脊髓损伤、硬脊膜撕裂、术后脑脊液漏、术后感染、术后脊髓损伤加重症状。所有患者术后胸椎 MRI 和 CT 检查均显示脊髓充分减压，无任何残余压迫。背痛和神经根痛明显缓解，脊髓功能（Nurick、mJOA 和 ODI 评分）明显恢复。2 年随访时 mJOA 恢复率平均为 78.3%。
这是一项观察性队列研究，样本量相对较小，随访时间较短。
超声辅助全内镜整块切除骨化黄韧带是治疗胸椎骨化黄韧带引起的胸椎脊髓造影的一种安全有效的微创脊柱手术。
