We describe here the rare condition of compressive thoracic myelopathy and its management in four patients with combined thoracic ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum. One of the four patients underwent decompressive laminectomies only, whereas the other three patients had posterolateral fusion with posterior instrumentation (pedicle screws and rods system) in addition to decompressive laminectomies. All four patients developed transient complete paraplegia after surgery. The three patients who received decompressive laminectomies and posterior instrumentation with posterolateral fusion had improved sensation, motor, and sphincter functions compared with their preoperative neurological state. The patient who underwent laminectomy only showed no neurological gain after 7.5 years. A dural tear was noted in two patients and they recovered without complications after intraoperative repair. Posterior instrumentation with posterolateral fusion in addition to decompression laminectomies and excision of the ossification of the ligamentum flavum seems to have a better outcome than simple decompression laminectomies for this rare cause of compressive thoracic myelopathy.
Study design: Prospective study of surgical correction of thoracolumbar kyphotic deformity caused by ankylosing spondylitis. Objectives: To assess surgical outcomes and complications of thoracolumbar kyphotic deformity corrected with transpedicular closing-wedge osteotomy performed in a regional hospital. Summary of background data: There have been several studies reporting on the results of surgical correction of deformity in ankylosing spondylitis all over the world. However, there has not been any local data published. Methods: From 2003 to 2011, we had performed 12 transpedicular closing-wedge osteotomies in 9 patients with ankylosing spondylitis for correction of kyphotic and scoliotic deformity in thoracolumbar spine. Operative outcomes were assessed clinically by recording the Japanese Orthopaedic Association (JOA) scores, visual analogue scale (VAS) pain scores, Oswestry Disability Index (ODI) preoperatively and postoperatively and patient satisfaction postoperatively. Radiological outcome was assessed by measuring thoracic kyphosis, lumbar lordosis and sagittal plumb line preoperatively and postoperatively as well as the degree of surgical correction. Occurrence of complications was recorded by our standard audit protocol. Results: All patients had a single level of osteotomy done at a time. Most of the osteotomies were done at L2 or L3. The mean amount of correction was 21.6. Complications included dural tear, pseudoarthrosis and transient radiculopathy. The extent of correction and incidence of complications improved with experience. Conclusion: Despite transpedicular closing-wedge osteotomy being a major operation that is not without complications, most of our patients had good clinical results and subjective satisfaction.
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