Department of Spinal Surgery Hong-Hui Hospital Xi'an Jiaotong University.
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
Pain Physician. 2021 May;24(3):275-281.
Resection of the ossification of the thoracic ligamentum flavum (OTLF) with a high-speed burr may cause a high rate of perioperative complications, such as dural laceration and/or iatrogenic spinal cord injury.
The aim of this study was to investigate the safety and feasibility of the endoscopic-matched ultrasonic osteotome in full-endoscopic spinal surgery for direct removal of OTLF.
Retrospective study.
All data were from Honghui Hospital in Xi'an.
This study conducted between December 2017 and December 2018, included 27 consecutive patients who met the study criteria, had single-level OTLF, and underwent full-endoscopic decompression under local anesthesia. The postoperative follow-up was scheduled at 1, 3, 6, and 12 months postoperatively. Outcomes evaluations included the Visual Analog Scale (VAS) score for lower extremity pain and the modified Japanese Orthopaedic Association (mJOA) score and improvement rate for the assessment of thoracic myelopathy. Removal of OTLF was measured by comparing the pre- and postoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans.
The operation was completed in all patients without conversion to open surgery. The operation time ranged from 65 to 125 minutes (average, 83.7 ± 12.3 minutes). All patients were followed up for 12 to 18 months, with an average follow-up of 14.3 ± 1.3 months. Satisfactory neurologic decompression was confirmed by postoperative CT and MRI, and no revision surgery was required. The VAS and mJOA scores showed statistically higher improvement at the 1-month follow-up and the last follow-up compared with the preoperative assessment (P < 0.05). According to the improvement rate at the final follow-up, 20 cases were classified as good, 6 cases were fair, and 1 case remained unchanged.
A single-center, noncontrol study.
The endoscopic-matched ultrasonic osteotome can be considered quite safe and feasible for direct removal of OTLF during full-endoscopic spinal surgery in strictly selected patients, as this allows for effective direct decompression of OTLF while minimizing trauma and instability. In addition, because of the design characteristics of the ultrasonic osteotome, surgical complications, especially dural tears and spinal cord injury, can also be effectively controlled.
使用高速磨钻切除黄韧带骨化（OTLF）可能会导致较高的围手术期并发症发生率，如硬脊膜撕裂和/或医源性脊髓损伤。
本研究旨在探讨内镜匹配超声骨刀在全内镜脊柱手术中直接切除 OTLF 的安全性和可行性。
回顾性研究。
所有数据均来自西安红会医院。
本研究于 2017 年 12 月至 2018 年 12 月进行，纳入了 27 例符合研究标准、单节段 OTLF 并在局部麻醉下接受全内镜减压的连续患者。术后随访时间为术后 1、3、6 和 12 个月。疗效评估包括下肢疼痛的视觉模拟评分（VAS）和改良日本骨科协会（mJOA）评分，以及胸髓病的评估改善率。通过比较术前和术后 CT 和 MRI 扫描来测量 OTLF 的切除情况。
所有患者均成功完成手术，无中转开放手术。手术时间为 65 至 125 分钟（平均 83.7 ± 12.3 分钟）。所有患者均随访 12 至 18 个月，平均随访 14.3 ± 1.3 个月。术后 CT 和 MRI 证实神经减压满意，无需再次手术。VAS 和 mJOA 评分在术后 1 个月和末次随访时较术前均有统计学意义上的显著改善（P < 0.05）。末次随访时，按改善率评定，20 例为优，6 例为良，1 例为差。
单中心、非对照研究。
在严格选择的患者中，内镜匹配超声骨刀可用于全内镜脊柱手术中直接切除 OTLF，该方法可有效直接减压 OTLF，同时最大限度地减少创伤和不稳定性，被认为是相当安全和可行的。此外，由于超声骨刀的设计特点，手术并发症，特别是硬脊膜撕裂和脊髓损伤，也可以得到有效控制。
