Decompressive surgery for thoracic myelopathy due to anterior pathology can be challenging. Direct decompression through anterior approaches is associated with approach-related complications, whereas anterior decompression through posterior approaches is technically demanding and may result in neurological deterioration. We present a simple and effective surgical technique of indirect decompression through lordotic rod contouring to reduce such complications.
Patients who presented to our center between March 2016 and March 2017 with symptoms and signs suggestive of thoracic myelopathy predominantly due to anterior pathologies such as ossification of the thoracic posterior longitudinal ligament, posterior bony spur, and thoracic disc herniation were evaluated in our study. The indications for surgical treatment were progressive neurological impairment and severe myelopathy (grade III or more on Nurick grade). Only those patients classified as grade III and above on American Society of Anaesthesiologists (ASA) physical status scale were included in the study. All the cases were operated by a single surgeon by a posterior-only approach. We have used this technique in four patients with thoracic myelopathy due to combined or predominant anterior pathology. Postoperative imaging confirmed adequate decompression of the spinal cord. All the cases improved substantially in terms of clinical outcome.
This surgical technique could be a useful alternative to direct anterior decompression in patients who present with symptoms of progressive severe myelopathy due to anterior compression and could be the standard of care in those at high risk for major surgery.
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Yonenobu K, Ebara S, Fujiwara K, Yamashita K, Ono K, Yamamoto T. Thoracic myelopathy secondary to ossification of the spinal ligament. J Neurosurg. 1987;66:511–8. https://www.ncbi.nlm.nih.gov/pubmed/3104552.
Sato T, Kokubun S, Tanaka Y, Ishii Y. Thoracic myelopathy in the Japanese: epidemiological and clinical observations on the cases in Miyagi Prefecture. Tohoku J Exp Med. 1998;184:1–11. https://www.ncbi.nlm.nih.gov/m/pubmed/9607393/.
Maiman DJ, Pintar FA. Anatomy and clinical biomechanics of the thoracic spine. Clin Neurosurg. 1992;38:296–324. https://www.ncbi.nlm.nih.gov/pubmed/1537190.
Chen Z, Sun C. Clinical guideline for treatment of symptomatic thoracic spinal stenosis: guideline for treatment symptomatic TSS. Orthop Surg 2015;7:208–12.
Imagama S, Ando K, Takeuchi K, Kato S, Murakami H, Aizawa T. Perioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study. Spine (Philos Pa 1976). 2018;43:E1389–E1397. https://journals.lww.com/spinejournal/Abstract/2018/12010/Perioperative_Complications_After_Surgery_for.6.aspx.
Tsuzuki N, Hirabayashi S, Abe R, Saiki K. Staged spinal cord decompression through posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine (Phila Pa 1976). 2001;26: 1623–30. https://www.ncbi.nlm.nih.gov/pubmed/11464158.
Fujimura Y, Nishi Y, Nakamura M, Watanabe M, Matsumoto M. Myelopathy secondary to ossification of the posterior longitudinal ligament of the thoracic spine treated by anterior decompression and bony fusion. Spinal Cord. 1997;35:777–84. https://www.nature.com/articles/3100487.
Takahata M, Ito M, Abumi K, Kotani Y, Sudo H, Minami A. Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine (Philos Pa 1976). 2008;33:1199–208. https://www.ncbi.nlm.nih.gov/pubmed/18469693.
Tomita K, Kawahara N, Baba H, Kikuchi Y, Nishimura H. Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and ligamentum flavum. Spine (Philos Pa 1976). 1990;15:1114–20. https://www.ncbi.nlm.nih.gov/pubmed/2125147.
Tsuzuki N, Wadano Y, Kikuchi S-i. Extensive cervicothoracic laminoplastic decompression of the spinal cord: a new method of posterior decompression for thoracic myelopathy caused by ossification of the posterior longitudinal ligament. In: Yonenobu K, Sakou T, Ono K, editors OPLL. Tokyo: Springer; 1997. https://link.springer.com/chapter/10.1007%2F978-4-431-67046-9_22.
Yamazaki M, Okawa A, Koda M, Goto S, Minami S, Moriya H. Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of the posterior longitudinal ligament: a case report. Spine (Philos Pa 1976). 2005;30:E343–6. https://www.ncbi.nlm.nih.gov/pubmed/15959359.
Yamazaki M, Mochizuki M, Ikeda Y, Sodeyama T, Okawa A, Koda M. et al. Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion. Spine (Philos Pa 1976). 2006;31:1452–60. https://www.ncbi.nlm.nih.gov/pubmed/16741454.
Matsuyama Y et al. Surgical treatment for ossification of the posterior longitudinal ligament of the thoracic spine: outcomes of one-stage posterior decompression with corrective fusion surgery. In: Yonenobu K, Nakamura K, Toyama Y, editors OPLL. Tokyo: Springer; 2006. 10.1007/978-4-431-32563-5_36. https://link.springer.com/chapter/10.1007/978-4-431-32563-5_36.
Matsuyama Y, Sakai Y, Katayama Y, Imagama S, Ito Z, Wakao N, et al. Indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine: is it possible to predict the surgical results? Eur Spine J. 2009;18:943–8. https://doi.org/10.1007/s00586-009-0956-2.
Kawahara N, Tomita K, Murakami H, Hato T, Demura S, Sekino Y. et al. Circumspinal decompression with dekyphosis stabilization for thoracic myelopathy due to ossification of the posterior longitudinal ligament. Spine. 2008;33:39–46. https://doi.org/10.1097/BRS.0b013e31815e3911.
The authors would like to thank the concerned patients for allowing the details to be shared.
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