Department of Orthopedics, Hebei General Hospital;
Department of Orthopedics, Hebei General Hospital.
J Vis Exp. 2023 Jan 20(191). doi: 10.3791/64962.
Ossification of the ligamentum flavum (OLF) can result in spinal stenosis. Thoracic spinal cord compression due to spinal stenosis is a common cause of progressive thoracic myelopathy in Asian countries. The incidence of complications is high in open decompression surgeries for thoracic OLF. With dural ossification (DO), the risk of complications is even higher in thoracic OLF. We introduce a full-endoscopic decompression surgery for thoracic OLF combined with DO under local anesthesia. Hemilaminectomy is performed using a high-speed burr under the endoscopy first, and then decompression of the contralateral spinal canal is completed using an "over the top" technique. DO resection uses the eggshell technique; after the base of the DO is cut from the lamina, forceps or lamina rongeurs are typically used for removal. The dural defect left after resection does not need repair. Neurological function was improved, and no complications such as hematoma or neck pain occurred. On imaging, no pseudodural cyst, cerebrospinal fluid leakage, or wound complications were observed after the operation. Endoscopic surgery causes less damage to the posterior ligament complex, so no cases of persistent back pain complaints or secondary internal fixation requirements were found in this study. Full-endoscopic decompression can achieve good imaging and clinical effects in the treatment of thoracic OLF with DO.
黄韧带骨化（OLF）可导致椎管狭窄。由于椎管狭窄导致的胸段脊髓受压是亚洲国家进行性胸脊髓病的常见原因。开放性减压手术治疗胸段 OLF 的并发症发生率较高。对于伴有硬脊膜骨化（DO）的胸段 OLF，并发症的风险甚至更高。我们介绍一种在局部麻醉下使用全内窥镜治疗合并 DO 的胸段 OLF 的减压手术。首先在镜下使用高速磨钻进行半椎板切除术，然后使用“过顶”技术完成对侧椎管的减压。采用蛋壳技术切除 DO；从椎板上切除 DO 的基底后，通常使用咬骨钳或椎板咬骨钳进行切除。切除后留下的硬脑膜缺损无需修复。神经功能得到改善，且无血肿或颈部疼痛等并发症发生。影像学检查显示，术后无假性硬脑膜囊肿、脑脊液漏或伤口并发症。内窥镜手术对后韧带复合体的损伤较小，因此在本研究中未发现持续背痛投诉或二次内固定需求的病例。全内窥镜减压术在治疗伴有 DO 的胸段 OLF 方面可获得良好的影像学和临床效果。
