Zhong Zhuolin, Ying Jingjing, Wu Hongwei, Zhang Shaohua, Ying Mingshuai, Hu Qingfeng
Department of Orthopedics, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China.
Department of Orthopedics, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Spine Surg Relat Res. 2024 Dec 20;9(3):321-330. doi: 10.22603/ssrr.2024-0094. eCollection 2025 May 27.
Thoracic ossification of the ligamentum flavum (T-OLF), which leads to neurological impairment, is a rare pathologic entity. Open posterior laminectomy is the gold standard treatment for T-OLF. However, the high rates of postoperative complications and perioperative morbidity have raised many concerns among surgeons. This study presented a series of patients with symptomatic single-level T-OLF who underwent posterior decompression using biportal endoscopic spinal surgery (BESS). The objective of this study was to demonstrate our procedure using BESS for T-OLF resection and to evaluate its safety and efficacy.
We retrospectively reviewed patients who previously underwent thoracic posterior decompression with BESS between February 2021 and March 2023. Neurological status was assessed using the revised Japanese Orthopedic Association (JOA) score for thoracic myelopathy before surgery and at the final follow-up, along with the recovery rate (RR) at the final follow-up. The radiological outcome was evaluated by measuring the cross-sectional area (CSA) of the spinal canal from the T2 axial images at the most stenotic level, before and after surgery.
Twenty patients (8 male and 12 female; aged between 38 and 79 years) were enrolled in this study. The mean operation time was 89.7±21.8 min. The average JOA score was 5.6±1.1 before surgery and 9.1±1.0 at the final follow-up. The average RR at the final follow-up was 65.6%. Outcomes were classified as excellent in six patients (30.0%), good in nine patients (45.0%), and moderate in five patients (25.0%), with no cases categorized as fair or worsened (0%). The mean preoperative and postoperative CSA were 0.92±0.14 cm and 1.38±0.22 cm, respectively.
BESS is a safe, effective, and minimally invasive alternative to conventional open surgery for single-level T-OLF.
导致神经功能障碍的胸椎黄韧带骨化（T-OLF）是一种罕见的病理实体。开放性后路椎板切除术是T-OLF的金标准治疗方法。然而，术后并发症和围手术期发病率的高发生率引起了外科医生的诸多关注。本研究介绍了一系列有症状的单节段T-OLF患者，他们接受了双门内镜脊柱手术（BESS）进行后路减压。本研究的目的是展示我们使用BESS进行T-OLF切除的手术方法，并评估其安全性和有效性。
我们回顾性分析了2021年2月至2023年3月期间接受BESS胸椎后路减压的患者。术前和末次随访时使用修订的日本骨科协会（JOA）胸椎脊髓病评分评估神经功能状态，并计算末次随访时的恢复率（RR）。通过测量最狭窄节段T2轴位图像上术前和术后椎管的横截面积（CSA）来评估影像学结果。
本研究纳入了20例患者（8例男性和12例女性；年龄在38至79岁之间）。平均手术时间为89.7±21.8分钟。术前平均JOA评分为5.6±1.1，末次随访时为9.1±1.0。末次随访时的平均RR为65.6%。结果分类为优6例（30.0%），良9例（45.0%），中5例（25.0%），无差或恶化病例（0%）。术前和术后CSA的平均值分别为0.92±0.14平方厘米和1.38±0.22平方厘米。
对于单节段T-OLF，BESS是一种安全、有效且微创的传统开放手术替代方法。
